北京市某社区医院门诊患者及家属自杀意念及自杀未遂的影响因素分析

Influencing factors of suicidal ideation and suicide attempts among community residents in Beijing

目的 了解北京市海淀区某社区医院门诊就诊患者及家属的自杀意念和自杀未遂检出率及其危险因素.方法 2008年6月至9月,采用现况研究及偶遇抽样方法,对在北京市海淀区某社区卫生服务站,使用一般情况调查表、Beck抑郁量表、Beck焦虑量表和Beck无望量表,对前来该社区卫生服务站就诊的患者及家属进行问卷调查,在SPSS 13.0软件的支持下对自杀意念和自杀未遂的影响因素进行单因素Х^2检验和多因素Logistic回归分析.结果 发放问卷3100份,收回有效问卷2791份,问卷有效率为90.0％.调查对象的平均年龄（36.8±13.1）岁,其中男性1074例,女性1717例.近1年内自杀意念和自杀未遂的检出率分别为2.8％（77/2791）和1.1％（30/2791）.不同职业、有无负性生活事件、有无自杀家族史、有无精神疾病家族史、无望程度、抑郁程度和焦虑程度的调查对象在1年内自杀意念检出率方面,差异有统计学意义（Х^2=12.512、53.287、103.922、20.640、77.337、135.918、70.303,P＜0.05）.不同职业、有无精神疾病家族史、无望程度、抑郁程度和焦虑程度的调查对象在1年内自杀未遂检出率方面,差异有统计学意义（Х^2=7.954、6.257、29.838、21.352、10.014,P＜0.05）.多因素分析显示：抑郁（轻度、中度和重度抑郁的OR值分别为2.38、5.55和16.21;95％CI分别为1.07～5.31、2.31～13.37和6.93～37.92）、有自杀家族史（OR=11.68,95％CI：5.03～27.10）、无望（轻度、中度和重度无望的OR值分别为3.65、4.25和5.02;95％CI分别为1.55～8.56、1.70～10.65和1.46～17.26）以及近期有负性生活事件（0R=2.25,95％CI为1.35～4.45）是自杀意念的危险因素.无望（轻度、中度和重度无望的OR值分别为1.09、5.58和7.62;95％CI分别为0.36～3.34、2.03～15.30和1.50～38.72）、抑郁（轻度、中度和重度抑郁的OR值分别为1.08、0.27和3.02;95％CI分别为0.43～2.75、0.03～2.29和1.05～8.75）以及有精神病家族史（OR=3.00,95％CI为1.07～8.46）是自杀未遂的危险因素.结论 无望及抑郁情绪增加自杀的危险;应加强社区人群心理健康管理工作,培养社区医生识别、评估和处理心理危机的技能.

Objective To describe the prevalence and risk factors of suicidal ideation and suicide attempt among community patients and their family members in Beijing.Methods Accidental sampling method was used in this cross-sectional study to select patients and their family members who visited a community healthcare center in Beijing from June to September 2008.The subjects were required to complete essential information questionnaire,Beck Depression Inventory,Beck Anxiety Inventory and Beck Hopelessness Scale.Chi-square test and binary logistic regression were used to learn the risk factors of suicidal ideation and suicide attempt.Results A total of 2791 valid questionnaires were collected,with a response rate of 90.0%.The participants included 1074 males and 1717 females with mean age （36.8±13.1）years old.The one-year prevalence of suicidal ideation and suicide attempt was 2.8% （77/2791） or 1.1% （30/2791）,respectively.The one-year prevalence of suicidal ideation was significantly different among the subjects with different professions （Х^2=12.512,P=0.006）,negative events （Х^2=53.287,P〈0.001）,family history of suicide （Х^2=103.922,P〈0.001）,family history of psychiatry diseases （Х^2=20.640,P〈0.001）,hopelessness （Х^2=77.337,P〈0.001）,depression （Х^2=135.918,P〈0.001） and anxiety （Х^2=70.303,P〈0.001）.The one-year prevalence of suicidal attempt was statistically different among the subjects with different professions （Х^2=7.954,P=0.037）,family history of psychiatry diseases （Х^2=6.257,P=0.003）,hopelessness （Х^2=29.838,P〈0.001）,depression （Х^2=21.352,P〈0.001） and anxiety （Х^2=10.014,P〈0.001）.Multivariate logistic analysis found that the most important risk factors of suicidal ideation were depression （for mild,moderate and severe depression：odds ratio （OR） 2.38,5.55 and 16.21,respectively; 95% confidence internal （CI） 1.07-5.31,2.31-13.37 and 6.93-37.92,respectively）,family history of suicide （OR=1 1.68,95%CI 5.03-27.10）,hopelessness （for mild,moderate and severe hopelessness：OR 3.65,4.25 and 5.02,respectively; 95% CI 1.55-8.56,1.70-10.65 and 1.46-17.26,respectively）,negative life events （OR=2.25,95% CI 1.35-4.45）.The most important risk factors for suicide attempt were hopelessness （for mild,moderate and severe hopelessness：OR 1.09,5.58 and 7.62,respectively; 95% CI 0.36-3.34,2.03-15.30 and 1.50-38.72,respectively）,depression （for mild,moderate and severe depression：OR 1.08,0.27 and 3.02,respectively; 95% CI 0.43-2.75,0.03-2.29 and 1.05-8.75,respectively） and family history of psychiatry diseases （OR=3.00,95%CI 1.07-8.46）.Conclusions Hopelessness and depression could increase the risk of suicide behaviors.Family clinicians should be trained to identify such risk tactors and provide appropriate mental health intervention.