Suicide Immediately After Discharge From Psychiatric Inpatient Care: A Cohort Study of Nearly 2.9 Million Discharges
Suicide Immediately After Discharge From Psychiatric Inpatient Care: A Cohort Study of Nearly 2.9 Million Discharges
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DOI：
10.4088/jcp.18m12172
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发表时间：
2019-03-01
影响因子：
5.3
通讯作者：
Runeson, Bo
中科院分区：
文献类型：
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作者：
Haglund, Axel;Lysell, Henrik;Runeson, Bo
目的：从精神病医院出院后自杀的风险增加。本研究旨在探讨最近的自杀行为如何影响不同的精神病诊断的患者出院后立即自杀的风险。方法：注册与全国范围内的联系，以创建一个研究队列，包括从1973年至2009年在瑞典精神病医院出院的所有个人。计算出院诊断的风险比。在出院后30天内，在每个诊断类别的自杀行为已登记在入院前30天内的自杀风险estimated.Results：共3,695自杀发生后，2,883,088出院。如果登记了近期自杀行为，则所有诊断类别中自杀既遂的风险均显著增加，但精神分裂症（风险比[HR] = 8.9; 95%CI，6.4-12.4）和其他非器质性精神病（HR = 6.8; 95%CI，5.1-9.0）的风险尤其显著。抑郁症患者出院后自杀的总体风险最高（HR = 3.0; 95%CI，2.7-3.3）。这一发现尤其适用于男性抑郁症患者（HR = 4.5; 95%CI，4.0-5.0）或与危机反应（HR = 3.6; 95%CI 3.0-4.4）。结论：自杀的风险明显升高，在所有的诊断组，如果最近发生的自我伤害事件，特别是精神障碍患者。总体而言，无论近期是否有自杀行为，出院后立即自杀的风险都很高。本研究的发现与精神病住院治疗出院后立即善后和治疗的临床决策相关。
Objective: The risk of suicide is elevated after discharge from a psychiatric hospital. This study aimed to investigate how recent suicidal behavior affects the risk of suicide in patients with different psychiatric diagnoses immediately after discharge.Methods: Registers with national coverage were linked to create a study cohort including all individuals discharged from psychiatric hospitals in Sweden from 1973 through 2009. Hazard ratios for discharge diagnoses were calculated. The risk of suicide within 30 days after discharge in each diagnostic category when suicidal behavior had been registered within 30 days before admission was estimated.Results: A total of 3,695 suicides occurred after 2,883,088 discharges. If recent suicidal behavior was registered, the risk of completed suicide increased prominently in all diagnostic categories, but particularly for schizophrenia (hazard ratio [HR] = 8.9; 95% CI, 6.4-12.4) and other nonorganic psychosis (HR = 6.8; 95% CI, 5.1-9.0). Patients suffering from depression had the highest overall risk of suicide postdischarge (HR = 3.0; 95% CI, 2.7-3.3). This finding applied especially to male patients with depression (HR = 4.5; 95% CI, 4.0-5.0) or with reaction to crisis (HR = 3.6; 95% CI 3.0-4.4).Conclusions: A distinct elevation of the risk of suicide was seen in all diagnostic groups if a recent self-harm event had occurred, particularly among patients with psychotic disorders. Overall, the immediate risk of suicide after discharge was high regardless of recent suicidal behavior. The findings in this study have relevance for clinical decisions about immediate after-care and treatment in connection with discharge from psychiatric inpatient care.