Suicide Following Deliberate Self-Harm
Suicide Following Deliberate Self-Harm
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DOI：
10.1176/appi.ajp.2017.16111288
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发表时间：
2017-08-01
影响因子：
17.7
通讯作者：
Blanco, Carlos
中科院分区：
文献类型：
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作者：
Olfson, Mark;Wall, Melanie;Blanco, Carlos
目的：作者试图确定故意自残的成年人在接下来的一年内重复自残和完成自杀的危险因素。方法：对临床诊断为故意自残的由医疗补助资助的全国成年人群 (N=61,297) 进行长达 1 年的随访。确定了每 1,000 人年的重复自残率和每 100,000 人年的自杀率（基于国家死亡指数的死因信息）。通过Cox比例风险模型估计重复自残和自杀的风险比。结果：在非致命性自残后的12个月内，重复自残率为每1000人年263.2例，完成自杀率为每100000人年439.1例，比匹配的一般人群队列高37.2倍。与非暴力方法相比，涉及暴力的初次自残事件后自杀的风险较高（风险比=7.5，95% CI=5.5-10.1），尤其是枪支（风险比=15.86，95% CI=10.7-23.4；以中毒为参考计算），最近接受门诊心理健康护理的患者发生事件后自杀风险较低（风险比=1.6， 95% CI=1.2-2.0）。与使用非暴力方法的自残患者相比，使用暴力方法的患者在初次事件发生后的前 30 天内自杀风险显着增加（风险比=17.5，95% CI=11.2-27.3），但在接下来的 335 天内则没有。结论：因故意自残而接受治疗的成年人在接下来的一年中经常重复自残。最初使用暴力方法（尤其是枪支）进行自残的患者自杀的风险极高，尤其是在初次自残之后，这凸显了仔细评估和密切跟踪这一群体的重要性。
Objective: The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm.Method: A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 person-years and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models.Results: During the 12 months after nonfatal self-harm, the rate of repeat self-harm was 263.2 per 1,000 person-years and the rate of completed suicide was 439.1 per 100,000 person-years, or 37.2 times higher than in a matched general population cohort. The hazard of suicide was higher after initial self-harm events involving violent as compared with nonviolent methods (hazard ratio=7.5, 95% CI=5.5-10.1), especially firearms (hazard ratio=15.86, 95% CI=10.7-23.4; computed with poisoning as reference), and to a lesser extent after events of patients who had recently received outpatient mental health care (hazard ratio=1.6, 95% CI=1.2-2.0). Compared with self-harm patients using non violent methods, those who used violent methods were at significantly increased risk of suicide during the first 30 days after the initial event (hazard ratio=17.5, 95% CI=11.2-27.3), but not during the following 335 days.Conclusions: Adults treated for deliberate self-harm frequently repeat self-harm in the following year. Patients who use a violent method for their initial self-harm, especially firearms, have an exceptionally high risk of suicide, particularly right after the initial event, which highlights the importance of careful assessment and close follow-up of this group.