Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Division of Psychosomatic Medicine, Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
J Affect Disord. 2018 Feb;227:7-10. doi: 10.1016/j.jad.2017.10.020. Epub 2017 Oct 9.
Patients with end-stage renal disease (ESRD) who receive dialysis may experience increased distress and risk of suicide.
This population-based retrospective cohort study linked Taiwan's national register of ESRD patients on dialysis and the cause-of-death mortality data file. A separate multiple-cause-of-death data file was used to investigate the detailed suicide methods used. Standardized mortality ratios (SMRs) were calculated for the overall patient group and by sex, age, year of initiating dialysis, method of suicide, and time since initiation of dialysis.
Among 63,854 ESRD patients on dialysis, 133 died by suicide in Taiwan in 2006-2012; the suicide rate was 76.3 per 100,000 patient-years. The SMR for suicide was 2.38 (95% confidence interval [CI] 1.99-2.82) in this patient group. Suicide risk was highest in the first year of dialysis (SMR = 3.15, 95% CI 2.39-4.08). The risk of suicide by cutting was nearly 20 times (SMR = 19.91, 95% CI 12.88-29.39) that of the general population. Detailed information on death certificates indicated that three quarters of patients who killed themselves by cutting cut vascular accesses used for hemodialysis.
Information on risk factors such as socioeconomic position and mental disorders was unavailable.
In a country where the national health insurance program covers most expenses associated with dialysis treatment, the suicide risk in ESRD patients on dialysis still increased nearly 140%. Adequate support for ESRD patients initiating dialysis and the assessment of risk of cutting vascular access as a potential means of suicide could be important strategies for suicide prevention.
接受透析的终末期肾病 (ESRD) 患者可能会经历更多的痛苦和自杀风险。
本项基于人群的回顾性队列研究将台湾的 ESRD 透析患者国家登记处与死因死亡率数据文件相关联。单独使用多死因数据文件来调查自杀的详细方法。为整个患者群体以及按性别、年龄、开始透析的年份、自杀方式和开始透析后的时间计算标准化死亡率比 (SMR)。
在 2006-2012 年期间，63854 名接受透析的 ESRD 患者中，有 133 人在台湾死于自杀，自杀率为每 100000 患者年 76.3 例。该患者群体的自杀 SMR 为 2.38（95%置信区间 [CI] 1.99-2.82）。在透析的第一年，自杀风险最高（SMR = 3.15，95% CI 2.39-4.08）。割颈自杀的风险几乎是普通人群的 20 倍（SMR = 19.91，95% CI 12.88-29.39）。死亡证明上的详细信息表明，四分之三的自杀患者割开了用于血液透析的血管通路。
缺乏与社会经济地位和精神障碍等风险因素相关的信息。
在一个全民健康保险计划涵盖与透析治疗相关的大部分费用的国家，开始透析的 ESRD 患者的自杀风险仍然增加了近 140%。为开始透析的 ESRD 患者提供充分的支持，并评估作为潜在自杀手段的割开血管通路的风险，可能是预防自杀的重要策略。
