Beckman K, Mittendorfer-Rutz E, Lichtenstein P, Larsson H, Almqvist C, Runeson B, Dahlin M
Centre for Psychiatry Research, Department of Clinical Neuroscience,Karolinska Institutet and Stockholm Health Care Services,Stockholm City Council, St Goran,Stockholm,Sweden.
Department of Clinical Neuroscience,Insurance Medicine,Karolinska Institutet,Stockholm,Sweden.
Psychol Med. 2016 Dec;46(16):3397-3405. doi: 10.1017/S0033291716002282. Epub 2016 Sep 20.
Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.
We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.
Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9-20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8-6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7-3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.
We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.
在世界许多地区，年轻人的自我伤害是一种常见且呈上升趋势的现象。人们对年轻时自我伤害后的长期预后了解不足。我们旨在评估青年期自我伤害后成年期患精神疾病和自杀的风险，并确定不良结局的预后因素。
我们开展了一项基于全国人口的匹配病例队列研究。对1990年至2003年间因自我伤害住院的18 - 24岁患者（n = 13731）以及相同年龄的未暴露个体（n = 137310）进行随访，直至2009年12月。结局指标为短期（1 - 5年）和长期（>5年）随访中的自杀、精神科住院治疗以及使用精神药物情况。
自我伤害意味着随访期间自杀的相对风险增加[风险比（HR）16.4，95%置信区间（CI）12.9 - 20.9]。在长期随访中，20.3%的人有精神科住院治疗经历，51.1%的人使用精神药物，最常用的是抗抑郁药和抗焦虑药。长期随访中，精神科住院治疗的风险增加了6倍（HR 6.3，95% CI 5.8 - 6.8），使用精神药物的风险增加了近3倍（HR 2.8，95% CI 2.7 - 3.0）。基线时的精神障碍，尤其是精神病性障碍，以及自杀家族史与自我伤害患者的不良结局相关。
我们发现青年期自我伤害后未来患精神疾病和自杀的风险大幅增加。精神障碍病史是长期不良结局的重要指标。临床医生应考虑患有精神病性障碍的自我伤害患者自杀风险大幅增加的情况。
