Risk of suicide attempt and suicide death in patients treated for bipolar disorder
Risk of suicide attempt and suicide death in patients treated for bipolar disorder
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DOI：
10.1111/j.1399-5618.2007.00408.x
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发表时间：
2007-08-01
影响因子：
5.4
通讯作者：
Savarino, James
中科院分区：
文献类型：
--
作者：
Simon, Gregory E.;Hunkeler, Enid;Savarino, James
目的：评估以人群为基础的双相情感障碍（BD）治疗人群中自杀企图和自杀死亡的人口学和临床预测因素。方法：计算机记录用于识别在两个大型预付费健康计划中治疗双相障碍的32,360个人。通过门诊诊断和出院诊断的计算机记录来确定自杀企图。自杀死亡是根据州死亡证明数据确定的。结果：自杀死亡的总发生率为1.06 / 1000人年，自杀未遂导致住院的发生率为5.6 / 1000人年，自杀未遂未导致住院的发生率为13.9 / 1000人年。男性的自杀企图率明显较低[危险比（HR） 0.68, 95%可信区间（CI） 0.56 ~ 0.83]，但自杀死亡率较高(HR 2.70, 95%可信区间（CI 1.69 ~ 4.31）。自杀企图在年轻患者中明显更频繁，但自杀死亡在年龄上没有显著差异。药物使用共病与自杀企图风险显著相关（HR 2.53, 95% CI 2.07-3.09），但与自杀死亡风险无关（HR 1.02, 95% CI 0.54-1.93）。共病性焦虑症与自杀企图（HR 1.40, 95% CI 1.14-1.72）和自杀死亡（HR 1.81, 95% CI 1.09-2.99）的风险均显著升高。结论：在接受双相障碍治疗的患者中，自杀死亡风险与男性性别和共病焦虑症显著相关。自杀死亡的预测因子与自杀企图的预测因子明显不同。
Objectives: To evaluate demographic and clinical predictors of suicide attempt and suicide death in a population-based sample of people treated for bipolar disorder (BD).Methods: Computerized records were used to identify 32,360 individuals treated for BD at two large prepaid health plans. Suicide attempts were identified using computerized records of outpatient visit diagnoses and hospital discharge diagnoses. Suicide deaths were identified using state death certificate data.Results: Overall event rates were 1.06 per 1,000 person-years for suicide death, 5.6 per 1,000 person-years for suicide attempt leading to hospitalization, and 13.9 per 1,000 person-years for suicide attempt not leading to hospitalization. Men had a significantly lower rate of suicide attempt [hazard ratio (HR) 0.68, 95% confidence interval (CI) 0.56-0.83] but a higher rate of suicide death (HR 2.70, 95% CI 1.69-4.31). Suicide attempts were significantly more frequent among younger patients, but suicide deaths did not vary significantly by age. Substance use comorbidity was significantly related to risk of suicide attempt (HR 2.53, 95% CI 2.07-3.09) but not to risk of suicide death (HR 1.02, 95% CI 0.54-1.93). Comorbid anxiety disorder was associated with significantly higher risk of both suicide attempt (HR 1.40, 95% CI 1.14-1.72) and suicide death (HR 1.81, 95% CI 1.09-2.99).Conclusions: Among people treated for BD, risk of suicide death is significantly related to male sex and comorbid anxiety disorder. The predictors of suicide death differ markedly from predictors of suicide attempt.