Risk of self-harm after the diagnosis of psychiatric disorders in Hong Kong, 2000-10: a nested case-control study
Risk of self-harm after the diagnosis of psychiatric disorders in Hong Kong, 2000-10: a nested case-control study
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DOI：
10.1016/s2215-0366(20)30004-3
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发表时间：
2020-02-01
影响因子：
64.3
通讯作者：
Yip, Paul S. F.
中科院分区：
文献类型：
--
作者：
Chai, Yi;Luo, Hao;Yip, Paul S. F.
背景精神障碍是自我伤害的既定危险因素。然而，在人群代表性样本中，很少检查特定精神疾病和性别和年龄分层的自我伤害风险的变化。本研究旨在通过回顾香港临床数据分析及报告系统（CDARS）中的住院病例，探讨亚洲人群中不同精神疾病诊断后自我伤害的风险。2010年，从CDARS中提取。病例是10岁或以上的人，他们在研究期间因精神疾病的首次记录而住院治疗。关注的七种精神疾病是：抑郁症、酒精滥用或依赖、人格障碍、双相情感障碍、焦虑症、精神分裂症和物质滥用或依赖。每个病例匹配两名对照患者，这些患者来自所有具有相同性别、年龄和入院时间（即相同日历年和月）的个体的子样本，他们没有任何感兴趣的精神疾病记录。任何在首次诊断为精神疾病（病例）或入院（对照）之前或同时有自我伤害诊断史的患者均被排除在外。对于每个诊断类别，拟合考克斯比例风险回归模型以估计校正的风险比（人力资源部;加上95%CI），调整性别、年龄、对照组匹配的入院时间、20个居住区、身体合并症（作为自残的风险因素）（糖尿病、哮喘、偏头痛、癫痫、HIV和癌症），以及存在其他六种精神疾病。我们在按性别分层的亚组中重复了这一分析（男女）和年龄（青少年，10-24岁;青年人，25-44岁;中年人，45-64岁;结果在2000年至2010年期间，我们随访了86353名首次记录诊断为感兴趣的精神疾病的人，对照组134857例。在物质滥用或依赖患者中观察到的自我伤害风险最高（校正HR vs匹配对照组，9.6 [95% CI 8.4-11.0]），其次是人格障碍患者（3.7 [2.8-4.9]）和酒精滥用或依赖患者（3.2 [2.9-3.7]）。当按性别和年龄分层时，在物质滥用或依赖组中发现，男女自残行为的风险最高（女性患者：校正HR vs匹配对照组，7.7 [6.0-9.8];男性患者，10.5 [8.9-12.4]），所有年龄组（青少年：9.6 [7.2-12.7];年轻人：10.2 [8.4-12.3];中年人：11.2 [8.0-15.6];老年人：3.2 [1.7-6.1]）。解释精神障碍的首次记录诊断与随后自我伤害的风险升高显著相关。这些关联在不同性别和年龄亚组的诊断类别中差异很大。我们的研究结果强调了在精神病护理管理中制定更有效和更有针对性的预防措施的必要性，特别关注与同一诊断类别中风险增加相关的人口统计学特征。版权所有（c）2020 Elsevier Ltd.保留所有权利。
Background Psychiatric disorders are established risk factors for self-harm. However, variation in the risk of self-harm by specific psychiatric disorder and stratified by gender and age is rarely examined in population-representative samples. This study aimed to investigate the risk of self-harm following diagnosis of different psychiatric disorders in an Asian population, through a review of inpatient records retrieved from the Hong Kong Clinical Data Analysis and Reporting System (CDARS).Methods For this nested case-control study, the inpatient data of people admitted for any reason to Hong Kong public hospitals, between Jan 1, 2000, and Dec 31, 2010, were extracted from CDARS. Cases were people aged 10 years or older who had been admitted to inpatient care with a first-listed record of psychiatric disorder during the study period. The seven psychiatric disorders of interest were: depression, alcohol misuse or dependence, personality disorders, bipolar disorders, anxiety disorders, schizophrenia, and substance misuse or dependence. Two control patients were matched per case from a subsample of all individuals with the same gender, age, and admission time (ie, same calendar year and month), who did not have any record of the psychiatric disorders of interest. Any patients with a history of self-harm diagnosis before, or at the same time as, the first diagnosis of psychiatric disorder (cases) or admission (controls), were excluded. For each diagnostic category, a Cox proportional hazard regression model was fitted to estimate the adjusted hazard ratio (HR; plus 95% CIs) of associated self-harm, adjusting for gender, age, control-matched admission time, 20 districts of residence, physical comorbidities established as risk factors for self-harm (diabetes, asthma, migraine, epilepsy, HIV, and cancer), and presence of the six other psychiatric disorders. We repeated this analysis in subgroups stratified by gender (male and female) and by age (adolescent, 10-24 years; young adult, 25-44 years; middle-aged, 45-64 years; and older people, >= 65 years).Findings Between 2000 and 2010, we followed up a cohort of 86 353 people with a first-recorded diagnosis of a psychiatric disorder of interest, and 134 857 matched controls. The highest risk of self-harm was observed in patients with substance misuse or dependence (adjusted HR vs matched controls, 9.6 [95% CI 8.4-11.0]), followed by those with personality disorders (3.7 [2.8-4.9]) and alcohol misuse or dependence (3.2 [2.9-3.7]). When stratified by gender and age, the highest risk of self-harm behaviour was found in the substance misuse or dependence group for both genders (for female patients: adjusted HR vs matched controls, 7.7 [6.0-9.8]; and for male patients, 10.5 [8.9-12.4]), and for all age groups (adolescent: 9.6 [7.2-12.7]; young adults: 10.2 [8.4-12.3]; middle-aged: 11.2 [8.0-15.6], and older people: 3.2 [1.7-6.1]).Interpretation First-recorded diagnoses of psychiatric disorders were significantly associated with an elevated risk of subsequent self-harm. The associations varied considerably by diagnostic categories across gender and age subgroups. Our findings highlight the need to develop more efficient and targeted preventive measures in psychiatric care management, with specific attention to demographic characteristics linked to increased risk within the same diagnostic category. Copyright (c) 2020 Elsevier Ltd. All rights reserved.