炎症性肠病住院成人的自杀行为：美国全国性分析。

Suicidal Behavior Among Hospitalized Adults With Inflammatory Bowel Disease: A United States Nationwide Analysis.

机构信息

Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA.

Division of Digestive Diseases & Nutrition, Department of Medicine, University of South Florida, USA.

出版信息

Inflamm Bowel Dis. 2017 Dec 19;24(1):25-34. doi: 10.1093/ibd/izx005.

DOI:10.1093/ibd/izx005

PMID:29272476

Abstract

BACKGROUND

Suicidal behavior in inflammatory bowel disease (IBD) has been minimally explored. We aimed to determine United States (US) nationally representative prevalence estimates of suicidal ideation (SI) and suicide/self-inflicted injury (S/SII) among hospitalized adults with IBD and to examine trends in suicidal behavior over time.

METHODS

A retrospective cross-sectional study using National (Nationwide) Inpatient Sample data (2006-2011) identified adults with Crohn's disease (CD) or ulcerative colitis (UC), SI or S/SII, and multiple comorbid risk factors for suicidal behavior.

RESULTS

We identified 331,777 (estimated 1.64 million) IBD-related hospitalizations (64% CD, 36% UC) and 39,787,239 (estimated 196.08 million) hospitalizations among the general US population. Among IBD-related hospitalizations, 2502 discharges were associated with SI (prevalence 0.76%) and 1104 with S/SII (prevalence 0.33%). Both were significantly greater in CD versus UC (P < 0.001). Relative to the general US population, IBD patients were significantly less likely to demonstrate suicidal behavior: (SI:0.33% versus 0.59%, P < 0.001) (S/SII:0.75% versus 1.04%, P < 0.001). Multivariable logistic regression revealed that IBD was associated with decreased odds of SI (adjusted odds ratio [aOR] 0.62, 95%CI 0.60-0.65) and S/SII (aOR 0.43, 95%CI 0.40-0.45) relative to the general population, and suicidal behavior was lower in IBD compared to disease-related controls with rheumatoid arthritis and systemic lupus erythematosus. Similar increasing trends in suicidal behavior were observed in IBD and non-IBD populations (2006-2011).

CONCLUSION

In this large US database, SI or S/SII occurred in over 1% of the IBD population and was increased in CD versus UC.

摘要

背景

炎症性肠病（IBD）患者的自杀行为鲜有研究。本研究旨在明确美国全国范围内住院成人 IBD 患者中出现自杀意念（SI）和自杀/自伤（S/SI）的比例，并分析自杀行为随时间的变化趋势。

方法

本研究为回顾性、横断面研究，利用全国住院患者样本数据库（2006-2011 年），纳入患有克罗恩病（CD）或溃疡性结肠炎（UC）、出现 SI 或 S/SI 以及多种自杀行为相关共患病风险因素的成年患者。

结果

共纳入 331777 例（估计为 164 万例）与 IBD 相关的住院患者（64%为 CD，36%为 UC）和 39787239 例（估计为 1.9608 亿例）一般人群的住院数据。在与 IBD 相关的住院患者中，2502 例患者出现 SI（发生率为 0.76%），1104 例患者出现 S/SI（发生率为 0.33%），与 UC 相比，这两种情况在 CD 中更为常见（均 P<0.001）。与一般人群相比，IBD 患者发生自杀行为的概率显著降低：（SI：0.33% vs. 0.59%，P<0.001）（S/SI：0.75% vs. 1.04%，P<0.001）。多变量 logistic 回归分析显示，与一般人群相比，IBD 患者发生 SI（调整后比值比[aOR] 0.62，95%CI 0.60-0.65）和 S/SI（aOR 0.43，95%CI 0.40-0.45）的可能性降低，且与疾病相关的类风湿关节炎和系统性红斑狼疮对照组相比，IBD 患者的自杀行为发生率更低。在 IBD 和非 IBD 患者中，自杀行为的比例均呈上升趋势（2006-2011 年）。