Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Canada.
New York State Psychiatric Institute, United States; Columbia University, New York, NY, United States.
Schizophr Res. 2020 Aug;222:382-388. doi: 10.1016/j.schres.2020.04.025. Epub 2020 Jun 2.
Suicide is a major cause of mortality for individuals with schizophrenia spectrum disorders (SSD). Understanding the risk factors for suicide at time of diagnosis can aid clinicians in identifying people at risk.
Records from linked administrative health databases in Ontario, Canada were used to identify individuals aged 16 through 45 years who received a first lifetime diagnosis of SSD (schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified (NOS)) using a validated algorithm between 01/01/1993 and 12/31/2010. The main outcome was death by suicide following cohort entry until 12/31/2012.
75,989 individuals with a first SSD diagnosis (60.1% male, 39.9% female) were followed for an average of 9.56 years. During this period, 1.71% of the total sample (72.1% male, 27.9% female) died by suicide, after an average of 4.32 years. Predictors of suicide death included male sex (HR 2.00, 95% CI 1.76-2.27), age at diagnosis between 26 and 35 (HR 1.27, 95% CI 1.10-1.45) or 36-45 (HR 1.34, 95% CI 1.16-1.54), relative to 16-25, and suicide attempt (HR 2.23, 95% CI 1.86-2.66), drug use disorder (HR 1.21, 95% CI 1.04-1.41), mood disorder diagnosis (HR 1.32, 95% CI 1.17-1.50), or mental health hospitalization (HR 1.30 95% CI 1.13-1.49) in the 2 years prior to SSD diagnosis.
Death by suicide occurs in 1 out of every 58 individuals and occurred early following first diagnosis of SSD. Psychiatric hospitalizations, mood disorder diagnoses, suicide attempts prior to SSD diagnosis, as well as a later age at first diagnosis, are all predictors of suicide and should be integrated into clinical assessment of suicide risk in this population.
自杀是精神分裂症谱系障碍（SSD）患者死亡的主要原因。了解诊断时的自杀风险因素可以帮助临床医生识别高危人群。
利用加拿大安大略省链接的行政健康数据库，采用经过验证的算法，从 1993 年 1 月 1 日至 2010 年 12 月 31 日期间，确定了 16 至 45 岁首次诊断为 SSD（精神分裂症、分裂情感障碍、未特定的精神病性障碍）的个体。主要结局是队列进入后至 2012 年 12 月 31 日的自杀死亡。
75989 名首次 SSD 诊断患者（60.1%为男性，39.9%为女性）平均随访 9.56 年。在此期间，总样本中有 1.71%（72.1%为男性，27.9%为女性）死于自杀，平均在诊断后 4.32 年后。自杀死亡的预测因素包括男性（HR 2.00，95%CI 1.76-2.27）、诊断时年龄在 26 至 35 岁（HR 1.27，95%CI 1.10-1.45）或 36 至 45 岁（HR 1.34，95%CI 1.16-1.54），与 16 至 25 岁相比，以及自杀未遂（HR 2.23，95%CI 1.86-2.66）、药物使用障碍（HR 1.21，95%CI 1.04-1.41）、心境障碍诊断（HR 1.32，95%CI 1.17-1.50）或在 SSD 诊断前 2 年内的精神卫生住院（HR 1.30，95%CI 1.13-1.49）。
每 58 人中就有 1 人死于自杀，并且发生在首次 SSD 诊断后早期。自杀前的精神科住院、心境障碍诊断、自杀未遂、以及首次诊断时年龄较大，都是自杀的预测因素，应纳入该人群自杀风险的临床评估。
