Risk Factors Associated With Peripartum Suicide Attempts in Japan.
Risk Factors Associated With Peripartum Suicide Attempts in Japan.
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DOI：
10.1001/jamanetworkopen.2022.50661
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发表时间：
2023-01-03
影响因子：
13.8
通讯作者：
Yaegashi, Nobuo
中科院分区：
文献类型：
--
作者：
Akaishi, Tetsuya;Tarasawa, Kunio;Fushimi, Kiyohide;Hamada, Hirotaka;Saito, Masatoshi;Kobayashi, Natsuko;Kikuchi, Saya;Tomita, Hiroaki;Ishii, Tadashi;Fujimori, Kenji;Yaegashi, Nobuo
精神病和非精神病病史的哪些方面与围产期自杀企图的风险相关？在这项对日本804617名孕妇进行的队列研究中，与围产期自杀企图相关的风险因素包括产前酒精使用障碍、焦虑症、人格障碍、精神分裂症、抑郁症、重度吸烟者和年龄较小。这些因素对产后1年内因自杀未遂而再次入院有显著意义。这些研究结果表明，母亲重度酒精和/或烟草使用，焦虑症，人格障碍，精神分裂症，抑郁症应密切观察期间和怀孕后，以防止自杀企图，特别是在那些谁是年轻的。这项队列研究使用国家医院数据来描述与日本孕妇围产期自杀企图相关的风险因素。围产期自杀未遂是一种主要的精神并发症与怀孕，但危险因素仍然很大程度上不确定。确定围产期自杀未遂和产后抑郁症的人口统计学特征和易感风险。这项队列研究使用了2016年4月1日至2021年3月31日期间在日本712家医院分娩的孕妇的回顾性数据。使用全国诊断程序组合数据库。精神病和非精神病病史，年龄，酒精和烟草使用，产科并发症和程序。收集了同一住院期间因自杀未遂和分娩而入院的数据，以及产后1年内因抑郁或自杀未遂而再次入院的数据。对每个研究变量的患病率进行比较，并使用多变量logistic回归分析来确定风险因素。在总计39 908 649例住院事件中，确定了804 617例在入组医院分娩的累积孕妇（分娩时的中位[IQR]年龄为33 [29-36]岁），包括1202例在同一住院期间因自杀企图和分娩入院的孕妇，111例在产后1年内因自杀企图再次入院。与自杀未遂相关的危险因素包括年龄（校正比值比[aOR]，0.99; 95%CI，0.98-1.00）和人格障碍病史（aOR，10.81; 95%CI，5.70-20.49），抑郁（aOR，3.97; 95%CI，2.35-6.70）、精神分裂症（aOR，2.89; 95%CI，1.52-5.50）和适应障碍（aOR，2.66; 95%CI，1.07-6.58）。与产后自杀企图相关的风险因素包括年龄较小（aOR，0.96; 95% CI，0.93-1.00），重度烟草使用（aOR，23.09; 95%CI，5.46-97.62），以及酒精使用障碍史（aOR，163.54; 95%CI，28.30-944.95），人格障碍（aOR，10.28; 95%CI，3.29-32.10），焦虑障碍（aOR，8.13; 95%CI，2.88-22.98），抑郁（aOR，7.27; 95%CI，2.95-17.91），精神分裂症（aOR，5.77; 95%CI，2.17-15.38）、双相情感障碍（aOR，3.98; 95%CI，1.36-11.67）和失眠（aOR，3.17; 95%CI，1.30-7.78）。在敏感性分析中，排除产前抑郁症后，与产后抑郁症相关的危险因素包括人格障碍、适应障碍、双相情感障碍、失眠和焦虑障碍病史。这项队列研究的结果表明，吸烟史和产前精神疾病是围产期自杀企图的潜在危险因素，可能需要额外的治疗和预防干预。
Which aspects of psychiatric and nonpsychiatric medical histories are associated with the risk of peripartum suicide attempts? In this cohort study of 804 617 pregnant individuals in Japan, risk factors associated with peripartum suicide attempts were prenatal history of alcohol use disorder, anxiety disorders, personality disorder, schizophrenia, depression, being a heavy smoker, and younger age. These factors were significant for readmission for suicide attempt within 1 year post partum. These findings suggest that mothers with heavy alcohol and/or tobacco use, anxiety disorders, personality disorder, schizophrenia, and depression should be observed closely during and after pregnancy to prevent a suicide attempt, especially in those who are younger. This cohort study uses national hospital data to describe the risk factors associated with peripartum suicide attempts in pregnant individuals in Japan. Peripartum suicide attempt is a major psychiatric complication associated with pregnancy, but the risk factors remain largely uncertain. To identify the demographic characteristics and predisposing risks for peripartum suicide attempts and postpartum depression. This cohort study used retrospective data on pregnant women who delivered children between April 1, 2016, and March 31, 2021, at 712 hospitals in Japan. The nationwide Diagnosis Procedure Combination database was used. Psychiatric and nonpsychiatric medical history, age, alcohol and tobacco use, and obstetric complications and procedures. Data on admissions for prepartum suicide attempt and delivery during the same hospital stay and readmissions for depression or suicide attempt within 1 year post partum were collected. Comparisons of prevalence of each study variable were performed, and multivariable logistic regression analyses were used to determine risk factors. From a total of 39 908 649 hospitalization episodes, 804 617 cumulative pregnant women (median [IQR] age at childbirth, 33 [29-36] years) who delivered at the enrolled hospitals were identified, including 1202 who were admitted for suicide attempt and delivery during the same hospital stay and 111 readmitted for suicide attempt within 1 year post partum. Risk factors associated with prepartum suicide attempts included younger age (adjusted odds ratio [aOR], 0.99; 95% CI, 0.98-1.00) and histories of personality disorder (aOR, 10.81; 95% CI, 5.70-20.49), depression (aOR, 3.97; 95% CI, 2.35-6.70), schizophrenia (aOR, 2.89; 95% CI, 1.52-5.50), and adjustment disorder (aOR, 2.66; 95% CI, 1.07-6.58). Risk factors associated with postpartum suicide attempts included younger age (aOR, 0.96; 95% CI, 0.93-1.00), heavy tobacco use (aOR, 23.09; 95% CI, 5.46-97.62), and histories of alcohol use disorder (aOR, 163.54; 95% CI, 28.30-944.95), personality disorder (aOR, 10.28; 95% CI, 3.29-32.10), anxiety disorders (aOR, 8.13; 95% CI, 2.88-22.98), depression (aOR, 7.27; 95% CI, 2.95-17.91), schizophrenia (aOR, 5.77; 95% CI, 2.17-15.38), bipolar disorder (aOR, 3.98; 95% CI, 1.36-11.67), and insomnia (aOR, 3.17; 95% CI, 1.30-7.78). On sensitivity analysis, risk factors associated with postpartum depression after excluding those with prenatal depression included histories of personality disorder, adjustment disorder, bipolar disorder, insomnia, and anxiety disorders. The findings of this cohort study suggest that histories of smoking and prenatal psychiatric disorders are potential risk factors for peripartum suicide attempts and may require additional treatment and prevention interventions.
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