Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Br J Psychiatry. 2014 Nov;205(5):398-406. doi: 10.1192/bjp.bp.113.139352. Epub 2014 Sep 25.
Suicide prediction during psychiatric in-patient treatment remains an unresolved challenge.
To identify determinants of railway suicides in individuals receiving in-patient psychiatric treatment.
The study population was drawn from patients admitted to six psychiatric hospitals in Germany during a 10-year period (1997-2006). Data from 101 railway suicide cases were compared with a control group of 101 discharged patients matched for age, gender and diagnosis.
Predictors of suicide were change of therapist (OR = 22.86, P = 0.004), suicidal ideation (OR = 7.92, P<0.001), negative or unchanged therapeutic course (OR = 7.73, P<0.001), need of polypharmaceutical treatment (OR = 2.81, P = 0.04) and unemployment (OR = 2.72, P = 0.04). Neither restlessness nor impulsivity predicted in-patient suicide.
Suicidal ideation, unfavourable clinical course and the use of multiple psychotropic substances (reflecting the severity of illness) were strong determinants of railway suicides. The most salient finding was the vital impact of a change of therapist. These findings deserve integration into the clinical management of patients with serious mental disease.
在精神病住院治疗期间预测自杀仍然是一个未解决的挑战。
确定接受住院精神治疗的个体中铁路自杀的决定因素。
研究人群来自德国六家精神病院在十年期间（1997-2006 年）收治的患者。将 101 例铁路自杀病例的数据与年龄、性别和诊断相匹配的 101 例出院患者的对照组进行比较。
自杀的预测因素是治疗师的变化（OR = 22.86，P = 0.004）、自杀意念（OR = 7.92，P<0.001）、治疗效果负面或无变化（OR = 7.73，P<0.001）、需要多药物治疗（OR = 2.81，P = 0.04）和失业（OR = 2.72，P = 0.04）。躁动不安或冲动都不能预测住院自杀。
自杀意念、不良的临床病程和使用多种精神药物（反映疾病的严重程度）是铁路自杀的强烈决定因素。最显著的发现是治疗师的变化的重要影响。这些发现值得纳入严重精神疾病患者的临床管理中。
