加拿大安大略省的围产期自杀：一项基于人群的15年研究。
Perinatal suicide in Ontario, Canada: a 15-year population-based study.
作者信息
Grigoriadis Sophie, Wilton Andrew S, Kurdyak Paul A, Rhodes Anne E, VonderPorten Emily H, Levitt Anthony, Cheung Amy, Vigod Simone N
机构信息
Women's Mood and Anxiety Clinic: Reproductive Transitions (Grigoriadis) and Evaluative Clinical Sciences, Sunnybrook Research Institute (Grigoriadis, VonderPorten, Levitt, Cheung), Sunnybrook Health Sciences Centre; Department of Psychiatry (Grigoriadis, Kurdyak, Levitt, Cheung, Vigod), University of Toronto; Institute for Clinical Evaluative Sciences (Wilton, Kurdyak, Vigod); Health Outcomes and Performance Evaluation, Institute for Mental Health Policy Research (Kurdyak), Centre for Addiction and Mental Health, Toronto, Ont.; The Offord Centre for Child Studies (Rhodes), Hamilton, Ont.; Women's College Hospital and Research Institute (Vigod), Toronto, Ont.
出版信息
CMAJ. 2017 Aug 28;189(34):E1085-E1092. doi: 10.1503/cmaj.170088.
BACKGROUND
Death by suicide during the perinatal period has been understudied in Canada. We examined the epidemiology of and health service use related to suicides during pregnancy and the first postpartum year.
METHODS
In this retrospective, population-based cohort study, we linked health administrative databases with coroner death records (1994-2008) for Ontario, Canada. We compared sociodemographic characteristics, clinical features and health service use in the 30 days and 1 year before death between women who died by suicide perinatally, women who died by suicide outside of the perinatal period and living perinatal women.
RESULTS
The perinatal suicide rate was 2.58 per 100 000 live births, with suicide accounting for 51 (5.3%) of 966 perinatal deaths. Most suicides occurred during the final quarter of the first postpartum year, with highest rates in rural and remote regions. Perinatal women were more likely to die from hanging (33.3% [17/51]) or jumping or falling (19.6% [10/51]) than women who died by suicide non-perinatally ( = 0.04). Only 39.2% (20/51) had mental health contact within the 30 days before death, similar to the rate among those who died by suicide non-perinatally (47.7% [762/1597]; odds ratio [OR] 0.71, 95% confidence interval [CI] 0.40-1.25). Compared with living perinatal women matched by pregnancy or postpartum status at date of suicide, perinatal women who died by suicide had similar likelihood of non-mental health primary care and obstetric care before the index date but had a lower likelihood of pediatric contact (64.5% [20/31] v. 88.4% [137/155] at 30 days; OR 0.24, 95% CI 0.10-0.58).
INTERPRETATION
The perinatal suicide rate for Ontario during the period 1994-2008 was comparable to international estimates and represents a substantial component of Canadian perinatal mortality. Given that deaths by suicide occur throughout the perinatal period, all health care providers must be collectively vigilant in assessing risk.
背景
加拿大围产期自杀死亡情况一直未得到充分研究。我们调查了妊娠期间及产后第一年自杀事件的流行病学情况以及与之相关的医疗服务利用情况。
方法
在这项基于人群的回顾性队列研究中，我们将加拿大安大略省的卫生行政数据库与验尸官死亡记录（1994 - 2008年）进行了关联。我们比较了围产期自杀死亡女性、非围产期自杀死亡女性以及存活的围产期女性在死亡前30天和1年的社会人口学特征、临床特征及医疗服务利用情况。
结果
围产期自杀率为每10万例活产中有2.58例，自杀占966例围产期死亡中的51例（5.3%）。大多数自杀事件发生在产后第一年的最后一个季度，农村和偏远地区的自杀率最高。与非围产期自杀死亡女性相比，围产期女性更有可能死于上吊（33.3%[17/51]）或跳楼或坠楼（19.6%[10/51]）（P = 0.04）。只有39.2%（20/51）的人在死亡前30天内有过心理健康方面的接触，这一比例与非围产期自杀死亡者（47.7%[762/1597]）相似（优势比[OR]0.71，95%置信区间[CI]0.40 - 1.25）。与在自杀日期时按妊娠或产后状态匹配的存活围产期女性相比，围产期自杀死亡女性在索引日期前接受非心理健康初级保健和产科护理的可能性相似，但接受儿科护理的可能性较低（30天时为64.5%[20/31]对88.4%[137/155]；OR 0.24，95%CI 0.10 - 0.58）。
解读
1994 - 2008年期间安大略省的围产期自杀率与国际估计数相当，是加拿大围产期死亡率的一个重要组成部分。鉴于自杀死亡发生在整个围产期，所有医疗保健提供者都必须共同保持警惕以评估风险。
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