Risk of attempted suicide among adolescents and young adults with traumatic brain injury: A nationwide longitudinal study
Risk of attempted suicide among adolescents and young adults with traumatic brain injury: A nationwide longitudinal study
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DOI：
10.1016/j.jad.2019.02.059
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发表时间：
2019-05-01
影响因子：
6.6
通讯作者：
Chen, Mu-Hong
中科院分区：
文献类型：
--
作者：
Chang, Hsuan-Kan;Hsu, Ju-Wei;Chen, Mu-Hong
背景：创伤性脑损伤和自杀行为导致严重的发病率和过早死亡。成人脑外伤与较高的自杀发生率相关，但青少年和青壮年的风险尚不清楚。方法：从国家健康保险研究数据库中提取纵向随访数据。研究对象包括青少年和青壮年(12~29岁)，有无1：4的脑外伤，并分析以下自杀未遂的发生率。结果：总体而言，脑外伤组和对照组分别有31,599和126,396名受试者入选。脑外伤组自杀未遂的总体发生率显著高于对照组(4.6%比1.0%，P<；0.001)。在脑外伤队列中，首次自杀企图的年龄也较低(25.71+/-5.25岁比28.99+/-5.26岁，P<；0.001)。在调整混杂因素后，严重脑外伤、反复脑外伤、女性、脑外伤时年龄较小以及合并精神疾病(单相抑郁、双相情感障碍、酒精和药物使用障碍)与自杀未遂的风险增加相关。在脑外伤队列中，自杀未遂的长期累积风险显著增加(P<；0.001)。限制：无法获得个人详细的医疗记录。结论：脑外伤与青少年和年轻人自杀未遂的风险增加有关。颅脑损伤的严重程度、反复损伤、女性、受伤时年龄较小以及某些精神疾病的并存是独立的危险因素。
Background: Traumatic brain injury (TBI) and suicidal behavior lead to serious morbidity and premature mortality. TBI in adulthood is associated with a higher incidence of suicide, but the risk in adolescents and young adults is not clear.Methods: Longitudinal follow-up data were extracted from a National Health Insurance Research Database. Adolescents and young adults (12-29 years old) with and without TBI (1: 4) were included, and the incidences of following attempted suicide were analyzed. The association of TBI severity, repeated TBI, and comorbid psychiatric disorders with attempted suicide were also investigated.Results: Overall, 31,599 and 126,396 subjects were enrolled in the TBI and control cohorts, respectively. The overall incidence of attempted suicide was significantly higher in the TBI cohort than in the control cohort (4.6% versus 1.0%, P < 0.001). The age at first suicide attempt was also lower in the TBI cohort (25.71 +/- 5.25 versus 28.99 +/- 5.26 years, P< 0.001). After adjusting for confounding factors, severe TBI, repeated TBI, female, younger age at TBI, and comorbid psychiatric conditions (unipolar depression, bipolar disorder, alcohol and substance use disorders) were associated with higher risks of attempted suicide. Long-term cumulative risks of attempted suicide were significantly elevated in the TBI cohort (P< 0.001).Limitation: Access to individual's detailed medical record was not available.Conclusion: TBI is associated with an elevated risk of attempted suicide in adolescents and young adults. TBI severity, repetitive injury, female, younger age at injury, and certain psychiatric comorbidities are independent risk factors.