Nafilyan Vahé, Morgan Jasper, Mais David, Sleeman Katherine E, Butt Asim, Ward Isobel, Tucker James, Appleby Louis, Glickman Myer
Health Analysis and Life Events Division, Office for National Statistics, Newport, UK.
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
Lancet Reg Health Eur. 2022 Dec 14;25:100562. doi: 10.1016/j.lanepe.2022.100562. eCollection 2023 Feb.
The diagnosis of a severe physical health condition can cause psychological distress and lead to severe depression. The association between severe physical health conditions and the risk of suicide, and how the risk of suicide changes in the months following diagnosis, are not clear.
We estimated whether a diagnosis of severe physical health conditions is associated with an increase in the risk of death by suicide using a dataset based on the 2011 Census linked to hospital records and death registration records covering 47,354,696 people alive on 1 January 2017 in England. Patients diagnosed with a low-survival cancer, chronic ischaemic heart disease, chronic obstructive pulmonary disease, or degenerative neurological condition were matched to individuals using socio-demographic characteristics from the Census. Using the Aalen-Johansen estimator, we estimated the cumulative incidence of death by suicide occurring between 1 January 2017 and 31 December 2021 (registered by 31 December 2021) in patients and matched controls, adjusted for other potential confounders using inverse probability weighting.
Diagnosis of severe conditions was associated with an increased risk of dying by suicide. One year after diagnosis, the rate of suicide was 21.6 (95% confidence intervals: 14.9-28.4, number of events (N): 39) per 100,000 low-survival cancer patients compared to 9.5 (5.6-14.6, N:16) per 100,000 matched controls. For COPD patients, the one-year suicide rate was 22.4 (19.4-25.5, N:208) per 100,000 COPD patients (matched controls: 10.6, 8.3-13.0, N:85), for ischaemic heart disease 16.1 (14.1-18.2, N:225) per 100,000 patients (matched controls: 8.8, 7.1-10.4, N:128), for degenerative neurological conditions 114.5 (49.6-194.7, N:11) per 100,000 patients. The increase in risk was more pronounced in the first six months after diagnosis or first treatment.
A diagnosis of severe physical illness is associated with higher suicide risk. The interaction of physical and mental illness emphasises the importance of collaborative physical and mental health care in these patients.
The Office for National Statistics. KES is the Laing Galazka chair in palliative care at King's College London, funded by an endowment from Cicely Saunders International and the Kirby Laing Foundation.
严重身体健康状况的诊断可能会导致心理困扰并引发严重抑郁。严重身体健康状况与自杀风险之间的关联，以及在诊断后的数月内自杀风险如何变化，目前尚不清楚。
我们使用了一个基于2011年人口普查数据集，并与医院记录和死亡登记记录相链接的数据集，以评估严重身体健康状况的诊断是否与自杀死亡风险增加相关。该数据集涵盖了2017年1月1日在英格兰存活的47354696人。将被诊断患有低生存率癌症、慢性缺血性心脏病、慢性阻塞性肺疾病或退行性神经系统疾病的患者，根据人口普查中的社会人口学特征与个体进行匹配。使用Aalen-Johansen估计量，我们估计了2017年1月1日至2021年12月31日（截至2021年12月31日登记）患者及匹配对照中自杀死亡的累积发生率，并使用逆概率加权法对其他潜在混杂因素进行了调整。
严重疾病的诊断与自杀死亡风险增加相关。诊断后一年，每10万名低生存率癌症患者的自杀率为21.6（95%置信区间：14.9 - 28.4，事件数（N）：39），而每10万名匹配对照的自杀率为9.5（5.6 - 14.6，N：16）。对于慢性阻塞性肺疾病患者，每10万名慢性阻塞性肺疾病患者的一年自杀率为22.4（19.4 - 25.5，N：208）（匹配对照：10.6，8.3 - 13.0，N：85）；对于缺血性心脏病患者，每10万名患者的自杀率为16.1（14.1 - 18.2，N：225）（匹配对照：8.8，7.1 - 10.4，N：128）；对于退行性神经系统疾病患者，每10万名患者的自杀率为114.5（49.6 - 194.7，N：11）。风险增加在诊断或首次治疗后的前六个月更为明显。
严重身体疾病的诊断与较高的自杀风险相关。身体和精神疾病的相互作用凸显了这些患者身心联合医疗保健的重要性。
国家统计局。KES是伦敦国王学院姑息治疗领域的Laing Galazka主席，由西塞莉·桑德斯国际基金会和柯比·莱恩基金会的捐赠资助。
