Karlsson Anna, Hedén Olivia, Hansson Helena, Sandgren Jenny, Håkansson Anders
Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.
Department of Pediatrics, Skåne University Hospital, Malmö, Sweden.
Front Psychiatry. 2021 Oct 18;12:688285. doi: 10.3389/fpsyt.2021.688285. eCollection 2021.
There is an increased risk of suicidality in gambling disorder (GD) and economic hardship is common in the population. Economic hardship itself is a risk factor for suicidality. This study aims to explore the risk of intentional self-harm in GD utilizing social welfare payment (SWP) as a proxy for economic hardship and exploring how economic hardship, gender, criminality, socioeconomic-, and psychiatric risk factors might contribute to intentional self-harm in GD. This is a nationwide register-based study of 848 individuals diagnosed with GD in the Swedish healthcare system during the years of 2011-2014 with an average follow up of 4.9 years. Pearson's Chi-square analyses were carried out for comparisons regarding psychiatric comorbidity and intentional self-harm with regards to gender and SWPs. Univariable and multivariable Cox regression were utilized to analyse risk factors for intentional self-harm. A large part of the study population received SWPs (45.5% with an insignificant overrepresentation of women) and psychiatric disorders were more common in these individuals ( < 0.001). Conviction for crime in general ( < 0.001) as well as intentional self-harm ( = 0.025) were also more common amongst recipients of SWPs. Criminal conviction in general was abundant (26.5%). In the stepwise multivariable regression, substance-related diagnoses as well as anxiety, depressive, and personality disorders remained risk factors for intentional self-harm and no significant results were found with regards to gender, criminal history, or SWPs. Social welfare payment was common among GD patients and intentional self-harm was more common amongst recipients than GD patients as a whole. Social welfare payments were however not a significant risk factor for intentional self-harm. However, attention to suicidality and self-injurious behavior should be paid from social services controlling SWPs due to the large prevalence of intentional self-harm in this group. In accordance with previous studies, comorbid psychiatric disorders such as anxiety, depression, substance use, and personality disorders increased the risk of intentional self-harm.
赌博障碍（GD）患者的自杀风险增加，而且经济困难在这一人群中很常见。经济困难本身就是自杀的一个风险因素。本研究旨在利用社会福利金（SWP）作为经济困难的替代指标，探讨GD患者故意自我伤害的风险，并探究经济困难、性别、犯罪、社会经济和精神风险因素如何可能导致GD患者故意自我伤害。这是一项基于全国登记系统的研究，研究对象为2011年至2014年期间在瑞典医疗系统中被诊断为GD的848名个体，平均随访4.9年。采用Pearson卡方分析比较性别和社会福利金方面的精神共病和故意自我伤害情况。使用单变量和多变量Cox回归分析故意自我伤害的风险因素。研究人群中的很大一部分领取了社会福利金（45.5%，女性比例略高但不显著），这些个体中精神障碍更为常见（<0.001）。领取社会福利金者中，一般犯罪定罪（<0.001）以及故意自我伤害（=0.025）也更为常见。一般犯罪定罪情况很普遍（26.5%）。在逐步多变量回归中，与物质相关的诊断以及焦虑、抑郁和人格障碍仍然是故意自我伤害的风险因素，在性别、犯罪史或社会福利金方面未发现显著结果。社会福利金在GD患者中很常见，领取者中故意自我伤害比整个GD患者群体更常见。然而，社会福利金并非故意自我伤害的显著风险因素。不过，由于该群体中故意自我伤害的发生率很高，负责管理社会福利金的社会服务部门应关注自杀行为和自我伤害行为。与先前的研究一致，焦虑、抑郁、物质使用和人格障碍等共病精神障碍会增加故意自我伤害的风险。
