Law Yik Wa, Wong Paul W C, Yip Paul S F
Soc Work. 2015 Jan;60(1):65-74. doi: 10.1093/sw/swu054.
Although mental illness is a major suicide risk factor, some cases of suicide list no symptoms of mental disorder at the time of death. Studying suicides without psychiatric illness has important implications for social work because this group's service needs seem to have been overlooked. The authors of this article conducted a psychological autopsy study of 150 people who committed suicide and 150 age- and gender-matched living controls. Suicides without psychiatric illness showed similar detectable psychopathology as the suicide and living control groups with nonpsychotic psychiatric disorders. Though suicides without psychiatric disorders showed fewer warning signs that could be noticed by their informants, they experienced more negative life events than living controls. The suicide cases without psychiatric illness also seemed to be less protected by enabling factors (such as social support and employment) than living controls with and without psychiatric disorders. Furthermore, they had lower use of services than the control and deceased-with-diagnosis groups. With fewer at-risk signs and poorer enabling resources, they were undetected or unengaged by the existing physical, psychiatric, and psychosocial services. This group should be of concern to social workers, who may develop community-based health education programs and preventive services to meet this vulnerable population's psychosocial needs.
虽然精神疾病是自杀的主要风险因素，但有些自杀案例在死亡时并无精神障碍症状。研究无精神疾病的自杀案例对社会工作具有重要意义，因为这一群体的服务需求似乎一直被忽视。本文作者对150名自杀者以及150名年龄和性别匹配的在世对照者进行了一项心理解剖研究。无精神疾病的自杀者与患有非精神病性精神障碍的自杀者及在世对照者表现出相似的可检测到的精神病理学特征。虽然无精神疾病的自杀者表现出的、可被其提供信息者注意到的警示信号较少，但他们经历的负面生活事件比在世对照者更多。无精神疾病的自杀案例似乎也比患有和未患有精神疾病的在世对照者更少受到促成因素（如社会支持和就业）的保护。此外，他们比对照者和有诊断的死者组使用服务的频率更低。由于风险迹象较少且促成资源较差，他们未被现有的身体、精神和心理社会服务所发现或关注。社会工作者应关注这一群体，他们可以制定基于社区的健康教育项目和预防服务，以满足这一弱势群体的心理社会需求。
