Chen Pao-Huan, Tsai Shang-Ying, Pan Chun-Hung, Chen Yi-Lung, Chang Hu-Ming, Su Sheng-Siang, Chen Chiao-Chicy, Kuo Chian-Jue
Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.
Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
Psychol Med. 2023 Mar;53(4):1500-1509. doi: 10.1017/S003329172100307X. Epub 2021 Aug 11.
Evidence on sex-specific incidence and comorbidity risk factors of suicide among patients with bipolar disorder is scarce. This study investigated the sex-specific risk profiles for suicide among the bipolar disorder population in terms of incidence, healthcare utilization and comorbidity.
Using data from the Taiwan National Health Insurance Research Database between 1 January 2000 and 31 December 2016, this nationwide cohort study included patients with bipolar disorder ( = 46 490) and individuals representative of the general population ( = 185 960) matched by age and sex at a 1:4 ratio. Mortality rate ratios (MRRs) of suicide were calculated between suicide rates of bipolar disorder cohort and general population. In addition, a nested case-control study (1428 cases died by suicide and 5710 living controls) was conducted in the bipolar disorder cohort to examine the sex-specific risk of healthcare utilization and comorbidities.
Suicide risk was considerably higher in the cohort (MRR = 21.9) than in the general population, especially among women (MRR = 35.6). Sex-stratified analyses revealed distinct healthcare utilization patterns and physical comorbidity risk profiles between the sexes. Although female patients who died by suicide had higher risks of nonhypertensive cardiovascular disease, pneumonia, chronic kidney disease, peptic ulcer, irritable bowel syndrome, and sepsis compared to their living counterparts, male patients who died by suicide had higher risks of chronic kidney disease and sepsis compared to the living controls.
Patients with bipolar disorder who died by suicide had sex-specific risk profiles in incidence and physical comorbidities. Identifying these modifiable risk factors may guide interventions for suicide risk reduction.
关于双相情感障碍患者自杀的性别特异性发病率及共病风险因素的证据匮乏。本研究从发病率、医疗服务利用及共病情况方面，调查了双相情感障碍人群中自杀的性别特异性风险概况。
利用2000年1月1日至2016年12月31日台湾全民健康保险研究数据库的数据，这项全国性队列研究纳入了双相情感障碍患者（n = 46490）以及按年龄和性别以1:4比例匹配的具有一般人群代表性的个体（n = 185960）。计算双相情感障碍队列与一般人群自杀率之间的自杀死亡率比（MRR）。此外，在双相情感障碍队列中进行了一项巢式病例对照研究（1428例自杀死亡病例和5710例存活对照），以研究医疗服务利用和共病的性别特异性风险。
该队列中的自杀风险（MRR = 21.9）显著高于一般人群，尤其是女性（MRR = 35.6）。按性别分层分析显示，两性之间在医疗服务利用模式和躯体共病风险概况方面存在明显差异。与存活的女性患者相比，自杀死亡的女性患者有更高的非高血压性心血管疾病、肺炎、慢性肾脏病、消化性溃疡、肠易激综合征和脓毒症风险；与存活对照相比，自杀死亡的男性患者有更高的慢性肾脏病和脓毒症风险。
自杀死亡的双相情感障碍患者在发病率和躯体共病方面存在性别特异性风险概况。识别这些可改变的风险因素可能有助于指导降低自杀风险的干预措施。
