伴忧郁特征的抑郁症患者自杀风险因素分析

Factors of suicide risk in major depressive disorder patients with melancholic features

目的:探讨伴忧郁特征的抑郁症患者的自杀风险因素。方法:对"中国双相障碍患者诊断评估服务研究项目"中626例符合伴忧郁特征的抑郁症患者采用《简明国际神经精神访谈》(MINI)自杀模块评估自杀风险,并将患者分为自杀风险组(300例)和无自杀风险组(326例),比较两组的人口学及临床资料,采用Logistic回归分析伴忧郁特征抑郁症患者的自杀风险因素。结果:自杀风险组起病年龄明显小于无自杀风险组(t=-4.390,P=0.032),出现抑郁发作频繁(χ~2=8.036,P=0.005)、伴非典型症状(χ~2=4.586,P=0.032)、伴精神病性症状(χ~2=15.580,P<0.001)、症状晨重暮轻(χ~2=4.501,P=0.034)、伴不切实际的罪恶感(χ~2=33.105,P<0.001)的比率明显高于无自杀风险组。Logistic回归分析显示,伴精神病性症状(OR=2.38,P<0.001)、伴不切实际的罪恶感(OR=2.51,P<0.001)与伴忧郁特征抑郁症患者的自杀风险因素相关(P均<0.001)。结论:伴精神病性症状、伴不切实际的罪恶感可能是伴忧郁特征抑郁症患者的自杀风险因素。

Objective:To explore the factors of suicide risk in major depressive disorder(MDD)patients with melancholic features.Method:The data were obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China.According to the suicide module of Mini International Neuropsychiatric Interview(MINI),626 patients diagnosed with melancholia depression were classified as suicide and non-suicide risk groups.The socio-demographic and clinical characteristics differences were compared between the suicide and non-suicide risk groups.Multivariate Logistic regression analysis was used to analyze the risk factors for suicide risk in patients diagnosed with melancholia MDD.Results:The suicide risk groups had an earlier age of onset(t=-4.390,P=0.032)than the non-suicide risk groups.The rate of frequent depressive episodes(χ~2=8.036,P=0.005),combined with atypical features(χ~2=4.586,P=0.032),depressive episodes with psychotic symptoms(χ~2=15.580,P<0.001),depression regularly worse in the morning(χ~2=4.501,P=0.034),and excessive or inappropriate guilt(χ~2=33.105,P<0.001)were higher than those in the non-suicide risk groups.Logistic regression analysis indicated that depressive episodes with psychotic symptoms(OR=2.38,P<0.001),and excessive or inappropriate guilt(OR=2.51,P<0.001)were significantly associated with suicide risk in MDD patients with melancholic features.Conclusion:Depressive episodes with psychotic symptoms,and excessive or inappropriate guilt may be the factors of suicide risk in MDD patients with melancholic features.