伴非典型特征的抑郁症患者自杀未遂的危险因素分析

Attempted suicide risk factors in major depressive disorder patients with atypical features

目的探讨伴非典型特征抑郁症患者自杀未遂的社会人口学及临床特征方面危险因素。方法来自全国13个中心的1172例抑郁症患者,纳入其中179例伴非典型特征患者,依据简明国际神经精神访谈(the Mini International Neuropsychiatric Interview,MINI)5.0中文版自杀模块的访谈结果,分为自杀未遂组和无自杀未遂组,通过多因素logistic回归分析伴非典型特征的抑郁症患者在性别、年龄等社会人口学资料及伴焦虑症状、伴精神病性症状等临床特征方面可能与自杀未遂相关的危险因素。结果伴非典型特征抑郁症患者自杀未遂的发生率为23.5%(42/179)。与无自杀未遂组患者相比,自杀未遂组患者更多伴有自杀观念、产后起病,更常使用抗抑郁剂以外的其他药物治疗(如抗精神病药、情感稳定剂及苯二氮类药)(均P<0.05)。多因素logistic回归分析显示,既往住院次数(OR=1.730,95%CI:1.093~2.740)和自杀观念(OR=3.899,95%CI:1.506~10.092)与伴非典型特征的抑郁症患者发生自杀未遂相关(均P<0.05)。结论既往住院次数多及伴有自杀观念是伴非典型特征抑郁症患者自杀未遂的主要危险因素。

Objective To explore the attempted suicide risk factors of socio-demographic and clinical characteristics in major depressive disorder patients with atypical features（e.g. increased appetite, weight gain and greater time spent sleeping）. Methods This was a secondary analysis of the data from the Diagnostic Assessment Service for People with Bipolar Disorders in China（DASP）, which was initiated by the Chinese Society of Psychiatry（CSP） and carried out in 13 major mental health centers in China. Totally 179 patients were diagnosed as atypical major depressive disorder patients in all 1172 major depressive disorder patients using Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition（DSM-Ⅳ） by psychiatrists. Suicide attempters and nonattempters were grouped base on the interview results of suicidality module of the Mini International Neuro-psychiatric Interview（MINI）. Multiple logistic regression were used to assess association between independent variables and attempted suicide in major depressive disorder patients with atypical features. Results The rater of attempted snicide was 23.5%（42/179） of atypical major depressive disorder patients reported prior or current attempted suicide. Compared to nonattempters, attempters had higher levels of suicidal ideation, postpartum depressive episodes, and the use of antipsychotic, mood stabilizers and benzodiazepines（P〈0.05）. Logistic regression analysis showed that number of admissions（OR=1.73, 95% CI： 1.093~2.740） and depressive episodes with suicidal ideation（OR=3.90, 95%CI： 1.506~10.092） were significantly associated with attempted suicide in atypical unipolar depression patients（P〈0.05）. Conclusions High number of admissions and high levels of suicidal ideation may be considered as potential risk factors to identify atypical unipolar depression patients at risk for future suicidal behavior.