Short-term Suicide Risk After Psychiatric Hospital Discharge.
Short-term Suicide Risk After Psychiatric Hospital Discharge.
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精神病医院出院后的短期自杀风险。
DOI：
10.1001/jamapsychiatry.2016.2035
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发表时间：
2016-11-01
期刊：
影响因子：
25.8
通讯作者：
Blanco C
中科院分区：
文献类型：
--
作者：
Olfson M;Wall M;Wang S;Crystal S;Liu SM;Gerhard T;Blanco C
虽然精神科住院患者在出院后立即自杀的风险增加，但人们对他们的短期自杀风险在患有严重精神障碍的群体中的差异程度知之甚少。描述首次诊断为抑郁障碍、双相情感障碍、精神分裂症、物质使用障碍和其他精神障碍的成年人在出院后90天内自杀的风险与住院诊断为非精神障碍的患者和普通人群的关系。这一全国性的纵向回顾队列包括在医疗补助计划中年龄在18岁到之间的住院患者，他们在出院时被列为精神障碍(抑郁障碍、双相情感障碍、精神分裂症、物质使用障碍和其他精神障碍)的首选诊断，并随机抽取10%的非精神障碍住院患者作为样本。队列包括2001年1月1日至2007年12月31日期间精神障碍队列中的770 643名成年人，非精神障碍队列中的1 090 551名成年人，以及370例自杀死亡。对2015年3月5日至2016年6月6日的数据进行了分析。每个研究组在出院后的90天内和人口统计学上匹配的美国普通人群的自杀率被确定为每10万人年的自杀率。出院后短期自杀的调整危险比(ARH)也用COX比例风险回归模型估计。自杀作为死因的信息从国家死亡指数中获得。在1 861 194名成年人中(27%为男性；73%为女性；患有抑郁症(每100000人年235.1人)、双相情感障碍(每100000人年216.0人)、精神分裂症(每100000人年168.3人)、物质使用障碍(每100000人年116.5人)和其他精神疾病(每100000人年160.4人)的人群的自杀率显著高于非精神障碍人群(每100000人年11.6人)或美国普通人群(每10万人年自杀率14.2)。在有精神障碍的队列中，自杀的AHR与住院诊断抑郁症(AHR，2.0；95%CI，1.4-2.8；参考队列，物质使用障碍)、门诊诊断精神分裂症(AHR，1.6；95%CI，1.1-2.2)、门诊诊断双相情感障碍(AHR，1.6；95%CI，1.2-2.1)以及在入院前6个月内没有任何门诊保健(AHR，1.7；95%CI，1.2-2.5)有关。在精神病院出院后，患有明显抑郁特征的复杂精神病理障碍的成年人，特别是那些没有被纳入医疗保健系统的患者，似乎有特别高的短期自杀风险。
Although psychiatric inpatients are recognized to be at increased risk for suicide immediately after hospital discharge, little is known about the extent to which their short-term suicide risk varies across groups with major psychiatric disorders. To describe the risk for suicide during the 90 days after hospital discharge for adults with first-listed diagnoses of depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorders in relation to inpatients with diagnoses of nonmental disorders and the general population. This national retrospective longitudinal cohort included inpatients aged 18 to 64 years in the Medicaid program who were discharged with a first-listed diagnosis of a mental disorder (depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorder) and a 10% random sample of inpatients with diagnoses of nonmental disorders. The cohort included 770 643 adults in the mental disorder cohort, 1 090 551 adults in the nonmental disorder cohort, and 370 deaths from suicide from January 1, 2001, to December 31, 2007. Data were analyzed from March 5, 2015, to June 6, 2016. Suicide rates per 100 000 person-years were determined for each study group during the 90 days after hospital discharge and the demographically matched US general population. Adjusted hazard ratios (ARHs) of short-term suicide after hospital discharge were also estimated by Cox proportional hazards regression models. Information on suicide as a cause of death was obtained from the National Death Index. In the overall population of 1 861 194 adults (27% men; 73% women; mean [SD] age, 35.4 [13.1] years), suicide rates for the cohorts with depressive disorder (235.1 per 100 000 person-years), bipolar disorder (216.0 per 100000 person-years), schizophrenia (168.3 per 100000 person-years), substance use disorder (116.5 per 100000 person-years), and other mental disorders (160.4 per 100000 person-years) were substantially higher than corresponding rates for the cohort with nonmental disorders (11.6 per 100000 person-years) or the US general population (14.2 per 100 000 person-years). Among the cohort with mental disorders, AHRs of suicide were associated with inpatient diagnosis of depressive disorder (AHR, 2.0; 95% CI, 1.4-2.8; reference cohort, substance use disorder), an outpatient diagnosis of schizophrenia (AHR, 1.6; 95% CI, 1.1-2.2), an outpatient diagnosis of bipolar disorder (AHR, 1.6; 95% CI, 1.2-2.1), and an absence of any outpatient health care in the 6 months preceding hospital admission (AHR, 1.7; 95% CI, 1.2-2.5). After psychiatric hospital discharge, adults with complex psychopathologic disorders with prominent depressive features, especially patients who are not tied into a system of health care, appear to have a particularly high short-term risk for suicide.
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