基于队列数据探索精神分裂症患者自杀死亡的影响因素:一项来自中国西部170006例样本的实证研究  

Factors Influencing Suicide Deaths in Patients With Schizophrenia Based on Cohort Data: An Empirical Study of a Sample of 170006 Patients in Western China

作　　者：李硕 杨先梅[2] 王丹[2] 范箬馨 田绍丽 王荣科[2] 向虎[2] 张强[1] 刘元元[1] 刘祥[3] LI Shuo;YANG Xian-mei;WANG Dan;FAN Ruo-xin;TIAN Shaoli;WANG Rong-ke;XIANG Hu;ZHANG Qiang;LIU Yuan-yuan;LIU Xiang(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China;The Third Hospital of Mianyang and Sichuan Mental Health Center,Mianyang 621000,China;Department of Health Behavior and Social Medicine,West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西公共卫生学院/四川大学华西第四医院,成都610041 [2]绵阳市第三人民医院/四川省精神卫生中心,绵阳621000 [3]四川大学华西公共卫生学院/四川大学华西第四医院健康行为与社会医学系,成都610041

出　　处：《四川大学学报（医学版）》2023年第1期142-147,共6页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金项目(No.81903414);四川省科技厅重点研发计划项目(No.2020YFS0216);四川省基层卫生事业发展研究中心项目(No.SWFZ18-Y-21)资助。

摘　　要：目的 前瞻性探索精神分裂症患者因自杀死亡的危险因素。方法从某省严重精神障碍综合管理信息系统中获得2006–2018年的精神分裂症患者,使用Cox比例风险回归模型探索精神分裂症患者自杀的危险因素。结果 研究共纳入了170006名精神分裂症患者。随访期结束后有160570人存活,9436人由于各种原因死亡,其中929人死于自杀,自杀发生率为223.61/100000人年。Cox比例风险回归模型提示:贫困(HR=1.20,95%CI:1.02~1.41);与文盲与半文盲相比,较高的文化程度〔小学(HR=1.32,95%CI:1.09~1.60)、初中(HR=1.40,95%CI:1.14~1.73)、高中及以上(HR=1.93,95%CI:1.49~2.52)〕;自杀未遂(HR=2.70,95%CI:1.70~4.29);服药依从性好(HR=1.91,95%CI:1.66~2.20);存在抗精神药物治疗史(HR=1.42,95%CI:1.06~1.90);与61~90岁年龄组相比,较小的年龄组46~60岁(HR=1.95,95%CI:1.60~2.39)、31~45岁(HR=3.61,95%CI:2.92~4.47)、15~30岁(HR=12.37,95%CI:9.69~15.78);从事农业工作(HR=1.36,95%CI:1.13~1.65)是精神分裂症患者自杀的危险因素。结论 较高文化程度的中青年精神分裂症患者,尤其是有过自杀未遂史的患者为自杀发生的高危人群,应针对高危人群进行重点干预以减少精神分裂症患者自杀死亡的发生。Objective To prospectively explore the risk factors of suicide in patients with schizophrenia.Methods Data on schizophrenia patients in a certain province between 2006 and 2018 were obtained from the National Severe Mental Disorders Information System,and the Cox proportional hazards regression model was used to explore for risk factors for suicide in schizophrenia patients.Result A total of 170006 patients with schizophrenia were included in the study.At the end of the follow-up period,160570 patients were alive and 9436 died from various causes,929 of which being suicide deaths,resulting in a suicide rate of 223.61/100,000 person-years.The Cox proportional hazards regression model suggested that risk factors for suicide in patients with schizophrenia included poverty(HR=1.20,95%CI:1.02-1.41),higher education level(primary school[HR=1.32,95%CI:1.09-1.60],middle school[HR=1.40,95%CI:1.14-1.73],high school and above[HR=1.93,95%CI:1.49-2.52])in comparison with illiteracy and semi-literacy,suicide attempts(HR=2.70,95%CI:1.70-4.29),strict medication compliance(HR=1.91,95%CI:1.66-2.20),history of antipsychotic drug therapy(HR=1.42,95%CI:1.06-1.90),younger age group of patients of 46-60(HR=1.95,95%CI:1.60-2.39),31-45(HR=3.61,95%CI:2.92-4.47),and 15-30(HR=12.37,95%CI:9.69-15.78)compared with the 61-90 age group,and doing agriculture jobs(HR=1.36,95%CI:1.13-1.65).Conclusion Young and middle-aged schizophrenia patients with higher education levels,especially those with a history of suicide attempts,are at high risk for suicide.Focused interventions should be directed at high-risk groups to reduce suicide deaths in patients with schizophrenia.

关 键 词：精神分裂症 自杀 危险因素 队列研究 

分 类 号：R749.3[医药卫生—神经病学与精神病学]