Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
JAMA Psychiatry. 2018 May 1;75(5):458-464. doi: 10.1001/jamapsychiatry.2018.0185.
IMPORTANCE: Patients with schizophrenia have a substantially higher suicide rate than the general public. Early intervention (EI) services improve short-term outcomes. However, little is known about the association of EI with suicide reduction in the long term. OBJECTIVE: To examine the association of a 2-year EI service with suicide reduction in patients with first-episode schizophrenia-spectrum (FES) disorders during 12 years and the risk factors for early and late suicide. DESIGN, SETTING, AND PARTICIPANTS: This historical control study compared 617 consecutive patients with FES who received the 2-year EI service in Hong Kong between July 1, 2001, and June 30, 2003, with 617 patients with FES who received standard care (SC) between July 1, 1998, and June 30, 2001, matched individually. Clinical information was systematically retrieved for the first 3 years of clinical care for both groups. The details of death were collected up to 12 years from presentation to the services. Data analysis was performed from October 30, 2016, to August 18, 2017. MAIN OUTCOMES AND MEASURES: Suicide rate during 12 years was the primary measure. The association of the EI service with the suicide rates during years 1 through 3 and years 4 through 12 were explored separately. RESULTS: The main analysis included 1234 patients, with 617 in each group (mean [SD] age at baseline, 21.2 [3.4] years in the EI group and 21.3 [3.4] years in the SC group; 318 male [51.5%] in the EI group and 322 [52.2%] in the SC group). The suicide rates were 7.5% in the SC group and 4.4% in the EI group (McNemar χ2 = 5.55, P = .02). Patients in the EI group had significantly better survival (propensity score-adjusted hazard ratio, 0.57; 95% CI, 0.36-0.91; P = .02), with the maximum association observed in the first 3 years. The number of suicide attempts was an indicator of early suicide (1-3 years). Premorbid occupational impairment, number of relapses, and poor adherence during the initial 3 years were indicators of late suicide (4-12 years). CONCLUSIONS AND RELEVANCE: This study suggests that the EI service may be associated with reductions in the long-term suicide rate. Suicide at different stages of schizophrenia was associated with unique risk factors, highlighting the importance of a phase-specific service.
重要性：精神分裂症患者的自杀率明显高于普通人群。早期干预 (EI) 服务可改善短期预后。然而，对于 EI 在长期内降低自杀率的关联，人们知之甚少。 目的：本研究旨在探讨为期 2 年的 EI 服务与首发精神分裂谱系障碍 (FES) 患者 12 年内自杀率降低的关联，并探讨早期和晚期自杀的风险因素。 设计、环境和参与者：本历史对照研究比较了 2001 年 7 月 1 日至 2003 年 6 月 30 日期间在香港接受为期 2 年 EI 服务的 617 例 FES 连续患者，以及 1998 年 7 月 1 日至 2001 年 6 月 30 日期间接受标准护理 (SC) 的 617 例 FES 患者。为两组患者均系统地检索了前 3 年的临床资料。从就诊服务之日起，收集了长达 12 年的死亡详细信息。数据分析于 2016 年 10 月 30 日至 2017 年 8 月 18 日进行。 主要结局和测量：12 年内的自杀率是主要的衡量指标。分别探讨了 EI 服务与第 1 至 3 年和第 4 至 12 年期间自杀率的关联。 结果：主要分析包括 1234 例患者，每组 617 例（EI 组的基线平均[SD]年龄为 21.2[3.4]岁，SC 组为 21.3[3.4]岁；EI 组男性 318 例[51.5%]，SC 组为 322 例[52.2%]）。SC 组的自杀率为 7.5%，EI 组为 4.4%（McNemar χ2=5.55，P=0.02）。EI 组患者的生存情况明显更好（倾向性评分调整后的风险比，0.57；95%CI，0.36-0.91；P=0.02），最大关联发生在最初的 3 年内。自杀企图次数是早期自杀（1-3 年）的指标。发病前职业功能障碍、复发次数和最初 3 年内的治疗依从性差是晚期自杀（4-12 年）的指标。 结论和相关性：本研究表明，EI 服务可能与长期自杀率的降低有关。精神分裂症不同阶段的自杀与独特的风险因素有关，这突出了针对特定阶段的服务的重要性。
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