Angst F, Stassen H H, Clayton P J, Angst J
Institute of Social and Preventive Medicine, Zurich University, Zurich, Switzerland.
J Affect Disord. 2002 Apr;68(2-3):167-81. doi: 10.1016/s0165-0327(01)00377-9.
All follow-up studies of causes of death in affective disordered patients have found they have markedly elevated suicide rates and a less reproducible increased mortality from other causes. The reported rates by gender, disorder type and treatment are more variable.
Hospitalised affective disordered patients (n=406) were followed prospectively for 22 years or more. Later, mortality was assessed for 99% of them at which time 76% had died.
Standardised Mortality Rates (observed deaths/expected deaths) for patients were elevated especially for suicide and circulatory disorders in both men and women. Women actually had higher suicide rates but that did not take into account the twofold increase in general population rates for men. Unipolar patients had significantly higher rates of suicide than bipolar Is or IIs. In all groups long term medication treatment with antidepressants alone or with a neuroleptic, or with lithium in combination with antidepressants and/or neuroleptics significantly lowered suicide rates even though the treated were more severely ill. Although at the age of onset the suicide rates were most elevated, from ages 30 to 70 the rates were remarkably constant despite the different courses of illness.
The patients were identified as inpatients and followed prospectively. The treatments were uncontrolled and are not quantifiable but were documented during the follow-up.
Men and women hospitalised for affective disorders have elevated mortality rates from suicide and circulatory disorders. Unipolars have higher suicide rates than bipolar Is or IIs. Long term medication treatment lowers the suicide rates, despite the fact that it was the more severely ill who were treated.
所有关于情感障碍患者死因的随访研究均发现，他们的自杀率显著升高，而其他原因导致的死亡率升高则较难重现。按性别、障碍类型和治疗方式报告的死亡率差异更大。
对406例住院情感障碍患者进行了22年或更长时间的前瞻性随访。之后，对其中99%的患者进行了死亡率评估，此时已有76%的患者死亡。
患者的标准化死亡率（观察到的死亡数/预期死亡数）升高，尤其是男性和女性的自杀及循环系统疾病死亡率。女性的自杀率实际上更高，但未考虑到男性总体自杀率增加了两倍这一情况。单相情感障碍患者的自杀率显著高于双相I型或II型患者。在所有组中，单独使用抗抑郁药、或与抗精神病药联合、或锂盐与抗抑郁药和/或抗精神病药联合进行长期药物治疗，即使接受治疗的患者病情更严重，也能显著降低自杀率。尽管在发病年龄时自杀率最高，但从30岁到70岁，尽管疾病进程不同，自杀率却相当稳定。
这些患者被确定为住院患者并进行前瞻性随访。治疗未设对照且无法量化，但在随访期间有记录。
因情感障碍住院的男性和女性，自杀和循环系统疾病导致的死亡率升高。单相情感障碍患者的自杀率高于双相I型或II型患者。长期药物治疗可降低自杀率，尽管接受治疗的是病情更严重的患者。
