收住儿童重症监护病房的自杀儿童行为特点分析

Analysis of characteristics of suicidal behavior of children admissed in pediatric intensive care unit

目的总结儿童自杀行为的临床特点, 为进一步制订儿童自杀防范策略提供参考。方法回顾性分析2018年1月1日至2022年12月31日北京儿童医院儿童重症监护病房住院电子病历系统中因自杀住院儿童的临床资料, 总结其临床特点。结果共62例自杀儿童入组。男20例(32.3%), 女42例(67.7%), 男∶女比例为1∶2.1。就诊年龄(13.1±1.5)岁, 最小年龄7.9岁, 最大年龄15.7岁。既往诊断精神类疾病患儿17例(27.4%)。58.1%患儿存在自杀行为的触发因素。自杀方式:服药/毒(服药)53例(85.5%), 高处坠落6例(9.7%), 自缢3例(4.8%)。服药组中男性占比26.4%, 高处坠落及自缢组男性占比66.7%, 不同性别组自杀方式差异有统计学意义(χ2=5.704, P =0.025)。服药自杀药物成分:毒物20例(37.7%), 抗抑郁药物14例(26.4%), 非处方药物10例(18.9%), 其他处方药物5例(9.4%), 镇静安眠药物3例(5.7%), 日用化学品1例(1.9%)。药物来源:18例(34.0%)为自己购买, 16例(30.2%)为家中储存药品, 13例(24.5%)为正在使用的抗抑郁药物。服药患儿比非服药患儿儿童重症监护病房住院时间更短(Z=-2.884, P=0.004)。因自杀入住PICU患儿总病死率16.1%(10/62)。不同自杀方式之间病死率差异有统计学意义(χ2=7.883, P=0.019)。结论学龄期儿童以及男孩更容易选择冲动型、伤害性更高的自杀行为, 青春期女孩更容易选择服药作为自杀方式, 需重点关注不同年龄和性别人群的自杀风险。服药为儿童自杀的主要方式, 服药死亡患儿中主要为服用除草剂和抗抑郁药物, 提示可通过控制农药(尤其是除草剂)的获得途径和抗抑郁药的获得剂量, 降低儿童自杀行为的危险度。

Objective To summarize the clinical characteristics of suicidal behavior in children and provide a reference for further developing strategies for preventing childhood suicide.Methods The medical records of children hospitalized in the pediatric intensive care unit(PICU)at Beijing Children's Hospital for suicidal behavior in the electronic medical record system from January 1,2018,to December 31,2022 were retrospectively selected.Clinical data of children with suicidal behavior were collected.Results A total of 3249 patients were admitted to the PICU,including 62 suicide patients.There were 20(32.3%)males,and 42(67.7%)females,with a male-to-female ratio of 1:2.1.The average age was(13.1±1.5)years old,with a minimum age of 7.9 years and a maximum age of 15.7 years.There were 17(27.4%)children with previously diagnosed mental illnesses.Notably 58.1%children had triggering factors for suicidal behavior.Analysis of suicide methods,53(85.5%)cases were intentional drug ingestion,six(9.7%)cases were jumping from height,and three(4.8%)cases were hanging.Additionally 26.4%cases of poisoning were male,while 66.7%of cases of jumping from height and hanging were male.There was a statistical difference in suicide methods between genders(χ2=5.704,P=0.025).The poisoning ingestions were classified as 20(37.7%)cases of toxins;14(26.4%)cases of antidepressants;10(18.9%)cases of over-the-counter drugs;five(9.4%)cases of other prescription drugs;three(5.7%)cases of sedative drugs;one(1.9%)case of daily chemical.Sources of ingestions:18(34.0%)cases were purchased personally(pharmacies or online shopping);16(30.2%)cases were storing medicines at home;13(24.5%)cases were daily taking antidepressants.Compared with non-poisoning patients, poisoning patients had a significantly shorter PICU duration (Z=-2.884, P=0.004). The total mortality rate of children admitted to PICU due to suicide was 16.1%(10/62).There was a statistical difference in the mortality rate among different suicide methods (χ2=7.883,P=0.019).Conclusion School aged children and boys are more likely to choose impulsive and more harmful suicide behaviors such as jumping from heights and hanging, and adolescent girls are more likely to choose intentional poisoning as their suicide method. Attention should be paid to the suicide risk of different age and gender groups.Intentional drug ingestion is the main method of suicide in children.Herbicide poisoning and antidepressant drug poisoning are the leading causes of suicide death.The death risk of suicidal behavior in children may be reduced by controlling the way of getting pesticides (especially herbicides) and obtaining maximum doses of antidepressants.