Department of Clinical Pharmacy, Fujita Health University, Toyoake, Japan.
Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2022 May;84(2):301-310. doi: 10.18999/nagjms.84.2.301.
Repeated suicide attempts through intentional overdose are not infrequent, but little is known about the risk factors associated with intentional overdose. We investigated these risk factors within 1 year of discharge from hospital and developed an index predicting recurrence. This retrospective observational study included 419 patients admitted to our hospital between 2011 and 2018 due to intentional overdose. Of these, 43 (10.0%) repeated an overdose within 1 year of discharge. The risk factors with the highest odds ratios from multivariate logistic regression analyses were used to develop an index assessing Recurrence of Overdose Suicide Attempt. The following variables were significantly associated with recurrence and were included in the index: anxiety and/or insomnia at discharge; use of five or more psychotropic medications; diagnosis of an ICD-F4 anxiety disorders; and female sex (odds ratios: 4.24; 5.52; 2.41; and 3.41, respectively). The area under the receiver operating characteristic curve of the index was 0.797. Sensitivity, specificity, and positive and negative predictive values for Recurrence of Overdose Suicide Attempt >4 points (out of 6) were 72.1%, 75.8%, 25.4%, and 96.0%, respectively. Our novel index predicted the recurrence of intentional overdose with a good negative predictive value and may therefore be a useful screening tool for this high-risk population.
重复通过故意过量服药来自杀的情况并不少见，但与故意过量服药相关的风险因素知之甚少。我们在出院后 1 年内调查了这些风险因素，并开发了一种预测复发的指标。这项回顾性观察研究纳入了 2011 年至 2018 年期间因故意过量服药而在我院住院的 419 名患者。其中，43 名（10.0%）在出院后 1 年内再次过量服药。多变量逻辑回归分析显示，风险因素的优势比最高，我们使用这些因素开发了一种评估复发性过量服药自杀企图的指标。与复发显著相关的变量包括出院时的焦虑和/或失眠、使用五种或更多精神药物、ICD-F4 焦虑障碍的诊断以及女性（比值比分别为 4.24、5.52、2.41 和 3.41）。该指标的受试者工作特征曲线下面积为 0.797。对于 Recurrence of Overdose Suicide Attempt >4 分（总分为 6 分），该指标的敏感性、特异性、阳性预测值和阴性预测值分别为 72.1%、75.8%、25.4%和 96.0%。我们的新指标预测故意过量服药的复发具有良好的阴性预测值，因此可能是这种高危人群的有用筛查工具。
