Major Physical Health Conditions and Risk of Suicide
Major Physical Health Conditions and Risk of Suicide
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DOI：
10.1016/j.amepre.2017.04.001
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发表时间：
2017-09-01
影响因子：
5.5
通讯作者：
Simon, Gregory E.
中科院分区：
文献类型：
--
作者：
Ahmedani, Brian K.;Peterson, Edward L.;Simon, Gregory E.
导言：大多数人在自杀前进行过医疗保健访问，但许多人没有被诊断出精神健康状况。本研究旨在调查美国普通人群样本中具有一系列身体健康状况的患者的自杀风险，以及在调整了精神健康和药物使用诊断后风险是否仍然存在。方法：本研究包括2000年至2013年期间死于自杀的2674人，以及2016年在8个心理健康研究网络医疗系统中进行的病例对照研究中按年份和地点匹配的267400名对照者。在索引日期之前的一年中，使用医疗保健系统虚拟数据仓库中的诊断代码，包括电子健康记录和保险索赔数据，共确定了19种身体健康状况。结果：调整年龄和性别后，17种身体健康状况与自杀风险增加相关（p < 0.001）；在对精神健康和药物使用诊断进行额外调整后，仍有9种关联存在。三种情况的自杀风险增加了两倍以上：创伤性脑损伤（AOR = 8.80, p < 0.001）；睡眠障碍;和艾滋病毒/艾滋病。与对照组的15.5%相比，38%的病例存在多重疾病，自杀风险增加了近两倍。结论：尽管一些个体状况，例如创伤性脑损伤，与自杀的高风险相关，但几乎所有的身体健康状况都增加了自杀的风险，即使在调整了潜在的混杂因素后也是如此。此外，多种身体健康状况大大增加了自杀风险。这些数据支持基于身体健康总体负担的自杀预防。(C) 2017年美国预防医学杂志。Elsevier Inc.出版。版权所有。
Introduction: Most individuals make healthcare visits before suicide, but many do not have a diagnosed mental health condition. This study seeks to investigate suicide risk among patients with a range of physical health conditions in a U.S. general population sample and whether risk persists after adjustment for mental health and substance use diagnoses.Methods: This study included 2,674 individuals who died by suicide between 2000 and 2013 along with 267,400 controls matched on year and location in a case-control study conducted in 2016 across eight Mental Health Research Network healthcare systems. A total of 19 physical health conditions were identified using diagnostic codes within the healthcare systems' Virtual Data Warehouse, including electronic health record and insurance claims data, during the year before index date.Results: Seventeen physical health conditions were associated with increased suicide risk after adjustment for age and sex (p < 0.001); nine associations persisted after additional adjustment for mental health and substance use diagnoses. Three conditions had a more than twofold increased suicide risk: traumatic brain injury (AOR = 8.80, p < 0.001); sleep disorders; and HIV/AIDS. Multimorbidity was present in 38% of cases versus 15.5% of controls, and represented nearly a twofold increased risk for suicide.Conclusions: Although several individual conditions, for example, traumatic brain injury, were associated with high risk of suicide, nearly all physical health conditions increased suicide risk, even after adjustment for potential confounders. In addition, having multiple physical health conditions increased suicide risk substantially. These data support suicide prevention based on the overall burden of physical health. (C) 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.