系统性红斑狼疮患者的自杀意念：发生率和危险因素。

Suicidal ideation in patients with systemic lupus erythematosus: incidence and risk factors.

机构信息

Department of Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China.

出版信息

Rheumatology (Oxford). 2014 Apr;53(4):714-21. doi: 10.1093/rheumatology/ket404. Epub 2013 Dec 20.

DOI:10.1093/rheumatology/ket404

PMID:24361695

Abstract

OBJECTIVE

To study the incidence of suicidal ideation in patients with SLE and the associated risk factors.

METHODS

Consecutive patients who fulfilled four or more ACR criteria for SLE were recruited. Suicidal thought in the preceding month was assessed by three direct questions. The intensity of suicidal ideation was assessed by the validated Beck Scale for Suicidal Ideation (BSSI). Socio-demographic data, clinical manifestations, Hospital Anxiety and Depression Scale (HADS), SLEDAI and SLICC/ACR Damage Index (SDI) scores were compared between patients with and without suicidal thoughts. Linear regression was used to study the factors associated with higher BSSI scores.

RESULTS

Of the 367 SLE patients studied (96% women; mean age 40.2 years (S.D. 13), mean disease duration 9.3 years (S.D. 7.2), 67 (18.3%) patients had clinically active SLE and 137 (37.3%) had organ damage (SDI ≥ 1). Suicidal thoughts were present in 44 (12%) patients. Patients with suicidal thoughts, compared with those without, had significantly higher mean SLEDAI scores in the preceding year [5.1 (S.D. 4.0) vs 2.9 (S.D. 2.7), P < 0.001], higher SDI [1.4 (S.D. 1.7) vs 0.6 (S.D. 1.1), P < 0.001], HADS-depression [11.2 (S.D. 4.7) vs 4.4 (S.D. 3.8), P < 0.001] and anxiety [12.2 (S.D. 4.9) vs 5.6 (S.D. 4.1), P < 0.001] scores, and were more likely to be unemployed (P = 0.02), have a past history of psychiatric disorders (P = 0.03) and previous suicide attempts (P = 0.02), as well as major life events in the preceding month (P = 0.006). Linear regression revealed that the BSSI score correlated significantly with the HADS-depression score (β = 0.27, P = 0.001), previous suicide attempts (β = 0.12, P = 0.03), major life events (β = 0.13, P = 0.01) and cardiovascular SDI score (β = 0.27, P < 0.001).

CONCLUSION

Suicidal ideation is common in SLE and is more intense in patients with depressive symptoms, cardiovascular damage, recent life events and previous suicide attempts.

摘要

目的

研究系统性红斑狼疮（SLE）患者自杀意念的发生率及其相关危险因素。

方法

连续纳入符合 4 项或以上美国风湿病学会（ACR）SLE 分类标准的患者。采用 3 个直接问题评估患者过去 1 个月的自杀想法。采用贝克自杀意念量表（BSSI）评估自杀意念的强度。比较有自杀意念和无自杀意念的患者在人口统计学资料、临床表现、医院焦虑抑郁量表（HADS）、SLE 疾病活动指数（SLEDAI）和系统性红斑狼疮损伤指数（SDI）方面的差异。采用线性回归分析探讨与 BSSI 评分较高相关的因素。

结果

本研究共纳入 367 例 SLE 患者（96%为女性；平均年龄 40.2 岁，标准差 13 岁；平均病程 9.3 年，标准差 7.2 年；67 例患者存在临床活动的 SLE，137 例患者存在器官损伤[SDI≥1]）。44 例（12%）患者存在自杀意念。与无自杀意念的患者相比，有自杀意念的患者过去 1 年的 SLEDAI 评分明显更高[5.1（标准差 4.0）比 2.9（标准差 2.7），P＜0.001]，SDI 更高[1.4（标准差 1.7）比 0.6（标准差 1.1），P＜0.001]，HADS 抑郁评分更高[11.2（标准差 4.7）比 4.4（标准差 3.8），P＜0.001]，HADS 焦虑评分更高[12.2（标准差 4.9）比 5.6（标准差 4.1），P＜0.001]，更可能失业（P=0.02），既往有精神疾病史（P=0.03）和自杀未遂史（P=0.02），以及过去 1 个月有重大生活事件（P=0.006）。线性回归显示，BSSI 评分与 HADS 抑郁评分（β=0.27，P=0.001）、既往自杀未遂（β=0.12，P=0.03）、重大生活事件（β=0.13，P=0.01）和心血管 SDI 评分（β=0.27，P＜0.001）显著相关。