精神科急诊患者的自杀危险因素分析

Suicide risk factors of emergency psychiatric patients

目的旨在评估精神科急诊患者自杀的临床、心理、社会学和生物学危险因素。方法对首都医科大学附属北京安定医院2015至2017年精神科急诊就诊患者进行横断面分析,采用自杀危险因素评估表对患者进行自杀想法和行为(suicidal thoughts and behaviors,STB)检测,得分≤10分和>10分分别表示STB的存在和不存在,多因素Logistic回归分析确定STB的危险因素。结果共纳入12345例患者,其中女性6885例(56%)。患者年龄36(27~50)岁,简明精神病评定量表(Brief Psychiatric Rating Scale,BPRS)总分、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)总分、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)总分、杨氏躁狂量表(Yung Manic Rating Scale,YMRS)总分平均分分别为32(27~39)分、7(3~13)分、10(6~15)分和7(4~18)分。根据自杀风险评估表,有3436例(27.83%)患者有STB的危险。多因素分析显示,居住地、性别、婚姻状况、同住者、受教育年限、职业状况、与父母和兄弟姐妹的关系、诱因、性格、确定诊断、躯体疾病、简明精神疾病总分、焦虑总分、抑郁总分、躁狂总分、就医时间、精神科住院总次数是STB的独立危险因素。结论精神科急诊患者自杀风险较高,以中青年为主,尤其以男性、未婚、失业、社会和家庭支持较差的精神疾病患者为著。STB在这一人群中受到生理、心理和社会因素的影响。

Objective To evaluate the clinical,psychological,sociological and biological risk factors of suicide in psychiatric emergency patients.Methods Cross-sectional analysis was conducted on the psychiatric emergency patients from 2015 to 2017 in Beijing Anding Hospital affiliated to Capital Medical University.Suicidal thoughts and behaviors(STB)were assessed using the suicidal risk factor assessment form.The score≤10 and>10 points indicate the presence and absence of STB,respectively.A multivariate Logistic regression analysis was applied to determines the risk factors for STB.Results A total of 12345 patients were enrolled,including 6885(56%)female patients.The average age is 36(27-50)years old.The average scores of Brief Psychiatric Rating Scale(BPRS)total scores,Hamilton Anxiety Scale(HAMA)total scores,Hamilton Depression Scale(HAMD)total scores and Yung Manic Rating Scale(YMRS)total scores were 32(27-39)points,7(3-13)points,10(6-15)points and 7(4-18)points.According to the suicide risk assessment form,3436 patients(27.83%)were at risk of STB.Multi-factor analysis showed that the residence,gender,marital status,co-residents,years of education,occupational status,relationship with parents and siblings,incentive,premorbid personality,clarified diagnosis,physical illness,BPRS score,HAMA score,HAMD score,YRMS score,medical treatment time,and the number of psychiatric hospitalizations is independent risk factors for STB.Conclusion The risk of suicide in psychiatric emergency patients was higher,mainly in the young and middle-aged,especially in the mental illness patients who were male,unmarried,unemployed,with poor social and family support.STB was affected by physiological,psychological and social factors in this population.