误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的危险因素分析

Risk factors to suicide risk in misdiagnosed bipolar disorder Ⅱ treated for major depressive disorder

目的探讨误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的社会人口学及临床特征方面的危险因素。方法通过简明国际神经精神访谈（the Mini International Neuropsychiatric Interview,MINI）5.0中文版,对来自全国13个中心的1478例最初诊断为抑郁症的患者进行重新诊断,其中190例被诊断为双相障碍Ⅱ型,将这190例误诊患者按照有无自杀风险进行分组,从性别、年龄等社会人口学资料及起病年龄、是否伴有自杀观念等临床特征方面探讨被误诊患者自杀风险可能的危险因素。结果有自杀风险组共74例患者,无自杀风险组共116例。有自杀风险组与无自杀风险组相比,年龄更小[（34.45±11.18）vs.（37.23±13.22）],起病年龄更早[（26.20±9.16）vs.（30.37±11.59）],更常伴有自杀观念（82.4%vs.53.4%）,差异均具有统计学意义（P〈0.05）。Logistic回归分析显示,年龄（OR=0.969,95%CI：0.945-0.993）、伴有自杀观念（OR=4.129,95%CI：2.030-8.397）与误诊为抑郁症的双相障碍Ⅱ型患者发生自杀风险相关联（均P〈0.05）。结论年龄小、伴有自杀观念可能是误诊为抑郁症的双相障碍Ⅱ型患者自杀风险的独立危险因素。

Objective To analyze the risk factors of socio-demographic and clinical characteristics related to suicide risk in misdiagnosed bipolar disorder Ⅱ（BP Ⅱ） treated for major depressive disorder.MethodsA total of l478 consecutive major depressive disorder patients were interviewed with the Mini International Neuropsychiatric Interview（MINI） in 13 major mental health centers in China. Of the 1478 patients, 190 patients were diagnosed BP Ⅱ, who were divided into two groups（nonsuicidal risk and suicidal risk） with the suicidality module of MINI. Logistic regression was performed to evaluate significant risk factors associated with suicide risk in misdiagnosed BPⅡ treated for major depressive disorder.ResultsOf the 190 patients, 116 were in the nonsuicidal risk group and 74 were in the suicidal risk group. In comparison to the nonsuicidal risk group, the suicidal risk group had younger age [（34.45±11.18） vs.（37.23±13.22）, P=0.008], earlier age at onset [（26.20±9.16） vs.（30.37±11.59）, P=0.007], and more suicidal ideation（82.4% vs.53.4%, P=0.001）. Logistic regression analysis showed that age（OR=0.969,95% CI：0.945-0.993） and depressive episodes with suicidal ideation（OR=4.129,95% CI：2.030-8.397） were significantly associated with suicide risk in patients of misdiagnosed BP Ⅱ treated for major depressive disorder（P〈0.05）.ConclusionsYounger age, severer suicidal ideation may be potential independent risk factors to suicide risk in BP Ⅱ with misdiagnosed with major depressive disorder.