Iliachenko Elena K, Ragazan Dragos C, Eberhard Jonas, Berge Jonas
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden.
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden; Region Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, Sweden.
J Psychiatr Res. 2020 Aug;127:20-27. doi: 10.1016/j.jpsychires.2020.05.008. Epub 2020 May 15.
Bipolar disorder has long been associated with increased risks for suicidality; though factors associated with dying by suicide remain obscure. Here, we retrospectively examine the associations between the different phases of bipolar illness and other common comorbidities with death by suicide in the 120 days following each discharge for Swedes first admitted as inpatients for bipolar disorder during the years 2000-2014. Data on admissions and suicide deaths were extracted from the Swedish National Patient Register and the Cause of Death Register, respectively. ICD-10 diagnostic codes were used to define the phases: depressive, manic, mixed, and other; and the comorbidities: specific substance use disorders, attention deficit hyperactivity disorder, and personality disorders. Extended Cox regressions were employed to model the time to death by suicide as a function of the bipolar phases, comorbidities, and other important control variables. Our analysis included 60,643 admissions by 22,402 patients over an observation time of 15,187 person-years. Overall, 213 (35.7%) of all suicides occurred within 120 days of discharge. Upon adjustment and compared to the depressive phases, manic phases were significantly associated with a far lower hazard of dying by suicide (HR 0.34, 95% CI: 0.21-0.56, p < 0.001), though mixed phases were not (HR 0.92, 95% CI: 0.48-1.73, p = 0.957). With regard to comorbidity, only sedative use disorder remained significantly associated with dying by suicide upon adjustment (HR 2.08, 95% CI: 1.41-3.06, p = 0.001). Vigilant monitoring of patients post discharge and of prescription practices are recommended.
双相情感障碍长期以来一直与自杀风险增加有关；尽管与自杀死亡相关的因素仍不明确。在此，我们回顾性研究了2000年至2014年期间首次因双相情感障碍住院的瑞典人每次出院后120天内双相情感障碍不同阶段及其他常见共病与自杀死亡之间的关联。入院和自杀死亡数据分别从瑞典国家患者登记册和死亡原因登记册中提取。使用国际疾病分类第十版（ICD - 10）诊断代码来定义阶段：抑郁、躁狂、混合及其他；以及共病：特定物质使用障碍、注意力缺陷多动障碍和人格障碍。采用扩展的Cox回归模型将自杀死亡时间建模为双相情感障碍阶段、共病及其他重要控制变量的函数。我们的分析纳入了22,402名患者的60,643次入院，观察时间为15,187人年。总体而言，所有自杀事件中有213例（35.7%）发生在出院后120天内。经过调整后，与抑郁阶段相比，躁狂阶段与自杀死亡风险显著降低相关（风险比[HR]为0.34，95%置信区间[CI]：0.21 - 0.56，p < 0.001），而混合阶段则不然（HR为0.92，95% CI：0.48 - 1.73，p = 0.957）。关于共病，调整后仅镇静剂使用障碍与自杀死亡仍显著相关（HR为2.08，95% CI：1.41 - 3.06，p = 0.001）。建议对出院后的患者及处方行为进行密切监测。
