Isometsä Erkki T
Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Front Psychiatry. 2020 Jul 23;11:721. doi: 10.3389/fpsyt.2020.00721. eCollection 2020.
Although risk factors for nonfatal suicidal behavior in mood disorders have been vastly investigated, rate and risk factors of suicide deaths are less well known. Extensive health care and other population registers in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) allow national-level studies of suicide rates and risk factors. This systematic review examined Nordic studies of suicide in mood disorders.
National Nordic studies published after 1.1.2000 reporting on suicide mortality or relative risk in diagnosed unipolar depression or bipolar disorder treated in psychiatric settings; temporal variations in suicide risk after discharge, or risk factors for suicide were systematically reviewed.
Altogether 16 longitudinal studies reported on rate and risk of suicide in depression. They found 2%-8% of psychiatric inpatients with depression to have died by suicide. However, in Finland suicide risk among depressive inpatients halved since the early 1990s. Nine studies investigated suicide risk in bipolar disorder, finding 4-8% of patients having died by suicide in long term. The relative risk of suicide was consistently found extremely high (SMR > 100) during the first weeks postdischarge, declining steeply over time to approximately SMR of five after five years. Male gender, preceding suicide attempts, high severity of depression and substance abuse were found risk factors for suicide in depression, with only minor gender differences in risk factors, but major differences in lethal methods. Three studies investigated risk factors for suicide in bipolar disorder, finding male gender, preceding suicide attempts, and depressive episodes and psychiatric comorbidity to be associated with risk.
Overall, of psychiatric inpatients with depressive of bipolar disorders in the Nordic countries, 2%-8% have died by suicide in the last few decades, but current rates may be lower. Suicide risk is approximately similar or somewhat higher among patients with bipolar disorder, risk factor studies of whom are fewer. Risk of suicide is remarkably high immediately after discharge, and higher among males than females, those with preceding suicide attempts, high severity of depression, or concurrent substance abuse. Generalizability of findings from these Nordic studies to other countries need to be investigated, and their methodological limitations understood.
尽管对心境障碍中非致命自杀行为的风险因素已进行了大量研究，但自杀死亡的发生率及风险因素却鲜为人知。北欧国家（丹麦、芬兰、冰岛、挪威和瑞典）广泛的医疗保健及其他人口登记资料使得在国家层面研究自杀率及风险因素成为可能。本系统评价对北欧地区心境障碍自杀研究进行了考察。
对2000年1月1日后发表的北欧国家研究进行系统评价，这些研究报告了在精神科环境中接受治疗的确诊单相抑郁或双相情感障碍患者的自杀死亡率或相对风险；出院后自杀风险的时间变化，或自杀风险因素。
共有16项纵向研究报告了抑郁症患者的自杀率及风险。他们发现2% - 8%的患有抑郁症的精神科住院患者死于自杀。然而，自20世纪90年代初以来，芬兰抑郁症住院患者的自杀风险减半。9项研究调查了双相情感障碍患者的自杀风险，发现长期来看4% - 8%的患者死于自杀。出院后的头几周内自杀的相对风险一直被发现极高（标准化死亡比>100），随着时间推移急剧下降，五年后降至约为标准化死亡比5。男性、既往自杀未遂、抑郁症严重程度高及物质滥用被发现是抑郁症自杀的风险因素，风险因素中性别差异较小，但致死方法存在较大差异。3项研究调查了双相情感障碍患者自杀的风险因素，发现男性、既往自杀未遂、抑郁发作及精神共病与风险相关。
总体而言，在过去几十年中，北欧国家患有抑郁或双相情感障碍的精神科住院患者中有2% - 8%死于自杀，但目前的发生率可能较低。双相情感障碍患者的自杀风险大致相似或略高，针对双相情感障碍患者的风险因素研究较少。出院后自杀风险极高，男性高于女性，既往有自杀未遂史、抑郁症严重程度高或同时存在物质滥用的患者自杀风险更高。需要研究这些北欧研究结果对其他国家的可推广性，并了解其方法学局限性。
