From the Center for Suicide Prevention, National Institute of Mental Health (T.Y.), and Department of Epidemiology and Biostatistics, Translational Medical Center (N.Y.), National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Neuropsychiatry (M. Inagaki), Okayama University Hospital, Okayama, Japan; Epidemiology and Prevention Division (M. Iwasaki, M. Inoue, S.T.), Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan; Department of Psychiatry and Cognitive-Behavioral Medicine (T.A.), Nagoya City University Graduate School of Medical Sciences, Aichi, Japan; and Public Health Graduate School of Medicine (H.I.), Osaka University, Osaka, Japan.
Psychosom Med. 2014 Jul-Aug;76(6):452-9. doi: 10.1097/PSY.0000000000000079.
No large population-based prospective study has investigated the risks of suicide and death by other externally caused injuries (ECIs) among stroke patients. The purpose of this study was to examine whether stroke increases the risks of suicide and ECI deaths.
We analyzed data from the Japan Public Health Center-based Prospective Study between 1990 and 2010. Poisson regression models were used to calculate adjusted risk ratios (RR) for suicide and ECI deaths. To adjust for unmeasured confounders, case-crossover analyses of all stroke patients who died by suicide and ECIs were also performed.
A population-based cohort of 93,027 Japanese residents was established. During the follow-up period, 4793 residents had been diagnosed as having stroke. During this period, there were 22 suicides and 53 ECI deaths among stroke patients and 490 suicides and 675 ECI deaths among those who were stroke-free. Stroke patients were at increased risk for death by suicide and ECIs within the first 5 years after a stroke (suicide: RR = 10.2, 95% confidence interval [CI] = 6.3-16.6; ECI: RR = 12.8, 95% confidence interval = 9.0-18.2). Furthermore, case-crossover analyses confirmed the results of the Poisson regression models.
The RRs of suicide and ECI deaths within the first 5 years after a stroke were noticeably high. These findings underscore the need for clinicians and health care professionals to be aware of causes of death after a stroke and closely monitor patients during the first few poststroke years.
没有大型基于人群的前瞻性研究调查过中风患者自杀和其他外部原因导致的伤害（ECI）死亡的风险。本研究旨在探讨中风是否会增加自杀和 ECI 死亡的风险。
我们分析了 1990 年至 2010 年日本公共卫生中心前瞻性研究的数据。使用泊松回归模型计算自杀和 ECI 死亡的调整风险比（RR）。为了调整未测量的混杂因素，还对所有自杀和 ECI 死亡的中风患者进行了病例交叉分析。
建立了一个基于人群的 93027 名日本居民队列。在随访期间，有 4793 名居民被诊断患有中风。在此期间，中风患者中有 22 人自杀，53 人 ECI 死亡，无中风患者中有 490 人自杀，675 人 ECI 死亡。中风患者在中风后 5 年内自杀和 ECI 死亡的风险增加（自杀：RR=10.2，95%置信区间[CI]：6.3-16.6；ECI：RR=12.8，95%CI=9.0-18.2）。此外，病例交叉分析证实了泊松回归模型的结果。
中风后 5 年内自杀和 ECI 死亡的 RR 明显较高。这些发现强调了临床医生和医疗保健专业人员需要意识到中风后的死亡原因，并在中风后的头几年密切监测患者。
