Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy.
Department of Statistical Sciences, University of Padua, Padua, Italy.
Epidemiol Psychiatr Sci. 2022 Mar 30;31:e17. doi: 10.1017/S2045796021000792.
The present study investigated the relationship between suicide mortality and contact with a community mental health centre (CMHC) among the adult population in the Veneto Region (northeast Italy, population 4.9 million). Specifically, it estimated the effects of age, gender, time elapsed since the first contact with a CMHC, calendar year of diagnosis and diagnostic category on suicide mortality and modality.
The regional mortality archive was linked to electronic medical records for all residents aged 18-84 years who had been admitted to a CMHC in the Veneto Region in 2008. In total, 54 350 subjects diagnosed with a mental disorder were included in the cohort and followed up for a period of 10 years, ending in 2018. Years of life lost (YLL) were computed and suicide mortality was estimated as a mortality rate ratio (MRR).
During the follow-up period, 4.4% of all registered deaths were from suicide, but, given the premature age of death (mean 52.2 years), suicide death accounted for 8.7% of YLL; this percentage was particularly high among patients with borderline personality disorder (27.2%), substance use disorder (12.1%) and bipolar disorder (11.5%) who also presented the highest suicide mortality rates. Suicide mortality rates were halved in female patients (MRR 0.45; 95% CI 0.37-0.55), highest in patients aged 45-54 years (MRR 1.56; 95% CI 1.09-2.23), and particularly elevated in the 2 months following first contact with CMHCs (MRR 10.4; 95% CI 5.30-20.3). A sensitivity analysis restricted to patients first diagnosed in 2008 confirmed the results. The most common modalities of suicide were hanging (47%), jumping (18%), poisoning (13%) and drowning (10%), whereas suicide from firearm was rare (4%). Gender, age at death and time since first contact with CMHCs influenced suicide modality.
Suicide prevention strategies must be promptly initiated after patients' first contact with CMHCs. Patients diagnosed with borderline personality disorder, substance use disorder and bipolar disorder may be at particularly high risk for suicide.
本研究旨在调查威尼托地区（意大利东北部，人口 490 万）成年人群的自杀死亡率与社区心理健康中心（CMHC）接触之间的关系。具体而言，本研究评估了年龄、性别、首次接触 CMHC 后的时间、诊断年份和诊断类别对自杀死亡率和自杀方式的影响。
将区域死亡率档案与威尼托地区 2008 年 CMHC 住院的所有 18-84 岁居民的电子病历相链接。共有 54350 名被诊断为精神障碍的患者纳入队列并随访 10 年，截至 2018 年。计算了生命损失年（YLL），并将自杀死亡率估计为死亡率比（MRR）。
在随访期间，所有登记死亡的 4.4%是自杀死亡，但由于死亡年龄过早（平均 52.2 岁），自杀死亡占 YLL 的 8.7%；在边缘型人格障碍（27.2%）、物质使用障碍（12.1%）和双相障碍（11.5%）患者中，这一比例特别高，这些患者的自杀死亡率也最高。女性患者的自杀死亡率减半（MRR 0.45；95%CI 0.37-0.55），45-54 岁患者的自杀死亡率最高（MRR 1.56；95%CI 1.09-2.23），特别是在首次接触 CMHC 后的 2 个月内（MRR 10.4；95%CI 5.30-20.3）。一项仅限于 2008 年首次诊断的患者的敏感性分析证实了上述结果。最常见的自杀方式是上吊（47%）、跳楼（18%）、中毒（13%）和溺水（10%），而枪支自杀则很少见（4%）。性别、死亡年龄和首次接触 CMHC 后的时间影响自杀方式。
必须在患者首次接触 CMHC 后立即启动预防自杀策略。被诊断为边缘型人格障碍、物质使用障碍和双相障碍的患者自杀风险可能特别高。
