Wasserman Danuta, Carli Vladimir, Iosue Miriam, Javed Afzal, Herrman Helen
National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.
World Psychiatric Association (WPA)-Section on Suicidology, Geneva, Switzerland.
Asia Pac Psychiatry. 2021 Sep;13(3):e12450. doi: 10.1111/appy.12450. Epub 2021 Feb 18.
An increased risk of suicide has been reported for psychiatric patients. In several world regions, an underlying psychiatric disorder is reported in up to 90% of people who die from suicide, though this rate seems to be considerably lower in low- and middle-income countries. Major psychiatric conditions associated with suicidality are mood disorders, alcohol and substance use disorders, borderline personality disorder, and schizophrenia. Comorbidity between different disorders is frequently associated with a higher suicide risk. A history of suicide attempts, feelings of hopelessness, impulsivity and aggression, adverse childhood experiences, severe psychopathology, and somatic disorders are common risk factors for suicide among psychiatric patients. Stressful life events and interpersonal problems, including interpersonal violence, are often triggers. A comprehensive and repeated suicide risk assessment represents the first step for effective suicide prevention. Particular attention should be paid during and after hospitalization, with the first days and weeks after discharge representing the most critical period. Pharmacological treatment of mood disorders and schizophrenia has been shown to have an anti-suicidal effect. A significant reduction of suicidal thoughts and behavior has been reported for cognitive behavioral therapy and dialectical behavior therapy. Brief interventions, including psychoeducation and follow-ups, are associated with a decrease in suicide deaths. Further development of suicide prevention in psychiatric patients will require a better understanding of additional risk and protective factors, such as the role of a person's decision-making capacity and social support, the role of spiritual and religious interventions, and the reduction of the treatment gap in mental health care.
据报道，精神科患者的自杀风险有所增加。在世界上的几个地区，高达90%的自杀死亡者被报告患有潜在的精神障碍，不过在低收入和中等收入国家，这一比例似乎要低得多。与自杀倾向相关的主要精神疾病包括情绪障碍、酒精和物质使用障碍、边缘型人格障碍以及精神分裂症。不同疾病之间的共病常常与更高的自杀风险相关。自杀未遂史、绝望感、冲动和攻击性、童年不良经历、严重精神病理学以及躯体疾病是精神科患者自杀的常见风险因素。生活应激事件和人际问题，包括人际暴力，往往是触发因素。全面且反复的自杀风险评估是有效预防自杀的第一步。在住院期间及出院后都应特别关注，出院后的头几天和几周是最关键的时期。已证明对情绪障碍和精神分裂症进行药物治疗具有抗自杀作用。据报道，认知行为疗法和辩证行为疗法能显著减少自杀念头和行为。包括心理教育和随访在内的简短干预与自杀死亡人数的减少相关。要进一步发展精神科患者的自杀预防工作，需要更好地了解其他风险和保护因素，比如一个人的决策能力和社会支持的作用、精神和宗教干预的作用，以及缩小精神卫生保健方面的治疗差距。
