Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan.
Ann N Y Acad Sci. 2020 Feb;1462(1):79-91. doi: 10.1111/nyas.14216. Epub 2019 Sep 8.
Previous studies, which included predominantly Caucasian populations, examined psychiatric and physical illness and associated suicide risk. We used a nationwide database to reassess the findings in an Asian population, and also analyzed the influence of different onset timing of psychiatric and physical illness and the suicide risk. We included 55,630 suicide cases aged 20-110 years. Using an incidence density sampling approach, we selected 222,520 controls matched by age, sex, and residence area from 2000 to 2012. We included most major psychiatric and physical illnesses defined by ICD-9-CM codes with anatomical classifications. By using conditional logistic regression models with adjustment of covariates, such as patients' marital status and education levels, we found that patients with psychiatric illness had higher suicide risk (adjusted IRR, 7.72; 95% CI: 7.35-8.09) compared with those with neither physical nor psychiatric illness and the risk increased substantially in patients with both psychiatric and physical illnesses (adjusted IRR, 18.35; 95% CI: 16.40-20.86). Specifically, we found the suicide risk was relatively higher (adjusted IRR, 1.28; 95% CI: 1.10-1.40) when psychiatric disorders occurred before physical illness compared with the other way around. The findings warrant attention to high suicide risk and preventive treatments in patients with both psychiatric and physical illnesses.
先前的研究主要集中在白种人群体，考察了精神疾病和身体疾病以及与之相关的自杀风险。我们利用一个全国性数据库，在亚洲人群中重新评估了这些发现，并分析了不同精神疾病和身体疾病起始时间以及自杀风险的影响。我们纳入了年龄在 20-110 岁之间的 55630 例自杀病例。采用发病率密度抽样方法，我们从 2000 年到 2012 年选择了 222520 名年龄、性别和居住地区相匹配的对照。我们纳入了 ICD-9-CM 编码定义的大多数主要精神和身体疾病，这些疾病具有解剖分类。通过使用条件逻辑回归模型，并调整了患者的婚姻状况和教育水平等混杂因素，我们发现患有精神疾病的患者自杀风险更高（调整后的 IRR，7.72；95%CI：7.35-8.09），与既无精神疾病也无身体疾病的患者相比，风险显著增加；同时患有精神和身体疾病的患者自杀风险更高（调整后的 IRR，18.35；95%CI：16.40-20.86）。具体而言，我们发现与其他情况相比，当精神障碍先于身体疾病发生时，自杀风险相对较高（调整后的 IRR，1.28；95%CI：1.10-1.40）。这些发现值得关注，需要对同时患有精神和身体疾病的患者进行高自杀风险和预防治疗。
