Centre for Suicide Prevention, University of Manchester, Manchester Academic Health Sciences Centre, England, United Kingdom.
Schizophr Res. 2011 Aug;130(1-3):143-7. doi: 10.1016/j.schres.2011.04.031. Epub 2011 May 24.
Currently there is a lack of strong epidemiological evidence for violent offending and intelligence quotient (IQ) level as predictors of suicide risk among people with schizophrenia. We interlinked several Swedish routinely collected national registers, including the Hospital Discharge, Crime, Conscript, Migration and Cause of Death Registers, to identify 13,804 patients admitted at least twice with a schizophrenia diagnosis during 1973-2004. All deaths by specific cause were ascertained and suicides identified, and rate ratios were estimated using Poisson regression models with adjustment for age and period effects. There were 871 suicides: 6.3% of the cohort. Almost 80% of these cases were aged 20-39 years, and 80% occurred within 10 years of second discharge, with almost a quarter taking place within a year. The following risk factors were identified: younger age, 15-19 versus 40 years and older (rate ratio 3.18, 95% confidence interval 1.82-5.56), male sex (rate ratio 1.37, 1.18-1.59) and history of violent offending (rate ratio 1.45, 1.21-1.73). Intelligence quotient data were unavailable for women, but in men, lower IQ appeared protective compared to those of average or higher levels of intelligence (rate ratio 0.71, 0.58-0.86). Further stratified analyses to identify effect modification indicated that the elevated risk associated with past violent offending was restricted to males, and specifically to those with a lower IQ. Further research is needed to identify additional risk and protective factors for suicide that may be unique to people diagnosed with schizophrenia, and also other modifiers of the increased risk linked with violent offending.
目前，针对暴力犯罪和智商（IQ）水平作为精神分裂症患者自杀风险预测因素，缺乏强有力的流行病学证据。我们链接了几个瑞典常规收集的全国性登记处，包括住院病人、犯罪、兵役、移民和死因登记处，以确定 1973 年至 2004 年间至少两次因精神分裂症住院的 13804 名患者。所有特定原因的死亡都被确定，并确定了自杀事件，使用泊松回归模型估计率比，模型调整了年龄和时期的影响。共有 871 例自杀：占队列的 6.3%。这些病例中近 80%的年龄在 20-39 岁之间，80%发生在第二次出院后 10 年内，近四分之一发生在一年内。确定了以下风险因素：年龄较小，15-19 岁与 40 岁及以上（率比 3.18，95%置信区间 1.82-5.56），男性（率比 1.37，1.18-1.59）和暴力犯罪史（率比 1.45，1.21-1.73）。女性的智商数据不可用，但在男性中，与平均或更高智商的人相比，较低的智商似乎具有保护作用（率比 0.71，0.58-0.86）。进一步分层分析以确定效应修饰表明，过去暴力犯罪的风险增加仅适用于男性，特别是那些智商较低的男性。需要进一步研究，以确定可能对精神分裂症患者特有的自杀风险和保护因素，以及与暴力犯罪相关的增加风险的其他修饰因素。
