Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
BMC Public Health. 2010 Jul 22;10:431. doi: 10.1186/1471-2458-10-431.
Considerable attention has been focused on the study of suicides among those who have received help from healthcare providers. However, little is known about the profiles of suicide deceased who had psychiatric illnesses but made no contact with psychiatric services prior to their death. Behavioural model of health service use is applied to identify factors associated with the utilization of psychiatric service among the suicide deceased.
With respect to completed suicide cases, who were diagnosed with a mental disorder, a comparison study was made between those who had (contact group; n = 52; 43.7%) and those who had not made any contact (non-contact group; n = 67; 56.3%) with a psychiatrist during the final six months prior to death. A sample of 119 deceased cases aged between 15 and 59 with at least one psychiatric diagnosis assessed by the Structured Clinical Interview for DSM-IV-TR (SCID I) were selected from a psychological autopsy study in Hong Kong.
The contact and non-contact group could be well distinguished from each other by "predisposing" variables: age group & gender, and most of the "enabling", and "need" variables tested in this study. Multiple logistic regression analysis has found four factors are statistically significantly associated with non-contact suicide deceased: (i) having non-psychotic disorders (OR = 13.5, 95% CI:2.9-62.9), (ii) unmanageable debts (OR = 10.5, CI:2.4-45.3), (iii) being full/partially/self employed at the time of death (OR = 10.0, CI:1.6-64.1) and (iv) having higher levels of social problem-solving ability (SPSI) (OR = 2.0, CI:1.1-3.6).
The non-contact group was clearly different from the contact group and actually comprised a larger proportion of the suicide population that they could hardly be reached by usual individual-based suicide prevention efforts. For this reason, both universal and strategic suicide prevention measures need to be developed specifically in non-medical settings to reach out to this non-contact group in order to achieve better suicide prevention results.
人们对接受过医疗保健提供者帮助的自杀者进行了大量研究。然而，对于那些有精神疾病但在死亡前没有与精神科服务机构联系的自杀死者的特征，知之甚少。应用卫生服务使用行为模型来确定与自杀死者使用精神科服务相关的因素。
对于已确诊患有精神障碍的自杀死亡病例，对在死亡前最后 6 个月内与精神科医生有（接触组；n=52；43.7%）和无任何接触（非接触组；n=67；56.3%）的病例进行了比较研究。从香港心理解剖研究中选择了 119 名年龄在 15 至 59 岁之间的死者样本，这些死者至少有一个由 DSM-IV-TR 结构临床访谈（SCID I）评估的精神科诊断。
接触组和非接触组可以通过“倾向”变量很好地区分：年龄组和性别，以及本研究测试的大多数“使能”和“需要”变量。多变量逻辑回归分析发现，有四个因素与非接触自杀死亡者有统计学显著关联：（i）患有非精神病性障碍（OR=13.5，95%CI：2.9-62.9）；（ii）无法偿还债务（OR=10.5，CI：2.4-45.3）；（iii）在死亡时全职/兼职/自雇（OR=10.0，CI：1.6-64.1）；（iv）具有较高的社会问题解决能力（SPSI）（OR=2.0，CI：1.1-3.6）。
非接触组与接触组明显不同，实际上包含了更大比例的自杀人群，他们很难通过通常的个体为基础的自杀预防工作来接触到。因此，需要在非医疗环境中制定针对这一非接触组的普遍性和战略性自杀预防措施，以达到更好的自杀预防效果。
