Yim Patty H W, Yip Paul S F, Li Raymond H Y, Dunn Eva L W, Yeung W S, Miao Y K
Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, China.
Aust N Z J Psychiatry. 2004 Jan-Feb;38(1-2):65-72. doi: 10.1177/000486740403800103.
To identify the risk period and the risk factors for suicide in Chinese psychiatric patients after discharge from inpatient psychiatric treatment. The nature of psychiatric aftercare provided to these patients was also explored.
A case control study with 73 patients who were discharged from a large psychiatric unit in Hong Kong between January 1996 and December 1999 and had received coroners' verdict of suicide or undetermined death within the same period. Controls were 73 surviving patients discharged from the same unit. They were individually matched for sex, age, psychiatric diagnosis, and date of discharge.
Post-discharge clustering of suicides was observed among the cases. Nearly 80% of them died within 1 year of discharge. The most common principal diagnosis among the cases was schizophrenia and related psychotic disorders. Multivariate analysis showed that suicide was associated with: unemployment (OR = 12.2, 95% CI = 2.1 - 70.4), past suicidal attempts (OR = 3.4, 95% CI = 1.2 - 9.6), maternal mental illness (OR = 13.4, 95% CI = 1.0 - 170.0), and suicidal ideation or attempt before the last admission (OR = 5.0, 95% CI = 1.4 - 18.0). The psychiatric aftercare received by cases and controls were generally similar. However, cases were more likely to have had contact with health care services in the last week before death (OR = 4.0, 95% CI = 1.3 - 11.9).
Suicidal risk is high in Chinese psychiatric patients soon after discharge. They share some common risk factors for suicide identified in Western studies but several differences are evident: the predominance of schizophrenia in the suicides; the lower prevalence of substance abuse and comorbidity; the low proportion of patients living alone; and the increased clinical contact before death but the less suicidal intent expressed in Chinese patients. It is necessary to consider these socio-cultural factors in assessment of suicidal risk and implementation of suicide prevention strategies in Chinese psychiatric patients.
确定中国精神科住院患者出院后的自杀风险期及风险因素。同时探讨为这些患者提供的精神科后续照护的性质。
采用病例对照研究，选取1996年1月至1999年12月间从香港一家大型精神科病房出院、且在同一时期经死因裁判官判定为自杀或死因不明的73例患者。对照组为从同一病房出院的73例存活患者。按性别、年龄、精神科诊断和出院日期进行个体匹配。
病例组中观察到出院后自杀聚集现象。近80%的患者在出院后1年内死亡。病例组中最常见的主要诊断是精神分裂症及相关精神障碍。多因素分析显示，自杀与以下因素相关：失业（比值比[OR]=12.2，95%置信区间[CI]=2.1 - 70.4）、既往自杀未遂（OR=3.4，95%CI=1.2 - 9.6）、母亲患精神疾病（OR=13.4，95%CI=1.0 - 170.0）以及上次入院前有自杀意念或自杀未遂（OR=5.0，95%CI=1.4 - 18.0）。病例组和对照组接受的精神科后续照护总体相似。然而，病例组在死亡前最后一周与医疗服务机构接触的可能性更大（OR=4.0，95%CI=1.3 - 11.9）。
中国精神科患者出院后不久自杀风险较高。他们与西方研究中确定的一些自杀常见风险因素相同，但也存在一些明显差异：自杀者中精神分裂症占主导；物质滥用和共病的患病率较低；独居患者比例较低；死亡前临床接触增加，但中国患者表达的自杀意图较少。在评估中国精神科患者的自杀风险及实施自杀预防策略时，有必要考虑这些社会文化因素。
