Vasiliadis Helen-Maria, Lamoureux-Lamarche Catherine, Rochette Louis, Levesque Pascale, Pelletier Éric, Lesage Alain
Faculté de médecine et des sciences de la santé, Université de Sherbrooke ; Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS).
Université de Sherbrooke.
Sante Ment Que. 2018 Fall;43(2):153-173.
Objectives Population based studies on linked health administrative databases (HADBs) characterizing those who die by suicide and their use of health services are rare. The objectives of this study were to describe the use of health services among people who died by suicide in Quebec, with and without previously receiving a mental disorder (MD) and dependencies (D) (MD/D) diagnosis, and (2) living Quebecers diagnosed with MD/D. Methods This study is based on an analysis of data from the Integrated Chronic Disease Surveillance System of Quebec (SISMACQ), which combines databases on outpatient medical and emergency services and hospitalizations. The population of the study consists of Quebecers aged 15 years and over and insured between April 1, 1996 and March 31, 2013 under the Régie de l'assurance maladie du Québec (RAMQ). For the purposes of this study, the 7 years preceding suicide were examined in the HADBDS for the three following cohort groups: (i) cases of suicide with a diagnosed MD/D in the 7 years preceding the date of death; (ii) cases of suicide without a MD/D diagnosis in the 7 years preceding the date of death; and (iii) a control group of living persons at the time of death of the suicide case (5 controls, 1 case) with a MD/D diagnosis within 7 years matched by region, sex and age group of the case. Results The results show that cases of suicide without a MD/D (about 25% of suicide cases) were less likely to have consulted than those with a MD/D. Suicide cases with and without a MD/D were less likely to be heavy users of ambulatory health services (≥ 4 visits) than matched living controls. They were also more likely to consult for a physical disorder alone and less likely to consult for mental health reasons. Compared to cases of suicide with a MD/D, suicide cases without MD/D were less likely to be hospitalized and more likely to have visited only an emergency room. Suicide cases diagnosed with a MD/D were more likely to be hospitalized and use emergency services alone than the other two groups. Matched living controls with a MD/D were more likely to use outpatient services alone. Conclusions These results should be compared with those emerging from systematic suicide case audits. These show a prevalence of mental disorders of 90%, especially depression, personality disorders and substance use disorders. They also show deficits in the recognition and treatment of mental disorders, which would correspond to the 25% of cases of suicide in the HADBs not diagnosed in the last 7 years. Future studies should include multivariate analyses to better elucidate health service use trajectories and patient vulnerability profiles.
目标 基于健康管理数据库（HADBs）对自杀死亡者及其医疗服务使用情况进行的人群研究较为罕见。本研究的目的是描述魁北克省自杀死亡者中医疗服务的使用情况，这些人有无精神障碍（MD）和成瘾（D）（MD/D）诊断，以及（2）魁北克省被诊断患有MD/D的在世者。方法 本研究基于对魁北克省综合慢性病监测系统（SISMACQ）数据的分析，该系统整合了门诊医疗、急诊服务和住院数据库。研究人群包括1996年4月1日至2013年3月31日期间在魁北克省医疗保险局（RAMQ）参保的15岁及以上魁北克人。在本研究中，在自杀前的7年里，对以下三个队列组的HADBDS进行了检查：（i）在死亡日期前7年内被诊断患有MD/D的自杀病例；（ii）在死亡日期前7年内未被诊断患有MD/D的自杀病例；以及（iii）自杀病例死亡时的在世对照人群（5名对照，1名病例），在7年内患有MD/D诊断，按病例的地区、性别和年龄组进行匹配。结果 结果显示，未患MD/D的自杀病例（约占自杀病例的25%）就诊的可能性低于患MD/D的病例。患MD/D和未患MD/D的自杀病例成为门诊医疗服务重度使用者（≥4次就诊）的可能性低于匹配的在世对照。他们也更有可能仅因躯体疾病就诊，而因心理健康原因就诊的可能性较小。与患MD/D的自杀病例相比，未患MD/D的自杀病例住院的可能性较小，且更有可能仅去过急诊室。被诊断患有MD/D的自杀病例比其他两组更有可能住院且仅使用急诊服务。患有MD/D的匹配在世对照更有可能仅使用门诊服务。结论 这些结果应与系统自杀病例审核得出的结果进行比较。这些审核显示精神障碍的患病率为90%，尤其是抑郁症、人格障碍和物质使用障碍。它们还显示出精神障碍识别和治疗方面的不足，这与HADBs中过去7年未被诊断出的25%的自杀病例相符。未来的研究应包括多变量分析，以更好地阐明医疗服务使用轨迹和患者脆弱性概况。
