Walby Fredrik A, Odegaard Erik, Mehlum Lars
Suicide Research and Prevention Unit, Institute of Psychiatry, University of Oslo, Norway.
J Affect Disord. 2006 Jun;92(2-3):253-60. doi: 10.1016/j.jad.2006.02.005. Epub 2006 Mar 20.
To investigate the differential impact of DSM-IV axis-I and axis-II disorders on completed suicide and to study if psychiatric comorbidity increases the risk of suicide in currently and previously hospitalized psychiatric patients.
A nested case-control design based on case notes from 136 suicides and 166 matched controls. All cases and controls were rediagnosed using the SCID-CV for axis-I and the DSM-IV criteria for axis-II disorders and the inter-rater reliability was satisfactory. Raters were blind to the case and control status and the original hospital diagnoses.
Depressive disorders and bipolar disorders were associated with an increased risk of suicide. No such effect was found for comorbidity between axis-I disorders and for comorbidity between axis-I and axis-II disorders.
Psychiatric diagnoses, although made using a structured and criteria-based approach, was based on information recorded in case notes. Axis-II comorbidity could only be investigated at an aggregated level.
Psychiatric comorbidity did not predict suicide in this sample. Mood disorders did, however, increase the risk significantly independent of history of previous suicide attempts. Both findings can inform identification and treatment of patients at high risk for completed suicide.
探讨《精神疾病诊断与统计手册》第四版（DSM-IV）轴I和轴II障碍对自杀身亡的不同影响，并研究精神科共病是否会增加目前及既往住院精神科患者的自杀风险。
基于136例自杀病例及166例匹配对照的病历记录进行巢式病例对照研究。所有病例和对照均使用轴I障碍的《结构化临床访谈表-临床版》（SCID-CV）及轴II障碍的DSM-IV标准重新诊断，评定者间信度良好。评定者对病例和对照状态以及原医院诊断不知情。
抑郁障碍和双相情感障碍与自杀风险增加相关。未发现轴I障碍之间的共病以及轴I与轴II障碍之间的共病有此类影响。
精神科诊断虽采用结构化及基于标准的方法，但基于病历记录中的信息。轴II共病仅能在汇总层面进行研究。
在本样本中，精神科共病不能预测自杀。然而，心境障碍确实会显著增加自杀风险，且独立于既往自杀未遂史。这两项发现均有助于识别及治疗有自杀身亡高风险的患者。
