Wang Liang-Jen, Huang Yu-Chi, Lee Sheng-Yu, Wu Ya-Wen, Chen Chih-Ken
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Aust N Z J Psychiatry. 2015 Jan;49(1):65-73. doi: 10.1177/0004867414553951. Epub 2014 Oct 13.
Repetition of suicide attempts is common, but little is known about the relationship between switching methods of suicide attempt and the probability of completed suicide. This study aimed to determine the transition of methods chosen by individuals who repeat suicide attempts, and how the switched methods of suicide attempts influence the risk of suicide death.
All consecutive individuals (n = 2052) with an episode of non-fatal suicide attempt registered in a surveillance database provided by the Department of Health of the Keelung City Government from 1 January 2006 to 31 December 2010 were enrolled and followed up until the end of 2011. The earliest attempt recorded in the database was defined as the index attempt. Data on the time of subsequent completed suicide and methods chosen for repeated self-harm during the follow-up period were analyzed by performing a Cox proportional hazards regression.
Of the total subjects, 374 (18.2%) had at least one other attempted suicide and 50 (2.4%) eventually died by suicide. Subjects who used highly lethal methods in the index self-harm tended to switch methods in the next suicide attempt (p<0.001). Switching to a more lethal method was a significant predictor of completed suicide (adjusted hazard ratio (aHR) 7.05, 95% confidence interval (CI) 3.52-14.14). In addition, subjects who used charcoal-burning in the index self-harm attempt had a higher risk of subsequent suicide death (aHR 3.47, 95% CI 1.57-7.68).
The findings in this study give us some insight into the patterns of methods in repeat suicide attempters. The intent behind switching methods of suicide attempt might be considered as an important item of clinical assessment of the seriousness of suicidal behavior.
自杀未遂的重复发生很常见，但对于自杀未遂方式的转变与自杀既遂概率之间的关系却知之甚少。本研究旨在确定重复自杀未遂者所选择方式的转变情况，以及自杀未遂方式的转变如何影响自杀死亡风险。
纳入2006年1月1日至2010年12月31日在基隆市政府卫生局提供的监测数据库中登记的所有连续发生非致命性自杀未遂事件的个体（n = 2052），并随访至2011年底。数据库中记录的最早一次未遂事件被定义为索引未遂事件。通过进行Cox比例风险回归分析随访期间后续自杀既遂时间及重复自我伤害所选择的方式的数据。
在所有受试者中，374人（18.2%）至少有过一次其他自杀未遂经历，50人（2.4%）最终自杀死亡。在索引自我伤害中使用高致死性方式的受试者在下一次自杀未遂时倾向于转变方式（p<0.001）。转变为更具致死性的方式是自杀既遂的一个显著预测因素（调整后风险比（aHR）7.05，95%置信区间（CI）3.52 - 14.14）。此外，在索引自我伤害尝试中使用烧炭方式的受试者后续自杀死亡风险更高（aHR 3.47，95% CI 1.57 - 7.68）。
本研究结果为重复自杀未遂者的方式模式提供了一些见解。自杀未遂方式转变背后的意图可被视为自杀行为严重性临床评估的一个重要项目。
