Clinical Epidemiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Int J Gen Med. 2012;5:323-30. doi: 10.2147/IJGM.S30874. Epub 2012 Apr 11.
Major depressive disorder (MDD) is the leading cause of suicidal behaviors. Risk related to suicide attempts among individuals with MDD remains uninvestigated in upper northern Thailand, where the completed suicide rate is the highest in the nation.
To examine risk related to suicide attempts among individuals with MDD.
Individuals diagnosed with MDD using the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), codes F32.x and F33.x, seeking care at Suanprung Psychiatric Hospital between October 2006 and May 2009 were eligible. All individuals with MDD admitted due to suicide attempts were defined as cases (n = 186), and four controls per case were selected from those who did not attempt suicide on the same day or within a week of case selection (n = 914). Their medical charts were reviewed for sociodemographic and clinical factors influencing suicide attempts using multivariable logistic regression analysis.
Factors related to suicide attempts were stressful life events (adjusted odds ratio [OR], 2.32; 95% confidence interval [CI]: 1.27-4.24), alcohol use (adjusted OR, 2.08; 95% CI: 1.29-3.34), intermittent or poor psychiatric medications adherence (adjusted OR, 2.25; 95% CI: 1.44-3.51), up to two previous suicide attempts (adjusted OR, 3.64; 95% CI: 2.32-5.71), more than two previous suicide attempts (adjusted OR, 11.47; 95% CI: 5.73-22.95), and prescribed antipsychotics (adjusted OR, 3.84; 95% CI: 2.48-5.95). Risk factors that were inversely related to suicide attempts were increasing years of MDD treatment; one to five years (adjusted OR, 0.22; 95% CI: 0.11-0.44), over five years (adjusted OR, 0.44; 95% CI: 0.23-0.86), and antidepressant prescribed (norepinephrine [NE] and/or serotonin reuptake inhibitors [SRIs], adjusted OR, 0.28; 95% CI: 0.10-0.78). The final model explained 85.8% probability of suicide attempts.
Seven key factors suggested from this study may facilitate clinicians to identify individuals with MDD at risk of suicide attempt and provide them close monitoring, timely assessment, and intensive treatments.
重度抑郁症（MDD）是自杀行为的主要原因。在泰国北部地区，自杀未遂风险与 MDD 之间的关系尚未得到调查，该地区的自杀率是全国最高的。
研究 MDD 患者自杀未遂的相关风险因素。
2006 年 10 月至 2009 年 5 月期间，在素攀普精神病医院就诊的 MDD 患者（使用国际疾病分类第 10 次修订版（ICD-10）F32.x 和 F33.x 代码诊断）符合纳入标准。所有因自杀未遂而入院的 MDD 患者被定义为病例（n=186），并从同一天或在病例选择后一周内没有自杀的患者中，每例病例选择 4 名对照（n=914）。使用多变量逻辑回归分析评估影响自杀未遂的社会人口学和临床因素。
与自杀未遂相关的因素包括生活压力事件（调整后的优势比[OR]，2.32；95%置信区间[CI]：1.27-4.24）、酒精使用（调整后的 OR，2.08；95% CI：1.29-3.34）、间歇性或药物治疗依从性差（调整后的 OR，2.25；95% CI：1.44-3.51）、有两次或两次以上自杀未遂史（调整后的 OR，3.64；95% CI：2.32-5.71）、有三次或三次以上自杀未遂史（调整后的 OR，11.47；95% CI：5.73-22.95）、服用抗精神病药物（调整后的 OR，3.84；95% CI：2.48-5.95）。与自杀未遂呈负相关的风险因素包括 MDD 治疗年限的增加：1-5 年（调整后的 OR，0.22；95% CI：0.11-0.44）、5 年以上（调整后的 OR，0.44；95% CI：0.23-0.86）和服用抗抑郁药（去甲肾上腺素[NE]和/或 5-羟色胺再摄取抑制剂[SRI]，调整后的 OR，0.28；95% CI：0.10-0.78）。最终模型解释了 85.8%的自杀未遂概率。
本研究提出的七个关键因素可以帮助临床医生识别有自杀未遂风险的 MDD 患者，并对他们进行密切监测、及时评估和强化治疗。
