出院后精神分裂症患者的自杀意念变化及影响因素

Changes and influencing factors of suicidal ideation in schizophrenic patients after discharge

目的探讨精神分裂症患者出院后自杀意念的变化及影响因素。方法选取845例精神分裂症患者,在其出院后进行4次随访,随访时用大体功能评定量表(GAF)、Morisky服药依从性量表(MMAS)评估患者病情和服药依从情况,用Beck-自杀意念评估量表(BSI-CV)部分问题评估患者自杀意念存在情况。分析随访患者的一般情况,出院后24周内自杀意念变化,患者服药依从性对自杀意念的影响,患者病情对自杀意念的影响,可能影响患者自杀意念的临床因素。结果845例精神分裂症患者中成功完成2次初期随访并同意后续随访者346例,随访期间脱落患者121例(35.0%),完成随访患者225例(65.0%)。完成随访患者和脱落患者的性别、年龄、受教育程度、病程、住院天数、有家族史占比、有自杀史占比、GAF评分比较差异均无统计学意义(P>0.05)。出院后第1~4次随访时患者存在自杀意念占比分别为2.89%(10/246)、12.43%(43/346)、21.23%(62/292)、21.78%(49/225),,出院后精神分裂症患者24周内存在自杀意念的占比呈逐渐升高趋势(Z=7.62,P<0.05)。第2~4次随访期间患者MARS评分变化能够影响自杀意念存在情况(F=26.2,P<0.05);患者服药依从性能够对自杀意念存在情况产生影响(F=130.60,P<0.05);坚持服药患者出现自杀意念的风险仅为停药患者的1/10(OR=0.11,P>0.05)。第1~4次随访时患者GAF评分变化能够影响自杀意念存在情况(F=504.52,P<0.05);患者病情恶化能够对自杀意念存在情况产生影响(F=152.29,P<0.05);患者出现病情波动后自杀意念的发生风险增加约7倍(OR=7.38,P>0.05)。单因素分析显示,病程、住院天数、有自杀史是患者存在自杀意念的影响因素(P<0.05),将这3项作为自变量纳入二元Logistic回归分析中作进一步探索,仅提示更短的病程与更多的自杀意念存在相关(OR=9.24,P<0.05)。结论精神分裂症患者在出院后出现自杀意念的风险会明显上升,服药不依从和病情恶化可能会增加此类风险。

Objective To explore the changes and influencing factors of suicidal ideation in schizophrenic patients after discharge.Methods A total of 845 patients with schizophrenia were selected and 4 follow-up visits were conducted to each patient after his/her discharge.Global Assessment Function(GAF)and Morisky Medication Adherence Scale(MMAS)were utilized to evaluate patients’conditions and medication compliance,and some questions from Beck Scale for Suicide Ideation-Chinese Version(BSI-CV)were used to assess the existence of suicidal ideation in patients.The general conditions of the follow-up patients were analyzed:the change of suicidal ideation within 24 weeks after discharge,the influence of medication compliance on suicidal ideation,the influence of patient condition on suicidal ideation,and the possible clinical factors that may affect suicidal ideation.Results Among 845 schizophrenic patients,346 patients successfully completed two initial follow-up visits and agreed with following follow-up visits.During the following follow-up,121 patients(35.0%)were lost contact,and 225 patients(65.0%)completed the following follow-ups.Between the two groups,the differences in gender,age,education level,course of disease,days of hospital stay,ratio of family history,ratio of suicide history and GAF score were not statistically significant(P>0.05).In the first to the fourth followup after discharge,the proportion of suicidal ideation was 2.89%(10/246),12.43%(43/346),21.23%(62/292)and 21.78%(49/225),respectively.The proportion of suicidal ideation in schizophrenia patients within 24 weeks after discharge showed a gradually increase(Z=7.62,P<0.05).In the second to the fourth follow-up,the change of MARS score could affect the existence of suicidal ideation(F=26.2,P<0.05);the medication compliance of patients could affect the existence of suicidal ideation(F=130.60,P<0.05);the suicidal ideation risk for patients who kept taking medicine was only 1/10 of that for patients who stop taking medicine(OR=0.11,P>0.05).In the first to the fourth follow-up,the change of GAF score could affect the existence of suicidal ideation(F=504.52,P<0.05);the deterioration of patients'condition could affect the existence of suicidal ideation(F=152.29,P<0.05);the risk of suicidal ideation increased about seven times after the patient’s condition fluctuated(OR=7.38,P>0.05).Univariate analysis showed that the course of disease,days of hospital stay and suicide history were factors influencing the suicidal ideation(P<0.05).Taking these three independent variables into binary Logistic regression analysis for further exploration,it only indicated that a shorter course of disease was related with more suicidal ideation(OR=9.24,P<0.05).Conclusion The risk of suicidal ideation significantly increases in schizophrenic patients after discharge,and the risk significantly increases for patients with disobedience in medicine-taking and deterioration in conditions.