社区不同性别精神分裂症患者危险行为发生风险预测模型的建立与验证

Development and validation of risk prediction model for aggressive behaviors of community patients with schizophrenia

【目的】探讨上海市不同性别精神分裂症患者危险行为(AGB)发生的影响因素,并构建与验证风险预测模型。【方法】收集上海市徐汇区、虹口区和嘉定区2018年4月所有的社区精神分裂症患者共7955例,每3个月对其进行一次随访,随访6个月。利用多因素logistic回归分析模型分析计算比值比(OR)及其95%CI,筛选出精神分裂症患者AGB发生的影响因素,并基于β系数构建每个个体的风险评分,运用约登指数最大法确定风险评分的最佳截断点,采用ROC曲线下的面积(AUC)评价模型预测能力,并采用十折交叉验证法评价模型的内部验证能力。【结果】男性3563名,平均年龄(54.83±13.72)岁,AGB发生率为2.55%;女性4392名,平均年龄(57.20±14.98)岁,AGB发生率为2.64%。对于男性患者而言,单身/离异(OR=2.04,95%CI:1.15~3.61)、经济贫困(OR=2.79,95%CI:1.71~4.54)、不规律服药(OR=4.35,95%CI:2.23~8.47)、不服药(OR=1.83,95%CI:1.03~3.26)、自知力不完全/无(OR=1.97,95%CI:0.99~3.94)、药物不良反应(OR=2.61,95%CI:1.27~5.37)、涉及暴力的精神症状(OR=2.06,95%CI:1.01~4.18)、既往肇事肇祸史(OR=5.29,95%CI:2.33~11.98)和近期应激事件(OR=8.36,95%CI:4.13~16.92)是AGB发生的危险因素。对于女性患者而言,年龄<60岁(50~59岁,OR=2.09,95%CI:1.13~3.87;40~49岁,OR=2.74,95%CI:1.46~5.17;30~39岁,OR=2.88,95%CI:1.48~5.60;18~29岁:OR=5.71,95%CI:2.44~13.37)、学历高(高中,OR=3.30,95%CI:1.46~7.49;专科/本科/研究生,OR=2.88,95%CI:1.21~6.82)、无业(OR=1.81,95%CI:1.17~2.82)、不规律服药(OR=7.87,95%CI:4.75~13.05)、不服药(OR=2.11,95%CI:1.24~3.62)、药物不良反应(OR=2.75,95%CI:1.50~5.04)、涉及暴力的精神症状(OR=3.08,95%CI:1.77~5.37)、社会功能(OR=3.51,95%CI:2.07~5.94)和近期应激事件(OR=5.92,95%CI:2.82~12.44)是AGB发生的危险因素。男性和女性社区精神分裂症患者的AGB发生风险模型预测能力均较强(男性,AUC=0.779,95%CI:0.725~0.834;女性,AUC=0.822,95%CI:0.780~0.863)。【结论】在预防不同性别的社区精神分裂症患者发生AGB时,应注意不同的危险因素。

[Objective]To determine the factors associated with aggressive behaviors of patients with schizophrenia by gender in communities in Shanghai,and further develop and validate the prediction model.[Methods]A total of 7955 community patients with schizophrenia were investigated in Xuhui District,Hongkou District and Jiading District of Shanghai.Baseline information was collected from April 2018 and follow-up was conducted every 3 months for 6 months.Multivariate logistic regression was used to calculate the odd ratio(OR)and 95%CI,and determine the factors associated with aggressive behaviors of patients.The risk score for each patient was developed based on theβcoefficient,and the best cut-off value was determined by the Youden index.For the models,predictive ability was determined using area under the curve(AUC)of receiver operator characteristic curve(ROC curve),and internal validation ability was evaluated by the ten-fold cross validation method.[Results]There were 3563 males in this study with an average age of(54.83±13.72)years old,and the incidence of aggressive behaviors was 2.55%.There were 4392 females with an average age of(57.20±14.98)years,and the incidence of aggressive behaviors was 2.64%.For male patients with schizophrenia,single/divorced status(OR=2.04,95%CI:1.15‒3.61),low economic status(OR=2.79,95%CI:1.71‒4.54),irregular medication(OR=4.35,95%CI:2.23‒8.47),no medication(OR=1.83,95%CI:1.03‒3.26),incomplete/no insight(OR=1.97,95%CI:0.99‒3.94),adverse drug reaction(OR=2.61,95%CI:1.27‒5.37),psychiatric symptoms involving violence(OR=2.06,95%CI:1.01‒4.18),history of aggression(OR=5.29,95%CI:2.33‒11.98)and recent stress events(OR=8.36,95%CI:4.13‒16.92)were associated with aggressive behaviors.In contrast,for female patients,age less than 60 years(50‒59 years,OR=2.09,95%CI:1.13‒3.87;40‒49 years,OR=2.74,95%CI:1.46‒5.17;30‒39 years,OR=2.88,95%CI:1.48‒5.60;18‒29 years,OR=5.71,95%CI:2.44‒13.37),educational level of high school and above(senior high school,OR=3.30,95%CI:1.46‒7.49;college and university,OR=2.88,95%CI:1.21‒6.82),unemployed status(OR=1.81,95%CI=1.17‒2.82),irregular medication(OR=7.87,95%CI:4.75‒13.05),no medication(OR=2.11,95%CI:1.24‒3.62),adverse drug reaction(OR=2.75,95%CI:1.50‒5.04),psychiatric symptoms involving violence(OR=3.08,95%CI:1.77‒5.37),social function(OR=3.51,95%CI:2.07‒5.94)and recent stress events(OR=5.92,95%CI:2.82‒12.44)were risk factors.In both male and female,the prediction models for aggressive behaviors of community patients with schizophrenia had strong predictive ability(AUC=0.779,95%CI:0.725‒0.834;AUC=0.822,95%CI:0.780‒0.863).[Conclusion]This study suggests that diverse risk factors should be considered for community patients with schizophrenia by gender to prevent the aggressive behaviors.