Department of Psychology, National Chengchi University, Taipei, Taiwan.
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
Soc Psychiatry Psychiatr Epidemiol. 2021 Aug;56(8):1437-1446. doi: 10.1007/s00127-020-01985-8. Epub 2020 Nov 27.
Suicide is a leading cause of death in patients with schizophrenia. This nationwide cohort study investigated the incidence of each suicide method in patients with schizophrenia compared with the general population.
In total, records of 174,039 patients with schizophrenia were obtained from the National Health Insurance Research Database in Taiwan from 2001 to 2016. This schizophrenia cohort was linked with the national mortality database, and 26,926 patients died during this follow-up period. Of the deceased, 3033 had died by suicide. Univariate Cox regression was used to estimate the demographic variables associated with suicide. We estimated the difference in the proportion of each suicide method used in patients with schizophrenia compared with the general population. The incidence and standardized mortality ratio (SMR) of each suicide method were calculated and stratified based on sex.
Patients aged 25-34 years exhibited the highest suicide risk. Compared with the general population, patients with schizophrenia were more likely to commit suicide by jumping and drowning and less likely to use charcoal-burning and hanging. Women showed a higher incidence of suicide by drowning and jumping than did men. Comorbidity with substance use disorders (SUDs) was associated with a high suicide SMR (26.9, 95% confidence interval [CI] = 23.4-28.9), particularly for suicide by jumping (61.2, 95% CI = 48.3-76.3).
Patients with schizophrenia had higher suicide rates for all methods than did the general population. Suicide method differed based on sex. Patients with SUDs exhibit a high SMR for each suicide method and warrant intensive clinical attention.
自杀是精神分裂症患者的主要死亡原因。本全国性队列研究调查了与普通人群相比，精神分裂症患者使用每种自杀方法的发生率。
本研究共从台湾全民健康保险研究数据库获取了 2001 年至 2016 年期间的 174039 例精神分裂症患者的记录。该精神分裂症队列与国家死亡数据库相联系，在此随访期间有 26926 例患者死亡。在这些死亡患者中，有 3033 例死于自杀。采用单变量 Cox 回归来估计与自杀相关的人口统计学变量。我们估计了与普通人群相比，精神分裂症患者使用每种自杀方法的比例差异。计算了每种自杀方法的发生率和标准化死亡率比（SMR），并按性别分层。
年龄在 25-34 岁的患者自杀风险最高。与普通人群相比，精神分裂症患者更有可能通过跳楼和溺水自杀，而不太可能使用烧炭和上吊自杀。女性溺水和跳楼自杀的发生率高于男性。合并物质使用障碍（SUD）与高自杀 SMR 相关（26.9，95%置信区间 [CI] = 23.4-28.9），尤其是跳楼自杀（61.2，95% CI = 48.3-76.3）。
与普通人群相比，精神分裂症患者的所有自杀方法的自杀率都较高。自杀方法因性别而异。合并 SUD 的患者的每种自杀方法的 SMR 都很高，需要加强临床关注。
