Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort
Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort
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DOI：
10.1017/s0033291716002282
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发表时间：
2016-12-01
影响因子：
6.9
通讯作者：
Dahlin, M.
中科院分区：
文献类型：
--
作者：
Beckman, K.;Mittendorfer-Rutz, E.;Dahlin, M.
背景。在世界许多地方，年轻人的自残是一种常见且日益严重的现象。年轻时自残后的长期预后尚不清楚。我们的目的是评估青年时期自残后成年后患精神疾病和自杀的风险，并确定不良结果的预后因素。方法。我们进行了一项基于全国人群的匹配病例队列研究。对 1990 年至 2003 年间因自残而住院的 18-24 岁患者 (n = 13 731) 和同龄未暴露者 (n = 137 310) 进行随访直至 2009 年 12 月。短期（1-5 年）和长期（> 5 年）随访结果为自杀、精神病住院和精神药物治疗。结果。自残意味着随访期间自杀的相对风险增加[风险比 (HR) 16.4，95% 置信区间 (CI) 12.9-20.9）。在长期随访中，20.3% 的人接受过精神科住院治疗，51.1% 的人接受过精神药物治疗，最常见的是抗抑郁药和抗焦虑药。在长期随访中，精神科住院治疗的风险增加了六倍（HR 6.3，95% CI 5.8-6.8），精神药物治疗的风险几乎增加了三倍（HR 2.8，95% CI 2.7-3.0）。基线时的精神障碍，尤其是精神障碍和自杀家族史与自残患者的不良结局相关。结论。我们发现，自残后的年轻人未来患精神疾病和自杀的风险大大增加。精神障碍史是长期不良结果的重要指标。临床医生应考虑患有精神障碍的自残患者的自杀风险大幅增加。
Background. Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.Method. We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in shortterm (1-5 years) and long-term (> 5 years) follow-up.Results. Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9-20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8-6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7-3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.Conclusion. We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.