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因弱阿片类药物非致命性中毒住院与随后自杀风险:一项基于人群的研究。

Hospital admission for non-fatal poisoning with weak analgesics and risk for subsequent suicide: a population study.

机构信息

National Centre for Register-based Research, University of Aarhus, Denmark.

出版信息

Psychol Med. 2009 Nov;39(11):1867-73. doi: 10.1017/S0033291709005741. Epub 2009 Apr 9.

DOI:10.1017/S0033291709005741
PMID:19356263
Abstract

BACKGROUND

Poisoning with weak analgesics is a major public health problem because of easy accessibility of the compounds; however, few studies have investigated their influence on subsequent suicide in the context of subjects' psychiatric status and other factors.

METHOD

This nested case-control study was based on the entire Danish population including all 21,169 suicide cases and 423,128 matched population controls. Data on hospital admissions for poisoning and confounding factors were retrieved from national medical and administrative registries. Conditional logistic regression was used to compute relative risk.

RESULTS

A prior hospital admission for poisoning with weak non-opioid analgesics significantly increased the risk of subsequent suicide [crude incidence rate ratio (IRR) 24.7, 95% confidence interval (CI) 22.1-27.6], and the effect of paracetamol poisoning was substantially stronger than that of poisoning with salicylates or non-steroidal anti-inflammatory drugs (NSAIDs). This association could not be explained by confounding from socio-economic or psychiatric factors. The elevated risk was extremely high during the first week following the overdose (adjusted IRR 738.9, 95% CI 173.9-3139.1), then declined over time but still remained significantly high 3 years later (adjusted IRR 4.2, 95% CI 3.5-5.0). Moreover, a history of weak analgesic poisoning significantly interacted with a person's psychiatric history, increasing the risk for subsequent suicide substantially more for persons with no history of psychiatric hospitalization than did it for those with such a history.

CONCLUSIONS

A history of non-fatal poisoning with weak analgesics is a strong predictor for subsequent suicide. These results emphasize the importance of intensive psychiatric care of patients following overdose.

摘要

背景

弱阿片类镇痛药中毒是一个主要的公共卫生问题,因为这些化合物很容易获得;然而,很少有研究调查它们在考虑到受试者的精神状态和其他因素的情况下对随后自杀的影响。

方法

本巢式病例对照研究基于整个丹麦人群,包括所有 21169 例自杀病例和 423128 名匹配的人群对照。从国家医疗和行政登记处检索了与医院收治中毒和混杂因素有关的数据。使用条件逻辑回归计算相对风险。

结果

先前因弱非阿片类镇痛药中毒而住院治疗显著增加了随后自杀的风险[粗发病率比 (IRR) 24.7,95%置信区间 (CI) 22.1-27.6],而对扑热息痛中毒的影响明显强于对水杨酸盐或非甾体抗炎药 (NSAIDs) 中毒的影响。这种关联不能用社会经济或精神因素的混杂来解释。在服药过量后的第一周内,风险显著升高(校正 IRR 738.9,95% CI 173.9-3139.1),然后随着时间的推移而下降,但 3 年后仍显著升高(校正 IRR 4.2,95% CI 3.5-5.0)。此外,弱镇痛药中毒史与个人的精神病史显著相互作用,使无精神科住院史的人随后自杀的风险大大增加,而有精神科住院史的人则不然。

结论

非致命性弱阿片类镇痛药中毒史是随后自杀的一个强有力的预测指标。这些结果强调了对过量服药患者进行强化精神护理的重要性。

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