伴忧郁特征的抑郁症患者自杀风险因素分析  

Factors of suicide risk in major depressive disorder patients with melancholic features

作　　者：辛立敏[1] 陈林[1] 杨甫德[1] 颜峰[1] 王刚[2] 方贻儒[3] 陆铮[4] 杨海晨 胡建 陈致宇[7] 黄颐[8] 孙静[9] 王小平 李惠春[11] 张晋碚[12] 司天梅[13] XIN Li min;CHEN Lin;YANG Fu de;YAN Feng;WANG Gang;FANG Yi ru;LU Zheng;YANG Hai chen;HU Jian;CHENZhi yu;HUANG Yi;SUN Jing;WANG Xiao ping;LI Hui chun;ZHANG Jin bei;SI Tian mei(Beijing Huilongguan Hosipital,Beijing 100096,China)

机构地区：[1]北京回龙观医院,100096 [2]首都医科大学附属北京安定医院情感障碍中心 [3]上海交通大学附属精神卫生中心心境障碍科 [4]上海同济大学附属同济医院精神医学科 [5]深圳精神卫生中心情感障碍科 [6]哈尔滨医科大学附属第一医院 [7]杭州第七人民医院 [8]四川大学华西医院心理卫生中心 [9]南京医科大学附属脑科医院 [10]湖南湘雅二院精神卫生研究所 [11]浙江大学医学院附属第二医院精神科 [12]中山大学附属第三医院心理科 [13]国家精神心理疾病临床医学研究中心(北京大学第六医院/北京大学精神卫生研究所),卫生部(北京大学)精神卫生重点实验室

出　　处：《临床精神医学杂志》2020年第1期1-4,共4页Journal of Clinical Psychiatry

基　　金：首都卫生发展科研专项重点攻关项目(2016-1-4111);北京市科委首都临床特色项目(Z151100004015087);北京市科技计划项目(Z171100000117016);北京回龙观医院重点学科扶持项目(2014LYZD-05)

摘　　要：目的:探讨伴忧郁特征的抑郁症患者的自杀风险因素。方法:对"中国双相障碍患者诊断评估服务研究项目"中626例符合伴忧郁特征的抑郁症患者采用《简明国际神经精神访谈》(MINI)自杀模块评估自杀风险,并将患者分为自杀风险组(300例)和无自杀风险组(326例),比较两组的人口学及临床资料,采用Logistic回归分析伴忧郁特征抑郁症患者的自杀风险因素。结果:自杀风险组起病年龄明显小于无自杀风险组(t=-4.390,P=0.032),出现抑郁发作频繁(χ~2=8.036,P=0.005)、伴非典型症状(χ~2=4.586,P=0.032)、伴精神病性症状(χ~2=15.580,P<0.001)、症状晨重暮轻(χ~2=4.501,P=0.034)、伴不切实际的罪恶感(χ~2=33.105,P<0.001)的比率明显高于无自杀风险组。Logistic回归分析显示,伴精神病性症状(OR=2.38,P<0.001)、伴不切实际的罪恶感(OR=2.51,P<0.001)与伴忧郁特征抑郁症患者的自杀风险因素相关(P均<0.001)。结论:伴精神病性症状、伴不切实际的罪恶感可能是伴忧郁特征抑郁症患者的自杀风险因素。Objective:To explore the factors of suicide risk in major depressive disorder(MDD)patients with melancholic features.Method:The data were obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China.According to the suicide module of Mini International Neuropsychiatric Interview(MINI),626 patients diagnosed with melancholia depression were classified as suicide and non-suicide risk groups.The socio-demographic and clinical characteristics differences were compared between the suicide and non-suicide risk groups.Multivariate Logistic regression analysis was used to analyze the risk factors for suicide risk in patients diagnosed with melancholia MDD.Results:The suicide risk groups had an earlier age of onset(t=-4.390,P=0.032)than the non-suicide risk groups.The rate of frequent depressive episodes(χ~2=8.036,P=0.005),combined with atypical features(χ~2=4.586,P=0.032),depressive episodes with psychotic symptoms(χ~2=15.580,P<0.001),depression regularly worse in the morning(χ~2=4.501,P=0.034),and excessive or inappropriate guilt(χ~2=33.105,P<0.001)were higher than those in the non-suicide risk groups.Logistic regression analysis indicated that depressive episodes with psychotic symptoms(OR=2.38,P<0.001),and excessive or inappropriate guilt(OR=2.51,P<0.001)were significantly associated with suicide risk in MDD patients with melancholic features.Conclusion:Depressive episodes with psychotic symptoms,and excessive or inappropriate guilt may be the factors of suicide risk in MDD patients with melancholic features.

关 键 词：抑郁症 忧郁特征 自杀风险因素 

分 类 号：R749.4[医药卫生—神经病学与精神病学]