双相情感障碍抑郁发作患者自杀行为危险因素分析

Risk factors for suicidal behaviour in patients with depressive episodes of bipolar disorder

目的自杀是双相情感障碍抑郁发作患者高死亡率的关键因素之一,本研究探讨双相情感障碍抑郁发作患者自杀行为的危险因素,以期减少该类患者自杀行为的发生。方法采用横截面研究的方法,纳入2018年1月—2021年12月在杭州市第七人民医院住院治疗的182例双相情感障碍抑郁发作患者,根据有无自杀行为分为伴自杀行为组(80例)和不伴自杀行为组(102例),分别比较2组患者人口学特征、临床特征及甲状腺功能指标,将差异有统计学意义的因素纳入二分类logistic回归模型,分析双相情感障碍抑郁发作患者自杀行为的危险因素。结果与不伴自杀行为组比较,伴自杀行为组年龄、首次发病年龄更低,既往自杀未遂次数、既往非自杀性自伤次数更高,既往有自杀未遂行为、既往有非自杀性自伤行为的比例更高,外周血游离三碘甲状腺原氨酸(FT3)、总三碘甲状腺原氨酸(TT3)水平更低(均P<0.05);Logistic回归分析显示,既往存在自杀未遂行为(OR=3.399)、既往存在非自杀性自伤行为(OR=4.190)是双相情感障碍重度抑郁发作患者自杀行为的危险因素;较大的首发年龄(OR=0.874)、较高的FT3(OR=0.153)是该类患者自杀行为的保护因素(均P<0.05)。结论既往自杀未遂行为、既往非自杀性自伤行为是双相抑郁患者自杀行为的风险因子,较大的首发年龄、较高的FT3为保护因子,在临床需加以关注。

Objective Suicide is one of the key factors for high mortality in patients with depressive episodes of bipolar disorder.This study explored the risk factors of suicidal behaviour in patients with depressive episodes of bipolar disorder to reduce the occurrence of suicidal behaviour in such patients.Methods Using the method of cross-sectional study,182 patients with depressive episodes of bipolar disorder who were hospitalised in Hangzhou Seventh People's Hospital from January 2018 to December 2021 were enrolled.They were classified into the suicidal behaviour group(n=80)and non-suicide behaviour group(n=102).The demographic characteristics,clinical features and thyroid function parameters of the two groups were compared.The statistically significant factors were analysed by logistic regression to determine the risk factors of suicidal behaviour in patients with depressive episodes of bipolar disorder.Results Compared with the non-suicide behaviour group,the suicidal behaviour group showed decreased age and age of onset,the number of previous suicide attempts,the number of non-suicidal self-injury in the past were higher.The proportion of previous suicide attempts and non-suicidal self-injury in the past was higher.The levels of free triiodothyronine(FT3)and total triiodothyronine(TT3)in peripheral blood were lower(all P<0.05).Binary logistic regression showed,previous suicide attempt(OR=3.399),and non-suicidal self-injury(OR=4.190)were risk factors for suicidal behaviour in patients with bipolar in patients with major depressive episode of bipolar disorder,older age at first onset(OR=0.874)and higher FT3(OR=0.153)were protective factors(all P<0.05).Conclusion Previous attempted suicide behavior and previous non-suicidal self-injury behavior were risk factors of suicidal behavior in bipolar depression patients.Older age at first onset and higher FT3 were protective factors,which need to be paid attention to in clinic.