Violent crime, suicide, and premature mortality in patients with schizophrenia and related disorders: a 38-year total population study in Sweden.
Violent crime, suicide, and premature mortality in patients with schizophrenia and related disorders: a 38-year total population study in Sweden.
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DOI：
10.1016/s2215-0366(14)70223-8
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发表时间：
2014-06
影响因子：
64.3
通讯作者：
Lichtenstein, Paul
中科院分区：
文献类型：
--
作者：
Fazel, Seena;Wolf, Achim;Palm, Camilla;Lichtenstein, Paul
患有精神分裂症和相关疾病的人出现不良后果的风险增加，包括暴力犯罪，自杀和过早死亡。然而，这些结果的发生率和风险因素需要澄清，作为基于人口和有针对性的干预措施的基础。我们的目的是确定这些结果的发生率和风险因素，并调查它们在多大程度上在结果之间共享，并特异于精神分裂症和相关疾病。我们在1972年1月至2009年12月期间在瑞典对24297例精神分裂症及相关疾病患者进行了一项总人群队列研究。 患者按年龄和性别与普通人群（n=485 940）和未受影响的同胞对照组（n=26 357）相匹配。 首先，我们调查了暴力犯罪、自杀和过早死亡的定罪率，随访至暴力犯罪、移民、死亡或随访结束（2009年12月31日），以先发生者为准。其次，我们分别对男性和女性，用考克斯比例风险模型分析了这些不良结局与社会人口统计学、个体、家庭和远端风险因素之间的关系。最后，我们评估了1972年至2009年期间不良结局的时间趋势，比较了患者与未受影响的兄弟姐妹，并分析了与全国精神病机构住院天数变化的相关性。在首次诊断后的5年内，13.9%的男性和4.7%的女性精神分裂症及相关疾病患者有重大不良结局（10.7%的男性和2.7%的女性被判犯有暴力罪，3.3%的男性和2.0%的女性因任何原因过早死亡）。在研究期间，与一般人群对照相比，患者任何不良结局的校正比值比男性为7.5（95%CI 7.2 - 7.9），女性为11.1（10.2 - 12.1）。诊断前存在的三个危险因素可预测任何不良结局：药物使用障碍、犯罪和自我伤害，这也是未受影响的兄弟姐妹和一般人群中这些结局的危险因素。在1973-2009年期间，与未受影响的兄弟姐妹相比，精神分裂症和相关疾病患者发生这些结局的几率增加。精神分裂症和相关疾病与暴力犯罪、自杀和过早死亡率的大幅增加有关。这三种结果的风险因素包括精神分裂症和相关疾病个体特有的风险因素，以及与一般人群共有的风险因素。因此，结合人群和有针对性的策略可能是必要的，以减少精神分裂症和相关疾病患者的不良结局的显着率。Wellcome Trust和瑞典研究理事会。
People with schizophrenia and related disorders are at an increased risk of adverse outcomes, including conviction of a violent offence, suicide, and premature mortality. However, the rates of, and risk factors for, these outcomes need clarification as a basis for population-based and targeted interventions. We aimed to determine rates and risk factors for these outcomes, and investigate to what extent they are shared across outcomes and are specific to schizophrenia and related disorders. We undertook a total population cohort study in Sweden of 24 297 patients with schizophrenia and related disorders between January, 1972 and December, 2009. Patients were matched by age and sex to people from the general population (n=485 940) and also to unaffected sibling controls (n=26 357). First, we investigated rates of conviction of a violent offence, suicide, and premature mortality, with follow-up until conviction of a violent offence, emigration, death, or end of follow-up (Dec 31, 2009), whichever occurred first. Second, we analysed associations between these adverse outcomes and sociodemographic, individual, familial, and distal risk factors, for men and women separately, with Cox proportional hazards models. Finally, we assessed time trends in adverse outcomes between 1972 and 2009, for which we compared patients with unaffected siblings, and analysed associations with changes in the number of nights spent in inpatient beds in psychiatric facilities nationwide. Within 5 years of their initial diagnosis, 13·9% of men and 4·7% of women with schizophrenia and related disorders had a major adverse outcome (10·7% of men and 2·7% of women were convicted of a violent offence, and 3·3% of men and 2·0% of women died prematurely of any cause). During the study, the adjusted odds ratio of any adverse outcomes for patients compared with general population controls was 7·5 (95% CI 7·2–7·9) in men and 11·1 (10·2–12·1) in women. Three risk factors that were present before diagnosis were predictive of any adverse outcome: drug use disorders, criminality, and self-harm, which were also risk factors for these outcomes in unaffected siblings and in the general population. Over the period 1973–2009, the odds of these outcomes increased in patients with schizophrenia and related disorders compared with unaffected siblings. Schizophrenia and related disorders are associated with substantially increased rates of violent crime, suicide, and premature mortality. Risk factors for these three outcomes included both those specific to individuals with schizophrenia and related disorders, and those shared with the general population. Therefore, a combination of population-based and targeted strategies might be necessary to reduce the substantial rates of adverse outcomes in patients with schizophrenia and related disorders. Wellcome Trust and The Swedish Research Council.