Mortier P, Vilagut G, Ferrer M, Alayo I, Bruffaerts R, Cristóbal-Narváez P, Del Cura-González I, Domènech-Abella J, Felez-Nobrega M, Olaya B, Pijoan J I, Vieta E, Pérez-Solà V, Kessler R C, Haro J M, Alonso J
Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Epidemiol Psychiatr Sci. 2021 Feb 17;30:e19. doi: 10.1017/S2045796021000093.
To investigate the prevalence of suicidal thoughts and behaviours (STB; i.e. suicidal ideation, plans or attempts) in the Spanish adult general population during the first wave of the Spain coronavirus disease 2019 (COVID-19) pandemic (March-July, 2020), and to investigate the individual- and population-level impact of relevant distal and proximal STB risk factor domains.
Cross-sectional study design using data from the baseline assessment of an observational cohort study (MIND/COVID project). A nationally representative sample of 3500 non-institutionalised Spanish adults (51.5% female; mean age = 49.6 [s.d. = 17.0]) was taken using dual-frame random digit dialing, stratified for age, sex and geographical area. Professional interviewers carried out computer-assisted telephone interviews (1-30 June 2020). Thirty-day STB was assessed using modified items from the Columbia Suicide Severity Rating Scale. Distal (i.e. pre-pandemic) risk factors included sociodemographic variables, number of physical health conditions and pre-pandemic lifetime mental disorders; proximal (i.e. pandemic) risk factors included current mental disorders and a range of adverse events-experiences related to the pandemic. Logistic regression was used to investigate individual-level associations (odds ratios [OR]) and population-level associations (population attributable risk proportions [PARP]) between risk factors and 30-day STB. All data were weighted using post-stratification survey weights.
Estimated prevalence of 30-day STB was 4.5% (1.8% active suicidal ideation; n = 5 [0.1%] suicide attempts). STB was 9.7% among the 34.3% of respondents with pre-pandemic lifetime mental disorders, and 1.8% among the 65.7% without any pre-pandemic lifetime mental disorder. Factors significantly associated with STB were pre-pandemic lifetime mental disorders (total PARP = 49.1%) and current mental disorders (total PARP = 58.4%), i.e. major depressive disorder (OR = 6.0; PARP = 39.2%), generalised anxiety disorder (OR = 5.6; PARP = 36.3%), post-traumatic stress disorder (OR = 4.6; PARP = 26.6%), panic attacks (OR = 6.7; PARP = 36.6%) and alcohol/substance use disorder (OR = 3.3; PARP = 5.9%). Pandemic-related adverse events-experiences associated with STB were lack of social support, interpersonal stress, stress about personal health and about the health of loved ones (PARPs 32.7-42.6%%), and having loved ones infected with COVID-19 (OR = 1.7; PARP = 18.8%). Up to 74.1% of STB is potentially attributable to the joint effects of mental disorders and adverse events-experiences related to the pandemic.
STB at the end of the first wave of the Spain COVID-19 pandemic was high, and large proportions of STB are potentially attributable to mental disorders and adverse events-experiences related to the pandemic, including health-related stress, lack of social support and interpersonal stress. There is an urgent need to allocate resources to increase access to adequate mental healthcare, even in times of healthcare system overload.
NCT04556565.
调查西班牙2019冠状病毒病（COVID-19）大流行第一波期间（2020年3月至7月）西班牙成年普通人群中自杀想法和行为（STB，即自杀意念、计划或企图）的患病率，并调查相关远端和近端STB危险因素领域在个体和人群层面的影响。
采用观察性队列研究（MIND/COVID项目）基线评估数据的横断面研究设计。使用双框架随机数字拨号法抽取了3500名非机构化西班牙成年人的全国代表性样本（女性占51.5%；平均年龄=49.6岁[标准差=17.0]），按年龄、性别和地理区域分层。专业访谈员进行了计算机辅助电话访谈（2020年6月1日至30日）。使用来自哥伦比亚自杀严重程度评定量表的修改项目评估30天内的STB。远端（即大流行前）危险因素包括社会人口统计学变量、身体健康状况数量和大流行前的终生精神障碍；近端（即大流行期间）危险因素包括当前的精神障碍以及一系列与大流行相关的不良事件经历。使用逻辑回归研究危险因素与30天内STB之间的个体层面关联（比值比[OR]）和人群层面关联（人群归因风险比例[PARP]）。所有数据均使用事后分层调查权重进行加权。
估计30天内STB的患病率为4.5%（1.8%为活跃自杀意念；n = 5[0.1%]为自杀未遂）。在有大流行前终生精神障碍的34.3%的受访者中，STB为9.7%，在没有任何大流行前终生精神障碍的65.7%的受访者中，STB为1.8%。与STB显著相关的因素是大流行前的终生精神障碍（总PARP = 49.1%）和当前的精神障碍（总PARP = 58.4%），即重度抑郁症（OR = 6.0；PARP = 39.2%）、广泛性焦虑症（OR = 5.6；PARP = 36.3%）、创伤后应激障碍（OR = 4.6；PARP = 26.6%）、惊恐发作（OR = 6.7；PARP = 36.6%）和酒精/物质使用障碍（OR = 3.3；PARP = 5.9%）。与STB相关的与大流行相关的不良事件经历包括缺乏社会支持、人际压力、对个人健康和亲人健康的担忧（PARP为32.7 - 42.6%），以及亲人感染COVID-19（OR = 1.7；PARP = 18.8%）。高达74.1%的STB可能归因于精神障碍和与大流行相关的不良事件经历的联合作用。
西班牙COVID-19大流行第一波末期的STB发生率很高，且很大一部分STB可能归因于精神障碍和与大流行相关的不良事件经历，包括与健康相关的压力、缺乏社会支持和人际压力。即使在医疗系统不堪重负的时期，也迫切需要分配资源以增加获得适当心理保健的机会。
NCT04556565。
