Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan.
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
Soc Psychiatry Psychiatr Epidemiol. 2022 Aug;57(8):1579-1589. doi: 10.1007/s00127-022-02236-8. Epub 2022 Feb 12.
East Asia has high suicide rates but low prevalence of mental disorders. We examined the associations between prior lifetime mental disorders (mood disorders, anxiety disorders, substance use disorders, and impulse control disorders) and subsequent suicidal behaviors (suicidal ideation and attempts in the general population and suicide plans, planned attempts, and unplanned attempts in suicidal ideators) in Taiwan.
This survey applied the World Mental Health Survey Composite International Diagnostic Interview to a population representative sample of noninstitutionalized adults between 2003 and 2005. Odds ratios (ORs) obtained using discrete-time survival analysis were used to estimate population attributable fractions (PAFs) of suicidal behaviors due to lifetime mental disorders.
Lifetime mental illness was a significant risk factor for subsequent suicidal behaviors (except unplanned attempts among ideators) despite the relatively low prevalence of mental disorders in people with suicidality (16.1%-35.0%). Each diagnosis increased the odds of suicidal ideation. In terms of acting on suicidal ideation, mood disorders were most strongly associated with having plans (OR = 10.0; 95% confidence interval, CI 4.3-21.1), whereas substance use disorders most strongly with either planned (OR = 27.3; 95% CI 6.3-118.5) or unplanned attempts (OR = 14.5; 95% CI 1.7-121.5). PAFs of all mental disorders on suicidality lay between 20 and 30% (except 11% of unplanned attempts among ideators). Mood, anxiety, and substance use disorders had higher PAFs than impulse control disorders.
In addition to mood disorders, considering anxiety and substance use disorders is essential in devising population-based suicide prevention strategies.
东亚地区的自杀率很高，但精神障碍的患病率却很低。我们研究了台湾地区既往终生精神障碍（心境障碍、焦虑障碍、物质使用障碍和冲动控制障碍）与随后的自杀行为（一般人群中的自杀意念和自杀企图以及自杀意念者中的自杀计划、计划中的自杀企图和非计划中的自杀企图）之间的关联。
这项调查采用了世界心理健康调查复合国际诊断访谈，对 2003 年至 2005 年间非住院的成年人群进行了代表性抽样。使用离散时间生存分析获得的优势比（OR）用于估计由于终生精神障碍导致自杀行为的人群归因分数（PAF）。
尽管有自杀行为的人群中精神障碍的患病率相对较低（16.1%-35.0%），但终生精神疾病仍然是随后发生自杀行为的重要危险因素（自杀意念者中的非计划尝试除外）。每种诊断都增加了自杀意念的可能性。就实施自杀意念而言，心境障碍与有计划的自杀行为最密切相关（OR=10.0；95%置信区间，CI 4.3-21.1），而物质使用障碍与计划中的自杀行为（OR=27.3；95%置信区间，6.3-118.5）或非计划中的自杀企图（OR=14.5；95%置信区间，1.7-121.5）最密切相关。所有精神障碍对自杀行为的 PAF 介于 20%至 30%之间（自杀意念者中的非计划尝试除外，为 11%）。心境、焦虑和物质使用障碍的 PAF 高于冲动控制障碍。
除了心境障碍外，在制定基于人群的自杀预防策略时，还必须考虑焦虑和物质使用障碍。
