Recession, recovery and suicide in mental health patients in England: time trend analysis
Recession, recovery and suicide in mental health patients in England: time trend analysis
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DOI：
10.1192/bjp.2019.119
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发表时间：
2019-10-01
影响因子：
10.5
通讯作者：
Kapur, Nay
中科院分区：
文献类型：
--
作者：
Ibrahim, Saied;Hunt, Isabelle M.;Kapur, Nay
2008年的经济衰退与全球自杀率的上升有关。研究集中在对普通人群的影响上，很少考虑对精神疾病患者的影响。目的调查英国精神疾病患者中与经济衰退相关的自杀趋势。方法采用回归模型分析英国心理健康患者在经济衰退之前、期间和之后的自杀趋势，并分析患者的人口学和临床特征。我们使用的数据来自全国自杀和心理健康安全保密调查，这是英国所有自杀死亡的国家数据集，包括死亡前12个月内服务机构看到的详细临床信息。结果2000 - 2016年，16岁及以上患者自杀死亡21 224例。对于男性患者，继衰退前每季度稳定下降0.5%（季度百分比变化（QPC） 2000-2009 -0.46%, 95% CI -0.66至-0.27）之后，衰退期间自杀率呈现上升趋势（QPC 2009-2011 2.37%, 95% CI -0.22至5.04）。与经济衰退相关的自杀率上升发生在45-54岁的男性中，这些人失业或被诊断为物质依赖/滥用。2012年至2016年期间，尽管接受治疗的男性患者数量有所增加，但男性患者的自杀率有所下降。在女性中没有发现与经济衰退相关的显著趋势。结论：与经济衰退相关的自杀率增加在男性精神疾病患者和男性一般人群中都有发现，中年人群的自杀风险尤其高。对经济困难患者的支持和有针对性的干预可能有助于减少经济困难时期的风险。药物和酒精滥用等因素也需要加以考虑。最近自杀率的下降可能与经济环境的改善或心理健康的改善有关。利益声明N.K.由大曼彻斯特精神健康NHS基金会信托基金支持。L.A.是卫生部全国自杀预防战略咨询小组的主席（N.K.也是该小组的成员之一），也是护理质量委员会的非执行董事。N.K.是国家健康与护理卓越研究所（NICE）成人抑郁症指南的主席，也是NICE自杀预防指南的主题专家成员。
Background The 2008 economic recession was associated with an increase in suicide internationally. Studies have focused on the impact in the general population with little consideration of the effect on people with a mental illness. Aims To investigate suicide trends related to the recession in mental health patients in England. Method Using regression models, we studied suicide trends in mental health patients in England before, during and after the recession and examined the demographic and clinical characteristics of the patients. We used data from the National Confidential Inquiry into Suicide and Safety in Mental Health, a national data-set of all suicide deaths in the UK that includes detailed clinical information on those seen by services in the last 12 months before death. Results Between 2000 and 2016, there were 21 224 suicide deaths by patients aged 16 or over. For male patients, following a steady fall of 0.5% per quarter before the recession (quarterly percent change (QPC) 2000-2009 -0.46%, 95% CI -0.66 to -0.27), suicide rates showed an upward trend during the recession (QPC 2009-2011 2.37%, 95% CI -0.22 to 5.04). Recession-related rises in suicide were found in men aged 45-54 years, those who were unemployed or had a diagnosis of substance dependence/misuse. Between 2012 and 2016 there was a decrease in suicide in male patients despite an increasing number of patients treated. No significant recession-related trends were found in women. Conclusions Recession-associated increases in suicide were seen in male mental health patients as well as the male general population, with those in mid-life at particular risk. Support and targeted interventions for patients with financial difficulties may help reduce the risk at times of economic hardship. Factors such as drug and alcohol misuse also need to be considered. Recent decreases in suicide may be related to an improved economic context or better mental healthcare. Declaration of interest N.K. is supported by Greater Manchester Mental Health NHS Foundation Trust. L.A. chairs the National Suicide Prevention Strategy Advisory Group at the Department of Health (of which N.K. is also a member) and is a non-executive Director for the Care Quality Commission. N.K. chairs the National Institute for Health and Care Excellence (NICE) depression in adults guideline and was a topic expert member for the NICE suicide prevention guideline.