Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Postgrad Med J. 2020 Dec;96(1142):747-752. doi: 10.1136/postgradmedj-2019-136860. Epub 2020 Feb 3.
Traumatic brain injury (TBI) is a major cause of death and disability worldwide, and its treatment is potentially a heavy economic burden. Suicide is another global public health problem and the second leading cause of death in young adults. Patients with TBI are known to have higher than normal rates of non-fatal deliberate self-harm, suicide and all-cause mortality. The aim of this study was to explore the association between TBI and suicide risk in a Chinese cohort.
This study analysed data contained in the Taiwan National Health Insurance Research Database for 17 504 subjects with TBI and for 70 016 subjects without TBI matched for age and gender at a ratio of 1 to 4. Cox proportional hazard regression analysis was used to estimate subsequent suicide attempts in the TBI group. Probability of attempted suicide was determined by Kaplan-Meier method.
The overall risk of suicide attempts was 2.23 times higher in the TBI group compared with the non-TBI group (0.98 vs 0.29 per 1000 person-years, respectively) after adjustment for covariates. Regardless of gender, age or comorbidity, the TBI group tended to have more suicide attempts, and the risk attempted suicide increased with the severity of TBI. Depression and alcohol attributed disease also increased the risk of attempted suicide in the TBI group.
Suicide is preventable if risk factors are recognised. Hence, TBI patients require special attention to minimise their risk of attempted suicide.
创伤性脑损伤（TBI）是全球范围内导致死亡和残疾的主要原因，其治疗可能会带来沉重的经济负担。自杀是另一个全球性公共卫生问题，也是年轻人的第二大死因。已知 TBI 患者的非致命性蓄意自我伤害、自杀和全因死亡率高于正常水平。本研究旨在探讨中国队列中 TBI 与自杀风险之间的关联。
本研究分析了台湾全民健康保险研究数据库中包含的 17504 例 TBI 患者和 70016 例年龄和性别与 TBI 患者相匹配的非 TBI 患者的数据，匹配比例为 1:4。使用 Cox 比例风险回归分析来估计 TBI 组随后的自杀尝试。通过 Kaplan-Meier 方法确定自杀未遂的概率。
在调整了混杂因素后，与非 TBI 组相比，TBI 组自杀未遂的总体风险高 2.23 倍（分别为 0.98 与 0.29 例/1000 人年）。无论性别、年龄或合并症如何，TBI 组倾向于有更多的自杀尝试，且随着 TBI 的严重程度增加，自杀未遂的风险也随之增加。抑郁和酒精相关疾病也增加了 TBI 组自杀未遂的风险。
如果能够识别出风险因素，自杀是可以预防的。因此，TBI 患者需要特别关注，以降低自杀未遂的风险。
