Rahman Syed Ghulam, Alexanderson Kristina, Jokinen Jussi, Mittendorfer-Rutz Ellenor
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
BMJ Open. 2016 Apr 4;6(4):e010152. doi: 10.1136/bmjopen-2015-010152.
Adverse health outcomes, including suicide, in individuals on disability pension (DP) due to mental diagnoses have been reported. However, scientific knowledge on possible risk factors for suicidal behaviour (suicide attempt and suicide) in this group, such as age, gender, underlying DP diagnoses, comorbidity and DP duration and grade, is surprisingly sparse. This study aimed to investigate associations of different measures (main and secondary diagnoses, duration and grade) of DP due to common mental disorders (CMD) with subsequent suicidal behaviour, considering gender and age differences.
Population-based prospective cohort study based on Swedish nationwide registers.
A cohort of 46,515 individuals aged 19-64 years on DP due to CMD throughout 2005 was followed-up for 5 years. In relation to different measures of DP, univariate and multivariate HRs and 95% CIs for suicidal behaviour were estimated by Cox regression. All analyses were stratified by gender and age.
During 2006-2010, 1036 (2.2%) individuals attempted and 207 (0.5%) completed suicide. Multivariate analyses showed that a main DP diagnosis of 'stress-related mental disorders' was associated with a lower risk of subsequent suicidal behaviour than 'depressive disorders' (HR range 0.4-0.7). Substance abuse or personality disorders as a secondary DP diagnosis predicted suicide attempt in all subgroups (HR range 1.4-2.3) and suicide in women and younger individuals (HR range 2.6-3.3). Full-time DP was associated with a higher risk of suicide attempt compared with part-time DP in women and both age groups (HR range 1.4-1.7).
Depressive disorders as the main DP diagnosis and substance abuse or personality disorders as the secondary DP diagnosis were risk markers for subsequent suicidal behaviour in individuals on DP due to CMD. Particular attention should be paid to younger individuals on DP due to anxiety disorders because of the higher suicide risk.
已有报告称，因精神疾病诊断而领取残疾抚恤金（DP）的个体存在包括自杀在内的不良健康后果。然而，关于该群体自杀行为（自杀未遂和自杀）可能的风险因素，如年龄、性别、潜在的DP诊断、合并症以及DP持续时间和等级等方面的科学知识却出奇地匮乏。本研究旨在探讨因常见精神障碍（CMD）导致的DP的不同衡量指标（主要和次要诊断、持续时间和等级）与后续自杀行为之间的关联，并考虑性别和年龄差异。
基于瑞典全国登记册的基于人群的前瞻性队列研究。
对2005年全年因CMD领取DP的46515名19至64岁个体组成的队列进行了5年随访。针对DP的不同衡量指标，通过Cox回归估计自杀行为的单变量和多变量风险比（HR）及95%置信区间（CI）。所有分析均按性别和年龄分层。
在2006 - 2010年期间，1036名（2.2%）个体自杀未遂，207名（0.5%）自杀身亡。多变量分析显示，与“抑郁症”相比，DP主要诊断为“与压力相关的精神障碍”与后续自杀行为风险较低相关（HR范围为0.4 - 0.7）。物质滥用或人格障碍作为DP次要诊断在所有亚组中均预示着自杀未遂（HR范围为1.4 - 2.3），在女性和较年轻个体中预示着自杀（HR范围为2.6 - 3.3）。与兼职DP相比，全职DP在女性以及两个年龄组中与自杀未遂风险较高相关（HR范围为1.4 - 1.7）。
抑郁症作为DP主要诊断以及物质滥用或人格障碍作为DP次要诊断是因CMD领取DP个体后续自杀行为的风险标志物。由于自杀风险较高，对于因焦虑症领取DP的较年轻个体应给予特别关注。
