Teasdale T W, Engberg A W
Department of Psychology, University of Copenhagen, Njalsgade 88, 2300 Copenhagen S, Denmark.
J Neurol Neurosurg Psychiatry. 2001 Oct;71(4):436-40. doi: 10.1136/jnnp.71.4.436.
To determine the rates of suicide among patients who have had a traumatic brain injury.
From a Danish population register of admissions to hospital covering the years 1979-93 patients were selected who had had either a concussion (n=126 114), a cranial fracture (n=7560), or a cerebral contusion or traumatic intracranial haemorrhage (n=11 766). All cases of deaths by the end of the study period were identified.
In the three diagnostic groups there had been 750 (0.59%), 46 (0.61%), and 99 (0.84%) cases of suicide respectively. Standardised mortality ratios, stratified by sex and age, showed that the incidence of suicide among the three diagnostic groups was increased relative to the general population (3.0, 2.7, and 4.1 respectively). In all diagnosis groups the ratios were higher for females than for males, and lower for patients injured before the age of 21 or after the age of 60. The presence of a codiagnosis relating to substance misuse was associated with increased suicide rates in all diagnosis groups. There was a tendency, among patients with cerebral contusions or traumatic intracranial haemorrhages, for suicide risk to increase with duration of stay in hospital. Cox regression analyses for proportional hazards confirmed that there was a significantly greater risk of suicide among patients with cerebral contusions or traumatic intracranial haemorrhages than among patients with concussion or cranial fractures (hazard ratios=1.42 and 1.50 respectively). There was, however, no evidence of a specific risk period for suicide after injury.
The increased risk of suicide among patients who had a mild traumatic brain injury may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally the physical, psychological, and social consequences of the injuries as directly contributing to the suicides.
确定创伤性脑损伤患者的自杀率。
从丹麦1979 - 1993年的医院入院人口登记册中选取曾有脑震荡（n = 126114）、颅骨骨折（n = 7560）或脑挫裂伤或外伤性颅内出血（n = 11766）的患者。确定研究期末所有死亡病例。
在这三个诊断组中，自杀病例分别有750例（0.59%）、46例（0.61%）和99例（0.84%）。按性别和年龄分层的标准化死亡率显示，这三个诊断组的自杀发生率相对于普通人群有所增加（分别为3.0、2.7和4.1）。在所有诊断组中，女性的比率高于男性，21岁之前或60岁之后受伤的患者比率较低。与物质滥用相关的共病诊断与所有诊断组的自杀率增加有关。在脑挫裂伤或外伤性颅内出血患者中，自杀风险有随住院时间延长而增加的趋势。比例风险的Cox回归分析证实，脑挫裂伤或外伤性颅内出血患者的自杀风险显著高于脑震荡或颅骨骨折患者（风险比分别为1.42和1.50）。然而，没有证据表明受伤后存在特定的自杀风险期。
轻度创伤性脑损伤患者自杀风险增加可能是由于诸如精神疾病和社会心理劣势等伴随风险因素。更严重病例中更高的风险还表明损伤的身体、心理和社会后果直接导致了自杀。
