National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland.
Department of Public Health, University of Helsinki, Helsinki, Finland.
Psychol Med. 2014 Jan;44(2):291-302. doi: 10.1017/S0033291713000706. Epub 2013 Apr 10.
No previous study has prospectively investigated incidence and risk factors for suicide attempts among primary care patients with depression.
In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients was screened for depression, and Structured Clinical Interviews for DSM-IV used to diagnose Axis I and II disorders. A total of 137 patients were diagnosed with a DSM-IV depressive disorder. Altogether, 82% of patients completed the 5-year follow-up. Information on timing of suicide attempts, plus major depressive episodes (MDEs) and partial or full remission, or periods of substance abuse were examined with life charts. Incidence of suicide attempts and their stable and time-varying risk factors (phases of depression/substance abuse) were investigated using Cox proportional hazard and Poisson regression models.
During the follow-up there were 22 discrete suicide attempts by 14/134 (10.4%) patients. The incidence rates were 0, 5.8 and 107 during full or partial remission or MDEs, or 22.2 and 142 per 1000 patient-years during no or active substance abuse, respectively. In Cox models, current MDE (hazard ratio 33.5, 95% confidence interval 3.6-309.7) was the only significant independent risk factor. Primary care doctors were rarely aware of the suicide attempts.
Of the primary care patients with depressive disorders, one-tenth attempted suicide in 5 years. However, risk of suicidal acts was almost exclusively confined to MDEs, with or without concurrent active substance abuse. Suicide prevention among primary care patients with depression should focus on active treatment of major depressive disorder and co-morbid substance use, and awareness of suicide risk.
以前没有研究前瞻性地调查初级保健患者抑郁的自杀企图发生率和危险因素。
在万塔初级保健抑郁研究中，对 1119 名患者进行了抑郁筛查，并采用 DSM-IV 结构化临床访谈来诊断轴 I 和轴 II 障碍。共有 137 名患者被诊断为 DSM-IV 抑郁障碍。总共，82%的患者完成了 5 年的随访。使用生命图表检查自杀企图的时间以及主要抑郁发作（MDE）、部分或完全缓解或物质滥用期的信息。使用 Cox 比例风险和泊松回归模型调查自杀企图及其稳定和时变的危险因素（抑郁/物质滥用阶段）。
在随访期间，有 14 名/134 名（10.4%）患者发生了 22 次离散自杀企图。在完全或部分缓解或 MDE 期间，发生率分别为 0、5.8 和 107，在无或有活性物质滥用期间，发生率分别为 22.2 和 142/1000 患者年。在 Cox 模型中，当前 MDE（危险比 33.5，95%置信区间 3.6-309.7）是唯一显著的独立危险因素。初级保健医生很少意识到自杀企图。
在患有抑郁障碍的初级保健患者中，十分之一在 5 年内企图自杀。然而，自杀行为的风险几乎完全局限于 MDE，无论是否同时存在活跃的物质滥用。预防初级保健患者抑郁的自杀应该侧重于积极治疗主要抑郁障碍和共病物质使用，以及对自杀风险的认识。
