Ping Qin, MD, PhD, National Centre for Register-based Research, Aarhus University, Denmark, and National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway; Keith Hawton, DSc, DM, Centre for Suicide Study, Department of Psychiatry, Oxford University, UK; Preben Bo Mortensen, MD, DrMedSc, National Centre for Register-based Research, Aarhus University, Denmark; Roger Webb, MSc, PhD, Centre for Mental Health and Risk, University of Manchester, UK.
Br J Psychiatry. 2014 Jun;204(6):430-5. doi: 10.1192/bjp.bp.113.128785. Epub 2014 Feb 27.
People with physical illness often have psychiatric disorder and this comorbidity may have a specific influence on their risk of suicide.
To examine how physical illness and psychiatric comorbidity interact to influence risk of suicide, with particular focus on relative timing of onset of the two types of illness.
Based on the national population of Denmark, individual-level data were retrieved from five national registers on 27 262 suicide cases and 468 007 gender- and birth-date matched living controls. Data were analysed using conditional logistic regression.
Both suicides and controls with physical illness more often had comorbid psychiatric disorder than their physically healthy counterparts. Although both physical and psychiatric illnesses constituted significant risk factors for suicide, their relative timing of onset in individuals with comorbidity significantly differentiated the associated risk of suicide. While suicide risk was highly elevated when onsets of both physical and psychiatric illness occurred close in time to each other, regardless which came first, psychiatric comorbidity developed some time after onset of physical illness exacerbated the risk of suicide substantially.
Suicide risk in physically ill people varies substantially by presence of psychiatric comorbidity, particularly the relative timing of onset of the two types of illness. Closer collaboration between general and mental health services should be an essential component of suicide prevention strategies.
患有躯体疾病的人群常伴有精神障碍，这种共病情况可能会对其自杀风险产生特殊影响。
探讨躯体疾病和精神共病如何相互作用影响自杀风险，尤其关注两种疾病发病的相对时间。
基于丹麦全国人群，从五个全国性登记处获取了 27262 例自杀病例和 468007 名性别和出生日期相匹配的健在对照者的个体水平数据。采用条件逻辑回归分析数据。
患有躯体疾病的自杀病例和对照者比躯体健康者更常伴有精神障碍共病。尽管躯体和精神疾病均为自杀的显著危险因素，但共病患者中两种疾病的发病相对时间显著区分了相关自杀风险。当躯体和精神疾病的发病时间彼此接近时，无论哪种疾病先发病，自杀风险均显著升高，而当精神障碍在躯体疾病发病后一段时间才出现时，自杀风险会大幅升高。
躯体疾病患者的自杀风险随精神共病的存在而显著变化，尤其是两种疾病发病的相对时间。综合医院和精神卫生服务机构之间更紧密的合作应成为自杀预防策略的重要组成部分。
