Ose Solveig Osborg, Tveit Tone, Mehlum Lars
SINTEF, Health Services Research, Trondheim, Norway.
Haukeland University Hospital, Bergen, Norway.
J Psychiatr Res. 2021 Jan;133:1-9. doi: 10.1016/j.jpsychires.2020.11.031. Epub 2020 Nov 27.
Non-suicidal self-injury (NSSI) is a highly prevalent behavioural problem among people with mental illness, yet many fundamental aspects of NSSI remain unknown. We studied the prevalence of NSSI, and its relationship with suicide ideation (SI) and suicide attempts (SA) among adult psychiatric outpatients, with a special focus on patients with personality disorders compared with patients with other disorders.
During a 14-day period, data were collected on all available patients in all outpatient psychiatric clinics in Norway. This national clinical unselected cross-sectional dataset from 23,124 outpatients was used to generate proportional Venn diagrams of the prevalence of NSSI, SI and SA and their co-occurrence over the last four weeks. Differences in the risk for these behaviours across diagnoses were tested, both with and without adjustments for demographic and socio-demographic characteristics.
Over the previous four-week period, 8.1% of the patients had experienced at least one episode of NSSI, 17.3% had SI and 0.6% had made at least one SA. Among patients with NSSI, 27.8% had co-occurring SI, and among patients with SI, 13% had co-occurring NSSI. The prevalence of SA was more than seven times higher among patients with NSSI behaviour than among patients without NSSI behaviour. Patients with a diagnosis of personality disorder had a significantly higher prevalence of SI, NSSI, and NSSI with co-occurring SI, than all other diagnostic groups; however, they were not systematically different from patients with other diagnoses in their prevalence of NSSI without co-occurring SI. These findings remained statistically significant even when controlling for socio-demographic variables.
The prevalence of recent NSSI is high in patients receiving outpatient psychiatric treatment in Norway. NSSI is significantly more prevalent in patients with personality disorders than in patients with other diagnoses, mainly due to the significantly higher prevalence of NSSI with co-occurring SI in patients with personality disorders. The co-occurrence of NSSI and SI is also prevalent in all diagnostic groups, but both NSSI and SI appear alone more often than together. The strong association between NSSI and SA calls for a more proactive focus on NSSI behaviour in mental health clinical settings as an important suicide preventive measure.
非自杀性自伤（NSSI）是精神疾病患者中一种非常普遍的行为问题，但NSSI的许多基本方面仍不为人知。我们研究了成年精神科门诊患者中NSSI的患病率及其与自杀观念（SI）和自杀未遂（SA）的关系，特别关注人格障碍患者与其他疾病患者的比较。
在14天的时间里，收集了挪威所有门诊精神科诊所所有可及患者的数据。这个来自23124名门诊患者的全国性临床未筛选横断面数据集用于生成过去四周内NSSI、SI和SA患病率及其共现情况的比例维恩图。对这些行为在不同诊断中的风险差异进行了测试，包括调整和未调整人口统计学和社会人口统计学特征的情况。
在之前的四周内，8.1%的患者经历过至少一次NSSI发作，17.3%有SI，0.6%有至少一次SA。在有NSSI的患者中，27.8%同时有SI，在有SI的患者中，13%同时有NSSI。有NSSI行为的患者中SA的患病率比没有NSSI行为的患者高七倍多。诊断为人格障碍的患者中SI、NSSI以及伴有SI的NSSI的患病率显著高于所有其他诊断组；然而，在不伴有SI的NSSI患病率方面，他们与其他诊断的患者没有系统性差异。即使在控制社会人口统计学变量后，这些发现仍具有统计学意义。
在挪威接受门诊精神科治疗的患者中，近期NSSI的患病率很高。人格障碍患者中NSSI的患病率明显高于其他诊断的患者，主要是因为人格障碍患者中伴有SI的NSSI患病率显著更高。NSSI和SI的共现在所有诊断组中也很普遍，但NSSI和SI单独出现的频率比同时出现的频率更高。NSSI和SA之间的强关联要求在心理健康临床环境中更积极地关注NSSI行为，将其作为一项重要的自杀预防措施。
