Pan Yi-Ju, Lee Ming-Been, Chiang Hung-Chi, Liao Shih-Cheng
Department of Health, Taiwan Suicide Prevention Center, Taiwan, ROC.
Gen Hosp Psychiatry. 2009 Mar-Apr;31(2):181-4. doi: 10.1016/j.genhosppsych.2008.12.010. Epub 2009 Feb 20.
The objective of this study is to examine physicians' awareness of diagnosable psychiatric disorders in suicide cases' last medical contacts (MCs).
The contact rates and proportions of both psychiatric and somatic diagnoses in a national cohort of suicide subjects (N=3468) in Taiwan seeking psychiatric or nonpsychiatric medical services within 1 month and 1 year preceding death were examined.
The overall rates of MCs were 72.6% within 1 month and 89.2% within 1 year preceding suicide. While around 99.9% of the suicide subjects who contacted psychiatrists within 1 month preceding death were diagnosed as having psychiatric disorders, only 19.7% of those visiting nonpsychiatric physicians had psychiatric diagnoses. Suicide subjects, however, frequently complained of somatic symptoms, for example, gastrointestinal discomfort, headache/dizziness and back problem during their contacts with nonpsychiatric physicians within 1 month preceding death.
Despite the high rates of MCs preceding suicide, the majority of suicide subjects were not diagnosed. Emphasizing psychosomatic manifestations of psychiatric disorders in physician education programs may help enhance the awareness of psychiatric disorders/suicide risk in clinical settings.
本研究的目的是调查医生对自杀病例最后一次医疗接触（MCs）中可诊断的精神障碍的认知情况。
对台湾一个全国性自杀受试者队列（N = 3468）在死亡前1个月和1年内寻求精神科或非精神科医疗服务时的精神科和躯体诊断的接触率及比例进行了调查。
自杀前1个月内的MCs总发生率为72.6%，1年内为89.2%。在死亡前1个月内接触精神科医生的自杀受试者中，约99.9%被诊断患有精神障碍，而在就诊于非精神科医生的受试者中，只有19.7%有精神科诊断。然而，自杀受试者在死亡前1个月内与非精神科医生接触时，经常主诉躯体症状，如胃肠道不适、头痛/头晕和背部问题。
尽管自杀前MCs发生率较高，但大多数自杀受试者未被诊断。在医生教育项目中强调精神障碍的身心表现可能有助于提高临床环境中对精神障碍/自杀风险的认知。
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