Tham Su-Gwan, Hunt Isabelle M, Turnbull Pauline, Appleby Louis, Kapur Nav, Knipe Duleeka
National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK.
Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
EClinicalMedicine. 2023 Feb 27;57:101859. doi: 10.1016/j.eclinm.2023.101859. eCollection 2023 Mar.
Within the UK, limited research has examined migration and suicide risk. To assist with tailoring mental health care to the needs of different migrant groups, it is important to identify the clinical profile and antecedents to suicide.
We focussed on two groups of migrants: those resident in the UK for less than 5 years (recent migrants) and those seeking permission to stay in the UK. Data on mental health patients who died by suicide in the UK between 2011 and 2019 were obtained as part of the National Confidential Inquiry into Suicide and Safety in Mental Health.
13,948 patients died by suicide between 2011 and 2019: 593 were recent migrants with 48 seeking permission to stay in the UK. The overall suicide rate between 2011 and 2017 for patients seeking to stay was 23.8/100,000 (95% CI 17.3-32.1). There was some uncertainty around this estimate but it appeared higher than the general population suicide rate of 10.6/100,000 population (95% CI 10.5-10.7; p = .0001) for the same period. A higher proportion of migrants were from an ethnic minority group (15% recent migrants vs. 70% seeking to remain vs. 7% non-migrants) and more were viewed as at low long-term risk of suicide (63% recent migrants vs. 76% seeking to remain vs. 57% non-migrants). A higher proportion of recent migrants died within three months of discharge from psychiatric in-patient care (19% vs. 14%) compared to non-migrants. Proportionally more patients seeking to remain had a diagnosis of schizophrenia and other delusional disorders (31% vs. 15%) and more had experienced recent life events compared to non-migrants (71% vs. 51%).
A higher proportion of migrants had severe or acute illness at the time of their suicide. This may be linked to a range of serious stressors and/or lack of connection with services that could have identified signs of illness early. However, clinicians often viewed these patients as low risk. Mental health services should consider the breadth of stressors migrants may face and adopt a multi-agency approach to suicide prevention.
The Healthcare Quality Improvement Partnership.
在英国，针对移民与自杀风险的研究有限。为了根据不同移民群体的需求提供心理健康护理，识别自杀的临床特征和先兆很重要。
我们聚焦于两类移民群体：在英国居住不到5年的移民（新移民）以及寻求在英国居留许可的移民。作为国家心理健康自杀与安全机密调查的一部分，我们获取了2011年至2019年间在英国自杀身亡的心理健康患者的数据。
2011年至2019年间有13,948名患者自杀身亡：其中593名是新移民，48名是寻求在英国居留许可的移民。2011年至2017年间，寻求居留许可的患者总体自杀率为23.8/10万（95%置信区间17.3 - 32.1）。该估计存在一定不确定性，但似乎高于同期普通人群10.6/10万的自杀率（95%置信区间10.5 - 10.7；p = 0.0001）。移民中来自少数族裔群体的比例更高（新移民为15%，寻求居留的为70%，非移民为7%），且更多人被视为长期自杀风险较低（新移民为63%，寻求居留的为76%，非移民为57%）。与非移民相比，更高比例的新移民在从精神科住院治疗出院后的三个月内死亡（19%对14%）。按比例计算，寻求居留的患者中被诊断患有精神分裂症和其他妄想性障碍的更多（31%对15%），且与非移民相比，经历近期生活事件的更多（71%对51%）。
更高比例的移民在自杀时患有严重或急性疾病。这可能与一系列严重应激源和/或缺乏能早期识别疾病迹象的服务有关。然而，临床医生通常将这些患者视为低风险。心理健康服务机构应考虑移民可能面临的广泛应激源，并采用多机构方法预防自杀。
医疗质量改进伙伴关系组织。
