Agerbo Esben
National Centre for Register-Based Research, University of Aarhus, DK-8000 Aarhus C, Denmark.
Arch Gen Psychiatry. 2007 Dec;64(12):1377-84. doi: 10.1001/archpsyc.64.12.1377.
Studies dating back over 100 years have shown that the risk of suicide in the general population is associated with low income, unemployment, educational underachievement, and singleness. However, little is known about the association between suicide risk and these factors in psychiatric patients.
To estimate the association between suicide risk, socioeconomic position, and marital status in psychiatric patients.
DESIGN, SETTING, AND PATIENTS: Population-based cohort study of all first-ever psychiatric patients aged 16 to 65 years admitted from 1981 to 1998, with administrative longitudinal data on income, labor market affiliation, educational attainment, and marital and cohabitational status (96,369 patients, 256,619 admissions, and 2727 suicides).
Suicide risks after hospital discharge were depicted using Kaplan-Meier product-limit methods. Hazard ratios (HRs) for suicide from Cox proportional hazards regression and case-crossover/individually stratified analyses were calculated while adjusting for overall social drift.
Using Cox proportional hazards regression, compared with patients in the highest income quartile, the suicide HR decreased from 0.90 (95% confidence interval [CI], 0.79-1.02) in the third lowest to 0.83 (95% CI, 0.73-0.93) in the second lowest and to 0.68 (95% CI, 0.61-0.76) in the lowest income group. Compared with the fully employed, the HR for unemployed patients was 0.85 (95% CI, 0.77-0.93); for social benefits' recipients, 0.58 (95% CI, 0.48-0.70); and for disability or age pensioners, 0.63 (95% CI, 0.55-0.71). Compared with postgraduate education, HRs (95% CIs) associated with a bachelor's degree, vocational school, or primary school education were 0.82 (0.67-1.02), 0.66 (0.55-0.80), and 0.54 (0.44-0.65), respectively. The HRs (95% CIs) for widowed, divorced, and never-married patients were 1.07 (0.89-1.30), 0.74 (0.66-0.84), and 0.88 (0.79-0.98), respectively. Using individually stratified analyses, HRs (95% CIs) for transition into the third lowest, the second lowest, and the lowest income quartile were 1.19 (0.76-1.86), 1.47 (0.92-2.34), and 1.84 (1.14-2.97), respectively. The HRs (95% CIs) for patients who became unemployed, social benefits' recipients, disability or age pensioners, widowed patients, and divorced patients were 1.41 (1.01-1.95), 1.73 (1.06-2.80), 1.45 (0.91-2.30), 2.59 (0.76-8.89), and 1.86 (1.07-3.21), respectively.
Suicide risk is generally associated with low income, unemployment, educational underachievement, and singleness, but this study suggests that the opposite is true among psychiatric patients. However, loss of income, labor market status, and marriage increase the suicide risk.
100多年前的研究表明，普通人群中的自杀风险与低收入、失业、教育程度低以及单身有关。然而，对于精神疾病患者中自杀风险与这些因素之间的关联，人们知之甚少。
评估精神疾病患者自杀风险、社会经济地位和婚姻状况之间的关联。
设计、地点和患者：基于人群的队列研究，研究对象为1981年至1998年收治的所有年龄在16至65岁之间的首次精神疾病患者，有关于收入、劳动力市场归属、教育程度以及婚姻和同居状况的行政纵向数据（96369名患者，256619次入院，2727例自杀）。
采用Kaplan-Meier乘积限界法描述出院后的自杀风险。在调整总体社会漂移的同时，通过Cox比例风险回归以及病例交叉/个体分层分析计算自杀的风险比（HR）。
采用Cox比例风险回归分析，与收入最高四分位数的患者相比，自杀HR从第三低四分位数的0.90（95%置信区间[CI]，0.79 - 1.02）降至第二低四分位数的0.83（95% CI，0.73 - 0.93），再降至最低收入组的0.68（95% CI，0.61 - 0.76）。与完全就业者相比，失业患者的HR为0.85（95% CI，0.77 - 0.93）；领取社会福利者为0.58（95% CI，0.48 - 0.70）；残疾或养老金领取者为0.63（95% CI，0.55 - 0.71）。与研究生学历相比，与本科学历、职业学校学历或小学学历相关的HR（95% CI）分别为0.82（0.67 - 1.02）、0.66（0.55 - 0.80）和0.54（0.44 - 0.65）。丧偶、离婚和未婚患者的HR（95% CI）分别为1.07（0.89 - 1.30）、0.74（0.66 - 0.84）和0.88（0.79 - 0.98）。采用个体分层分析，进入第三低、第二低和最低收入四分位数转变的HR（95% CI）分别为1.19（0.76 - 1.86）、1.47（0.92 - 2.34）和1.84（1.14 - 2.97）。失业、成为社会福利领取者、残疾或养老金领取者、丧偶患者和离婚患者的HR（95% CI）分别为1.41（1.01 - 1.95）、1.73（1.06 - 2.80）、1.45（0.91 - 2.30）、2.59（0.76 - 8.89）和1.86（1.07 - 3.21）。
自杀风险通常与低收入、失业、教育程度低以及单身有关，但本研究表明在精神疾病患者中情况相反。然而，收入损失、劳动力市场状况和婚姻状况的变化会增加自杀风险。
