Björkenstam C, Björkenstam E, Hjern A, Bodén R, Reutfors J
Department of Clinical Neuroscience, Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Schizophr Res. 2014 Aug;157(1-3):1-7. doi: 10.1016/j.schres.2014.05.010. Epub 2014 Jun 2.
Relatively little is known about suicide in diagnostic subtypes of first episode psychosis (FEP). Our aim was to assess suicide rates and potential risk factors for suicide in FEP.
This is a national register-based cohort study of patients born in 1973-1978 in Sweden and who were hospitalized with a FEP between ages 15 and 30years (n=2819). The patients were followed from date of discharge until death, emigration, or 31st of December 2008. The suicide rates for six diagnostic subtypes of FEP were calculated. Suicide incidence rate ratios (IRRs) were calculated to evaluate the association between suicide and psychiatric, familial, social, and demographic factors.
In total 121 patients died by suicide. The overall suicide rate was 4.3 (95% confidence interval [CI] 3.5-5.0) per 1000person-years. The highest suicide rates were found in depressive disorder with psychotic symptoms and in delusional disorder. In an adjusted model, the strongest risk factors for suicide were self-harm (IRR 2.7, CI 1.7-4.4) or a conviction for violent crime (IRR 2.0, CI 1.3-3.2). Also having a first-degree relative with a schizophrenia/bipolar diagnosis (IRR 2.1, CI 1.2-3.6) or substance use disorder (IRR 2.0, CI 1.2-3.2) were significant risk factors for suicide.
Impulsive behavior such as self-harm as well as having a family history of severe mental disorder or substance use are important risk factors for suicide in FEP.
对于首发精神病（FEP）诊断亚型中的自杀情况，人们了解相对较少。我们的目的是评估FEP中的自杀率及自杀的潜在风险因素。
这是一项基于全国登记册的队列研究，研究对象为1973年至1978年在瑞典出生、15至30岁之间因FEP住院的患者（n = 2819）。从出院日期开始对患者进行随访，直至死亡、移民或2008年12月31日。计算了FEP六种诊断亚型的自杀率。计算自杀发病率比值（IRR）以评估自杀与精神、家族、社会和人口统计学因素之间的关联。
共有121名患者自杀死亡。总体自杀率为每1000人年4.3（95%置信区间[CI] 3.5 - 5.0）。在伴有精神病性症状的抑郁症和妄想障碍中发现自杀率最高。在调整模型中，自杀的最强风险因素是自我伤害（IRR 2.7，CI 1.7 - 4.4）或暴力犯罪定罪（IRR 2.0，CI 1.3 - 3.2）。有精神分裂症/双相情感障碍诊断（IRR 2.1，CI 1.2 - 3.6）或物质使用障碍的一级亲属（IRR 2.0，CI 1.2 - 3.2）也是自杀的重要风险因素。
诸如自我伤害等冲动行为以及有严重精神障碍或物质使用的家族史是FEP中自杀的重要风险因素。
