Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Schizophr Res. 2018 Dec;202:347-353. doi: 10.1016/j.schres.2018.06.025. Epub 2018 Jun 21.
To compare individuals with and without schizophrenia spectrum disorders (SSD) (schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified) who die by suicide.
This is a retrospective case control study which compared all individuals who died by suicide in Ontario, Canada with (cases) and without (controls) SSD between January 1, 2008 and December 31, 2012. Cases (individuals with SSD) were compared to controls on demographics, clinical characteristics, and health service utilization proximal to suicide. A secondary analysis compared the characteristics of those with SSD and those with severe mental illness (defined as those without SSD who have had a psychiatric hospitalization within the five-years before suicide (excluding the 30 days prior to death)).
Among 5650 suicides, 663 (11.7%) were by individuals with SSD. Compared to other suicides, SSD suicides were significantly more likely to be between the ages of 25-34. SSD suicide victims were significantly more likely to reside in the lowest income neighbourhoods and to reside in urban areas. SSD victims were also significantly more likely to have comorbid mood and personality disorders and all types of health service utilization, including outpatient mental health service contact in the 30 days prior to death, even when compared only with those who had a history of mental health hospitalization.
Individuals with schizophrenia spectrum disorder account for over 1 in 10 suicide deaths, tend to be younger, poorer, urban, more clinically complex, and have higher rates of mental health service contact prior to death. The demographic and service utilization differences persist even when the SSD group is compared with a population with severe mental illness that is not SSD. Suicide prevention strategies for people with schizophrenia spectrum disorder should emphasize the importance of clinical suicide risk assessment during clinical encounters, particularly early in the course of illness.
比较患有精神分裂谱系障碍（SSD）（精神分裂症、分裂情感障碍或未特定的精神病性障碍）和不患有 SSD 的个体的自杀死亡率。
这是一项回顾性病例对照研究，比较了 2008 年 1 月 1 日至 2012 年 12 月 31 日期间在加拿大安大略省自杀的所有个体（病例）和没有 SSD 的个体（对照）。病例（患有 SSD 的个体）与对照在自杀前最近的人口统计学特征、临床特征和卫生服务利用方面进行了比较。二次分析比较了 SSD 患者和严重精神疾病患者（定义为在自杀前五年内没有 SSD 但有过精神科住院治疗的患者（不包括死亡前 30 天））的特征。
在 5650 例自杀者中，有 663 例（11.7%）为 SSD 患者。与其他自杀者相比，患有 SSD 的自杀者年龄在 25-34 岁之间的可能性明显更高。患有 SSD 的自杀者更有可能居住在收入最低的社区和城市地区。患有 SSD 的自杀者还更有可能患有共病心境和人格障碍，以及所有类型的卫生服务利用，包括在死亡前 30 天内的门诊心理健康服务接触，即使仅与有精神健康住院治疗史的人相比也是如此。
患有精神分裂谱系障碍的个体占自杀死亡人数的 10%以上，他们往往更年轻、更贫穷、居住在城市地区、更具临床复杂性，并且在死亡前有更高的心理健康服务接触率。即使将 SSD 组与不患有 SSD 的严重精神疾病人群进行比较，人口统计学和服务利用方面的差异仍然存在。针对精神分裂谱系障碍患者的自杀预防策略应强调在临床就诊期间进行临床自杀风险评估的重要性，特别是在疾病早期。
