Suominen Kirsi, Haukka Jari, Valtonen Hanna M, Lönnqvist Jouko
National Institutes of Health and Welfare, Department of Mental Health and Substance Use, Mannerheimintie 166, 00300 Helsinki, Finland.
J Clin Psychiatry. 2009 Oct;70(10):1372-8. doi: 10.4088/JCP.09m05110blu.
To investigate the outcome of subjects with major depressive disorder after serious suicide attempt and to examine the effect of psychotic symptoms on their outcome.
The study population included all individuals aged 16 years or older in Finland who were hospitalized with ICD-10 diagnoses of major depressive disorder and attempted suicide from 1996 to 2003 (N = 1,820). The main outcome measures were completed suicides, overall mortality, and repeated suicide attempts during drug treatment versus no treatment.
During the 4-year follow-up period, 13% of patients died, 6% completed suicide, and 31% made a repeat suicide attempt. Subjects with major depression with psychotic features completed suicide more often than subjects without psychotic features during the follow-up (hazard ratio [HR] 3.32; 95% CI, 1.95 - 5.67). Antidepressant treatment reduced all-cause mortality by 24% (HR 0.74; 95% CI, 0.56 - 0.97) but did not reduce suicide mortality (HR 1.06; 95% CI, 0.71 - 1.58).
Psychotic symptoms during major depressive episode increase the risk of completed suicide after serious suicide attempt. The quality of treatment for major depression with psychotic features after attempted suicide should be improved to prevent suicide.
调查重度抑郁症患者严重自杀未遂后的结局，并研究精神病性症状对其结局的影响。
研究对象包括1996年至2003年期间在芬兰因国际疾病分类第10版（ICD - 10）诊断为重度抑郁症且自杀未遂而住院的所有16岁及以上个体（N = 1820）。主要结局指标为自杀死亡、全因死亡率以及药物治疗期间与未治疗期间的重复自杀未遂情况。
在4年随访期内，13%的患者死亡，6%自杀死亡，31%有重复自杀未遂。伴有精神病性特征的重度抑郁症患者在随访期间自杀死亡的频率高于无精神病性特征的患者（风险比[HR] 3.32；95%置信区间[CI]，1.95 - 5.67）。抗抑郁药治疗使全因死亡率降低了24%（HR 0.74；95% CI，0.56 - 0.97），但未降低自杀死亡率（HR 1.06；95% CI，0.71 - 1.58）。
重度抑郁发作期间的精神病性症状会增加严重自杀未遂后自杀死亡的风险。应改善自杀未遂后伴有精神病性特征的重度抑郁症的治疗质量以预防自杀。
