重性抑郁障碍患者自杀意念及其影响因素分析

The influencing factors of suicidal ideation among patients with major depressive disorder

目的探讨重性抑郁障碍患者中自杀意念的发生率及其影响因素。方法使用贝克自杀意念量表(Beck scale for suicidal ideation,SSI)对155例重性抑郁障碍患者评估有无自杀意念,并使用自制的一般资料调查问卷收集人口学资料,使用17项汉密尔顿抑郁量表(Hamilton depression scale,HAMD-17)和汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)对患者进行自杀意念影响因素的评估。结果 重性抑郁障碍患者自杀意念的发生率为49.7%(77/155),有自杀未遂史的患者为17.4%(27/155)。相对于非汉族患者,汉族患者自杀意念更强(P<0.05);相对于无自杀未遂史患者,有自杀未遂史患者自杀意念更强(P<0.05);与无自杀意念组比较,有自杀意念患者的HAMD总分、焦虑/躯体化因子分、认知障碍因子分、阻滞因子分更高(P<0.05)。路径分析结果表明,抑郁(β=0.22,P<0.01)、自杀未遂史(β=0.41,P<0.01)和疑病(β=-0.21,P<0.01)对自杀意念具有直接预测作用,焦虑(β=0.08,P<0.01)和疑病(β=0.07,P<0.01)皆通过抑郁对自杀意念起间接作用。Bootstrap BC中介效应检验显示,抑郁在焦虑对自杀意念的影响中起完全中介作用,在疑病对自杀意念的影响中起部分中介作用。结论 重性抑郁障碍患者自杀意念的发生率较高,有自杀未遂史和抑郁情绪严重程度是自杀意念主要的危险因素,在自杀预防工作中要多关注有自杀未遂史和严重抑郁情绪的患者。

bjective To explore the prevalence and influencing factors of suicidal ideation among patients with major depressive disorder(MDD).Methods We collected self-reported general information questionnaire of the demographic characteristics from the 155 MDD patients.The suicidal ideation was assessed by using Beck Scale for Suicidal Ideation(SSI),and the influencing factors of suicidal ideation were assessed by 17-item Hamilton Rating Scale for Depression(HAMD-17)and Hamilton Rating Scale for Anxiety(HAMA).Results The prevalence rate of suicidal ideation was 49.7%(77/155)and the prevalence rate of patients with a history of attempted suicide was 17.4%(27/155).Compared with non-Han patients,the number of patients with suicidal ideation was higher in Han people had(P<0.05).Compared with patients without a history of attempted suicide,the patients with suicidal ideation had significantly higher scores on total scores of HAMD-17 and factor scores of anxiety/somatization,cognitive disturbance and retardation(P<0.05).Pathway analysis showed that depression(β=0.22,P<0.01),a history of attempted suicide(β=0.41,P<0.01)and hypochondria(β=-0.21,P<0.01)can directly affect suicidal ideation and anxiety(β=0.08,P<0.01),hypochondria(β=0.07,P<0.01)could indirectly affect suicidal ideation.The depression had a full mediation effect on the association between anxiety and suicidal ideation and a partial mediation effect on the association between hypochondria and suicidal ideation.Conclusion The occurrence of suicidal ideation and suicide attempts is high in MDD patients.The severity of depression and a history of attempted suicide are considered as important risk factors on suicidal ideation.It is imperative for psychological department in general hospitals to pay attention to MDD patients with a history of attempted suicide.