UCL Division of Psychiatry, University College London, UK; Camden & Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK.
Centre for Mental Health and Safety, University of Manchester, UK.
J Affect Disord. 2019 Oct 1;257:173-179. doi: 10.1016/j.jad.2019.06.027. Epub 2019 Jul 3.
Many physical health problems are associated with elevated suicide risk whilst also providing access to means of overdose. We aimed to investigate whether psychiatric patients with physical co-morbidities who die by suicide were more likely than those without co-morbidities to self-poison with non-psychotropic medications.
We analysed data on 14,648 psychiatric patients who died by suicide in England & Wales during 2004-2015, as recorded by the National Confidential Inquiry into Suicide and Safety in Mental Health. Using logistic regression models adjusted for age, gender, ethnicity, and primary drug dependence/misuse we compared patients diagnosed with physical co-morbidities versus those without to assess whether a greater proportion of the former had died by overdose, and medication prescribed to treat such disorders (e.g. opioids, insulin).
24% (n = 3525) were recorded as having physical co-morbidity. A greater proportion of these individuals died by self-poisoning than those without physical co-morbidity (37% vs. 20%, p < .001; adjusted OR 2.47; 95% CI 2.26-2.70), and they were more likely to have used medications for a physical health disorder in overdose (50% vs. 34%; adjusted OR 2.10; 95% CI 1.80-2.46), particularly opioids (30% vs. 22%; p < .001), paracetamol/opioid compounds (11% vs. 7%, p < .001) and insulin (4% vs. 1%, p < .001).
Use of survey data may have resulted in under-reporting of physical health problems and/or overdose medications.
Overdose, rather than hanging, is the leading cause of suicide among psychiatric patients with physical co-morbidities, particularly using non-psychotropic medications. There is potential for means restriction in preventing suicide among these patients.
许多身体健康问题与自杀风险升高有关，同时也为过量用药提供了途径。我们旨在调查患有躯体合并症的自杀身亡精神科患者是否比无合并症患者更有可能使用非精神类药物自杀。
我们分析了 2004 年至 2015 年期间在英格兰和威尔士因自杀而死亡的 14648 名精神科患者的数据，这些数据由国家精神健康保密自杀和安全调查记录。我们使用逻辑回归模型，根据年龄、性别、种族和主要药物依赖/滥用情况进行调整，比较了诊断为躯体合并症的患者和无合并症的患者，以评估前者中是否有更大比例的人因过量用药而死亡，以及用于治疗这些疾病的药物（如阿片类药物、胰岛素）。
24%（n=3525）被记录为患有躯体合并症。这些人因自杀而死亡的比例高于无躯体合并症的人（37%比 20%，p<0.001；调整后的比值比 2.47；95%置信区间 2.26-2.70），他们更有可能使用治疗躯体健康障碍的药物过量（50%比 34%；调整后的比值比 2.10；95%置信区间 1.80-2.46），特别是阿片类药物（30%比 22%；p<0.001）、对乙酰氨基酚/阿片类化合物（11%比 7%，p<0.001）和胰岛素（4%比 1%，p<0.001）。
使用调查数据可能导致身体健康问题和/或过量用药的报告不足。
在患有躯体合并症的精神科患者中，过量用药而非上吊是自杀的主要原因，特别是使用非精神类药物。在这些患者中，限制手段可能有助于预防自杀。
