Department of Clinical Sciences, Lund University Faculty of Medicine, Lund, Sweden
Department of Clinical Sciences, Lund University Faculty of Medicine, Lund, Sweden.
BMJ Open. 2022 May 27;12(5):e054898. doi: 10.1136/bmjopen-2021-054898.
The primary aim of the present study was to investigate the putative excess mortality by suicide in suicide attempters. As a secondary aim, we investigate excess mortality in specific, clinically relevant subgroups: individuals with repeated suicide attempts (RA); individuals who used violent method at the attempt (VA); and those who scored high on the Suicide Intent Scale (HS) at the time of the baseline attempt. Finally, we investigate excess mortality in men and women separately and within 5 years and over 5 years after hospital admission for attempted suicide.
Prospective register-based follow-up for 21-32 years. Standardised mortality ratio (SMR) was calculated for suicide using national census data. Clinically relevant subgroups were investigated separately.
Medical emergency inpatient unit in the south of Sweden.
1039 individuals who were psychiatrically assessed at admission to medical inpatient care for attempted suicide between 1987 and 1998.
Suicide.
The overall SMR for suicide was 23.50 (95% CI 18.68 to 29.56); significantly higher (p<0.001) among women (30.49 (95% CI 22.27 to 41.72)) than men (18.61 (95% CI 13.30 to 26.05)). Mortality was highest within the first 5 years after the index suicide attempt (48.79 (95% CI 35.64 to 66.77)) compared with those who died after 5 years (p<0.001) (14.74 (10.53 to 20.63)). The highest independent SMR was found for VA (70.22 (95% CI 38.89 to 126.80)). In a regression model including RA, VA and HS all contributed significantly to excess suicide mortality.
An elevated risk of premature death by suicide was found in suicide attempters compared with the general population. Assessment of previous suicide attempts is important, even though the attempt/s may have occurred decades ago. When assessing suicide risk, clinicians should consider repeated attempts and whether the attempts involved high suicidal intent and violent method. Healthcare interventions may benefit from targeting identified subgroups of attempters.
本研究的主要目的是调查自杀未遂者自杀导致的潜在超额死亡率。作为次要目的，我们调查了特定的、临床上相关的亚组的超额死亡率：多次自杀企图者（RA）；在尝试时使用暴力手段者（VA）；以及在基线尝试时自杀意向量表（HS）得分高者。最后，我们分别在男性和女性中，以及在自杀未遂后 5 年内和 5 年以上进行了超额死亡率的调查。
前瞻性登记为基础的随访 21-32 年。使用全国人口普查数据计算自杀的标准化死亡率（SMR）。分别对临床上相关的亚组进行了调查。
瑞典南部的医疗急救住院病房。
1987 年至 1998 年间，因企图自杀而接受医疗住院治疗的 1039 名精神科评估患者。
自杀。
自杀的总体 SMR 为 23.50（95%CI 18.68-29.56）；女性（30.49（95%CI 22.27-41.72））明显高于男性（18.61（95%CI 13.30-26.05））（p<0.001）。与 5 年后死亡者相比（p<0.001）（14.74（10.53-20.63）），在自杀企图后 5 年内死亡率最高（48.79（95%CI 35.64-66.77））。VA 组的独立 SMR 最高（70.22（95%CI 38.89-126.80））。在包括 RA、VA 和 HS 的回归模型中，所有因素都显著增加了自杀死亡的超额风险。
与一般人群相比，自杀未遂者有更高的过早死亡风险。评估以前的自杀企图很重要，即使这些企图可能发生在几十年前。在评估自杀风险时，临床医生应考虑到重复尝试以及尝试是否涉及高度自杀意图和暴力手段。医疗保健干预措施可能受益于针对特定自杀未遂者亚组的干预措施。
