综合医院心理科门诊抑郁症患者自杀未遂的相关因素分析

Analysis of related factors to suicide attempt among patients with major depressive disorder in general hospital psychology clinic

目的探讨抑郁症患者自杀未遂的发生情况和相关危险因素,为预防抑郁症患者发生自杀行为提供科学的理论依据。方法针对2017年1月至2018年3月在中国医科大学附属第一医院心理科门诊就诊的患者,以美国精神障碍诊断与统计手册第四版(DSM-Ⅳ)为诊断标准、轴Ⅰ障碍临床定式检查-病人版(SCID-P)为诊断工具对患者进行抑郁症的诊断,共收集162例研究对象。采用自编的一般资料问卷和汉密尔顿抑郁-17项量表(HAMD-17)调查分析抑郁症患者自杀未遂的相关因素。结果自杀未遂的检出率为17.3%(28/162)。有、无自杀未遂行为两组相比,患者在年龄(Z=-2.183,P=0.029)、居住地(χ^2=5.405,P=0.020)、HAMD-17量表总分(t=-2.132,P=0.035)、抑郁情绪因子分(Z=-3.627,P<0.001)、有罪感因子分(Z=-3.086,P=0.002)、自杀因子分(Z=-5.088,P<0.001)和入睡困难因子分(Z=-2.021,P=0.043)差异有统计学意义。多因素logistic回归分析显示,高龄(OR=0.930,P=0.022)为自杀未遂的保护因素,居住地在农村(OR=3.955,P=0.038)、抑郁情绪严重(OR=3.795,P=0.020)和有自杀意念(OR=2.496,P=0.002)为自杀未遂的独立危险因素。结论居住地在农村、低龄、有自杀意念和抑郁情绪严重是抑郁症患者自杀未遂的独立危险因素,综合医院临床心理科医生在问诊时应加强对这些因素的评估,预防自杀未遂行为的发生。

Objective To explore the prevalence and related factors of suicide attempt among patients with major depressive disorder(MDD)and to provide a scientific theoretical basis for preventing suicide attempts in patients with MDD.Methods The researchers selected 162 patients with MDD based on the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition(DSM-Ⅳ)diagnostic criteria from some patients presenting in the department of Psychology at the First Affiliated Hospital of China Medical University during the January 2017 to March 2018,using the Structured Clinical Interview for DSM-Ⅳ-TR Patient version(SCID-P)as a screening tool.The self-designed General Information Questionnaire and Hamilton Depression Scale-17 items(HAMD-17)were used to investigate and evaluate the factors that affected suicide attempt.Results The detection rate of suicide attempt was 17.3%(28/162).Compared with the two groups with or without a history of suicide attempt,the age of the MDD patients(Z=-2.183,P=0.029),the place of residence of the MDD patients(χ^2=5.405,P=0.020),and the total score of the HAMD-17 scale(t=-2.132,P=0.035),the score of the depression factor(Z=-3.627,P<0.001),guilt factor score(Z=-3.086,P=0.002),the score of the suicidal ideation factor(Z=-5.088,P<0.001)and sleepiness score(Z=-2.021,P=0.043)were significantly different.Multivariate logistic regression analysis showed that age(OR=0.930,P=0.022)was a protective factor of suicide attempt and the residence in rural areas(OR=3.955,P=0.038),severe depression(OR=3.795,P=0.020)and suicidal ideation(OR=2.496,P=0.002)were independent risk factors for attempted suicide.Conclusions Residence in rural areas,younger age,suicidal ideation and depression are independent risk factors for suicide attempt of depressive patients.Clinical psychologists in general hospitals should strengthen the evaluation of these factors when inquiring to prevent the occurrence of suicide attempt.