社区重性抑郁障碍患者自杀相关特征及影响因素研究

Suicide Related Characteristics and Influencing Factors of Community Patients with Major Depressive Disorder

目的：探讨社区重性抑郁障碍患者自杀意念和自杀未遂发生情况及影响因素。方法采用多阶段分层整群随机抽样法，选择厦门市仙岳医院2010年5-11月进行的精神障碍流行病学调查部分资料。实际抽样12071例，其中10764例完成调查，完成率为89.17%。最终2155例需进行诊断检查，共发现并确诊重性抑郁障碍患者145例，其中现患63例，既往发作82例。收集并分析其人口学特征及相关影响因素。结果重性抑郁障碍患者男56例，女89例，自杀意念发生率为42.8%（62/145），其中女性有过自杀意念41例，发生率为46.1%〔95%CI（0.36，0.56）〕，男性有过自杀意念21例，发生率为37.5%〔95%CI（0.25，0.50）〕，差异无统计学意义〔χ2＝1.03，P＝0.31，OR＝1.42，95%CI（0.72，2.80）〕。自杀未遂发生率为9.6%（14/145），其中7例女性患者自杀未遂，发生率为7.9%〔95%CI（0.02，0.14）〕，7例男性患者自杀未遂，发生率为12.5%〔95%CI（0.04，0.21）〕，差异无统计学意义〔χ^2＝0.83，P＝0.36，OR＝0.60，95%CI（0.20，1.81）〕。正规受教育年限≥7年人群自杀意念发生率低于0～6年，农村人群自杀意念发生率低于城镇；外地户籍人群自杀未遂发生率高于本地户籍，年家庭人均收入﹥8000元人群自杀未遂发生率高于≤8000元人群（P﹤0.05）。疲倦或精力缺失和无价值感或自罪感两项症状阳性者自杀意念发生率高于阴性者，而思考或集中注意力障碍症状阳性者自杀未遂发生率低于阴性者（ P﹤0.05）。多因素Logistic回归分析显示，正规受教育年限≥7年〔OR＝0.39，95%CI（0.16，0.95）〕，居住地在农村〔OR＝0.32，95%CI（0.14，0.71）〕为自杀意念的保护因素，而疲倦或精力缺失阳性〔OR＝2.91，95%CI（1.04，8.11）〕为自杀意念的独立危险因素（ P﹤0.05）。外地户籍〔OR＝4.91，95%CI（1.57，15.31）〕为自杀未遂的独立危险因素（ P﹤0.05）。结论重性抑郁障碍患者自杀意念和自杀未遂的发生率较高；受教育程度、居住地和精神症状疲倦或精力缺失为影响自杀意念的独立因素，而户籍为影响自杀未遂的独立因素。

Objective To explore the suicide idea and attempts of patients with major depressive disorders （MDD） and their influencing factors. Methods We used a multi - stage stratified cluster random sampling method to investigate part of the data of mental disorder epidemiology in Xiamen from may to November 2010. A total of 12 071 cases were selected actually, 10 764 of whom completed the investigation（89. 17%）,and 2 155 of whom needed diagnosis checks,which found 145 mDD patients including 63 suffering mDD now,82 having had episodes before. The demographic characteristics and related factors wereanalyzed.Results The occurrence rate of suicide idea of MDD patients were 42. 8% （62/145）, including 41 females〔46. 1%,95%CI（0. 36,0. 56）〕,21 males〔37. 5%,95%CI（0. 25,0. 50）〕,which was not significantly different〔χ^2 =1. 03,P=0. 31,OR=1. 42,95%CI（0. 72,2. 80）〕. The occurrence rate of suicide attempts was 9. 6%（14/145）,including 7 females〔7. 9%,95%CI（0. 02,0. 14）〕,7 males〔12. 5%,95%CI（0. 04,0. 21）〕,the difference was not significant〔χ^2 =0. 83,P=0. 36,OR=0. 60,95%CI（0. 20,1. 81）〕. The suicide attempt rate was lower in those with≥7 year formal education than in those with 0-6 year formal education,lower in rural group than in urban group,higher in foreign permanent population than in local permanent population,higher in group with ﹥8 000 Yuan of household incomes per capita than in group with ≤8 000 yuan（P﹤0. 05）,higher in groups positive in symptoms of tiredness or lack of energy and of feeling of worthlessness or guilt than in groups negative in the above-mentioned symptoms（P﹤0. 05）. multivariate Logistic regression analysis showed that ≥7 year formal education〔OR=0. 39,95%CI（0. 16,0. 95）〕,rural place of residence〔OR=0. 32, 95%CI（0. 14,0. 71）〕were protective factors of suicide idea,tiredness or lack of energy〔OR =2. 91,95%CI（1. 04, 8. 11）〕was an independent risk factor of suicide idea（P﹤0. 05）. Foreign census register was an independent risk factor influ-encingsuicideattempts〔OR=4.91,95%CI（1.57,15.31）,P﹤0.05〕.ConclusionThe occurrence of suicide idea and attempts is high in mDD patients. Educational level,residence place,tiredness or lack of energy are independent factors of suicide idea,household registration is an independent factor influencing suicide attempts.