Reassessing the Long-term Risk of Suicide After a First Episode of Psychosis
Reassessing the Long-term Risk of Suicide After a First Episode of Psychosis
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DOI：
10.1001/archgenpsychiatry.2010.157
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发表时间：
2010-12-01
影响因子：
--
通讯作者：
Boydell, Jane
中科院分区：
文献类型：
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作者：
Dutta, Rina;Murray, Robin M.;Boydell, Jane
背景：首次精神病发作后的长期自杀风险尚不清楚，因为以前的研究通常基于患病率队列，偏向于病情较重的住院患者，从较短的随访时间推断，并区分了精神分裂症和其他精神病。目的：确定具有临床代表性的首次精神病发作患者队列中自杀的流行病学。设计： 回顾性起始队列。背景：英国伦敦的地理区域（1965 年 1 月 1 日至 2004 年 12 月 31 日；n=2056）；英国诺丁汉（1997年9月1日至1999年8月31日；n=203）；以及苏格兰邓弗里斯和加洛韦（1979 年 1 月 1 日至 1998 年 12 月 31 日期间；n = 464）。参与者：在 3 个定义的服务区域中首次就诊的 2723 名患有精神病的患者在平均随访期 11.5 年后进行了追踪。主要结果指标：自杀死亡和根据国际自杀分类的公开判决疾病（第七至 第十版）。结果：自杀死亡率大大低于先前研究的预期（1.9% [53/2723]）；死亡率比例为 11.9% (53/444)。尽管自杀率在发病后第一年最高，但风险持续到随访后期，中位自杀时间为 5.6 年。英格兰和威尔士普通人群的自杀发生率比预期高出约 12 倍（标准化死亡率为 11.65；95% 置信区间为 8.73-15.24），53 起自杀事件中有 49 起为超额死亡。即使在首次就诊十年后（此时对风险的临床监测可能不那么严格），自杀风险仍然比一般人群高出近 4 倍（标准化死亡率，3.92；95% 置信区间，2.22-6.89）。结论：精神病发作后自杀的最高风险发生在就诊后不久，但医生在第一次接触后十年或更长时间评估风险时仍应保持警惕。人们普遍认为 10% 到 15% 的人死于自杀，这种观点具有误导性，因为它指的是比例死亡率，而不是终生风险。然而，与一般人群相比，自杀风险大幅增加。
Context: The long-term risk of suicide after a first episode of psychosis is unknown because previous studies often have been based on prevalence cohorts, been biased to more severely ill hospitalized patients, extrapolated from a short follow-up time, and have made a distinction between schizophrenia and other psychoses.Objective: To determine the epidemiology of suicide in a clinically representative cohort of patients experiencing their first episode of psychosis.Design: Retrospective inception cohort.Setting: Geographic catchment areas in London, England (between January 1, 1965, and December 31, 2004; n=2056); Nottingham, England (between September 1, 1997, and August 31, 1999; n=203); and Dumfries and Galloway, Scotland (between January 1, 1979, and December 31, 1998; n=464).Participants: All 2723 patients who presented for the first time to secondary care services with psychosis in the 3 defined catchment areas were traced after a mean follow-up period of 11.5 years.Main Outcome Measure: Deaths by suicide and open verdicts according to the International Classification of Diseases (seventh through tenth editions).Results: The case fatality from suicide was considerably lower than expected from previous studies (1.9% [53/2723]); the proportionate mortality was 11.9% (53/444). Although the rate of suicide was highest in the first year after presentation, risk persisted late into follow-up, with a median time to suicide of 5.6 years. Suicide occurred approximately 12 times more than expected from the general population of England and Wales (standardized mortality ratio, 11.65; 95% confidence interval, 8.73-15.24), and 49 of the 53 suicides were excess deaths. Even a decade after first presentation-a time when there may be less intense clinical monitoring of risk-suicide risk remained almost 4 times higher than in the general population (standardized mortality ratio, 3.92; 95% confidence interval, 2.22-6.89).Conclusions: The highest risk of suicide after a psychotic episode occurs soon after presentation, yet physicians should still be vigilant in assessing risk a decade or longer after first contact. The widely held view that 10% to 15% die of suicide is misleading because it refers to proportionate mortality, not lifetime risk. Nevertheless, there is a substantial increase in risk of suicide compared with the general population.