Birkbak J, Stuart E A, Lind B D, Qin P, Stenager E, Larsen K J, Wang A G, Nielsen A C, Pedersen C M, Winsløv J-H, Langhoff C, Mühlmann C, Nordentoft M, Erlangsen A
Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark.
Department of Mental Health,Johns Hopkins Bloomberg School of Public Health,Baltimore, MD,USA.
Psychol Med. 2016 Dec;46(16):3419-3427. doi: 10.1017/S0033291716001872. Epub 2016 Sep 22.
Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death.
In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period.
At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37-0.79], alcohol-related causes (0.63, 95% CI 0.50-0.80) and other diseases and medical conditions (0.61, 95% CI 0.49-0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions.
Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.
蓄意自伤后接受心理社会治疗可能与特定死因风险降低有关。
在这项匹配队列研究中，我们纳入了1992年至2010年间在丹麦一家自杀预防诊所经历过蓄意自伤事件并接受心理社会治疗的患者。我们采用倾向评分匹配法，以1:3的比例从59046名接受标准护理的个体中选取一个对照组。丹麦国家登记处提供了20年随访期内特定死因的数据。
随访结束时，心理社会治疗组5678例患者中有391例（6.9%）死亡，而匹配对照组17034例患者中有1736例（10.2%）死亡。心理社会治疗组因精神或行为障碍死亡的比值比更低[0.54，95%置信区间（CI）0.37 - 0.79]，因酒精相关原因死亡的比值比更低（0.63，95%CI 0.50 - 0.80），因其他疾病和医疗状况死亡的比值比更低（0.61，95%CI 0.49 - 0.77）。此外，我们发现自杀以及其他外部原因导致的死亡风险降低，但肿瘤和循环系统疾病导致的死亡风险未降低。作为死因，精神或行为障碍的需治疗人数为212.9（95%CI 139.5 - 448.4），酒精相关原因的需治疗人数为111.1（95%CI 79.2 - 210.5），其他疾病和医疗状况的需治疗人数为96.8（95%CI 69.1 - 161.8）。
我们的研究结果表明，蓄意自伤后接受心理社会治疗可能会降低某些医疗状况和外部原因导致的长期死亡风险。这些有前景的结果应通过随机设计进行验证。
