Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.
Health & Mental Health Lab, Yonsei University Graduate School of Social Welfare, Seoul, Republic of Korea.
JMIR Public Health Surveill. 2023 Apr 12;9:e41261. doi: 10.2196/41261.
Deliberate self-harm (DSH) along with old age, physical disability, and low socioeconomic status are well-known contributors to suicide-related deaths. In recent years, South Korea has the highest suicide death rate among all Organization for Economic Co-operation and Development countries. Owing to the difficulty of accessing data of individuals with DSH behavior who died by suicide, the factors associated with suicide death in these high-risk individuals have not been sufficiently explored. There have been conflicting findings with regard to the relationship between previous psychiatric visits and suicidal death.
We aimed to address the following 3 questions: Are there considerable differences in demographics, socioeconomic status, and clinical features in individuals who received psychiatric diagnosis (either before DSH or after DSH event) and those who did not? Does receiving a psychiatric diagnosis from the Department of Psychiatry, as opposed to other departments, affect survival? and Which factors related to DSH contribute to deaths by suicide?
We used the Korean National Health Insurance Service Database to design a cohort of 5640 individuals (3067/5640, 54.38% women) who visited the hospital for DSH (International Classification of Diseases codes X60-X84) between 2002 and 2020. We analyzed whether there were significant differences among subgroups of individuals with DSH behavior based on psychiatric diagnosis status (whether they had received a psychiatric diagnosis, either before or after the DSH event) and the department from which they had received the psychiatric diagnosis. Another main outcome of the study was death by suicide. Cox regression models yielded hazard ratios (HRs) for suicide risk. Patterns were plotted using Kaplan-Meier survival curves.
There were significant differences in all factors including demographic, health-related, socioeconomic, and survival variables among the groups that were classified according to psychiatric diagnosis status (P<.001). The group that did not receive a psychiatric diagnosis had the lowest survival rate (867/1064, 81.48%). Analysis drawn using different departments from where the individual had received a psychiatric diagnosis showed statistically significant differences in all features of interest (P<.001). The group that had received psychiatric diagnoses from the Department of Psychiatry had the highest survival rate (888/951, 93.4%). These findings were confirmed using the Kaplan-Meier survival curves (P<.001). The severity of DSH (HR 4.31, 95% CI 3.55-5.26) was the most significant contributor to suicide death, followed by psychiatric diagnosis status (HR 1.84, 95% CI 1.47-2.30).
Receiving psychiatric assessment from a health care professional, especially a psychiatrist, reduces suicide death in individuals who had deliberately harmed themselves before. The key characteristics of individuals with DSH behavior who die by suicide are male sex, middle age, comorbid physical disabilities, and higher socioeconomic status.
蓄意自伤（DSH）与年龄增长、身体残疾和低社会经济地位是已知的自杀相关死亡的促成因素。近年来，韩国是所有经济合作与发展组织国家中自杀死亡率最高的国家。由于难以获取自杀的 DSH 行为个体的数据，这些高风险个体的自杀死亡相关因素尚未得到充分探讨。既往精神科就诊与自杀死亡之间的关系存在矛盾的发现。
我们旨在解决以下 3 个问题：接受精神科诊断（无论是在 DSH 之前还是之后）和未接受精神科诊断的个体在人口统计学、社会经济地位和临床特征方面是否存在显著差异？从精神科而不是其他科室获得精神科诊断是否会影响生存？与 DSH 相关的哪些因素会导致自杀死亡？
我们使用韩国国家健康保险服务数据库设计了一个队列，其中包括 5640 名（3067/5640，54.38%为女性）在 2002 年至 2020 年期间因 DSH 到医院就诊的个体（国际疾病分类第 X60-X84 代码）。我们分析了根据精神科诊断状态（是否在 DSH 事件之前或之后接受过精神科诊断）和接受精神科诊断的科室，DSH 行为个体的亚组之间是否存在显著差异。该研究的另一个主要结果是自杀死亡。Cox 回归模型得出自杀风险的风险比（HR）。使用 Kaplan-Meier 生存曲线绘制模式。
根据精神科诊断状态进行分类的各组之间，所有因素（包括人口统计学、健康相关、社会经济和生存变量）均存在显著差异（P<.001）。未接受精神科诊断的组的生存率最低（867/1064，81.48%）。使用个体接受精神科诊断的不同科室进行分析显示，所有感兴趣的特征均存在统计学显著差异（P<.001）。从精神科获得精神科诊断的组的生存率最高（888/951，93.4%）。Kaplan-Meier 生存曲线也证实了这一点（P<.001）。DSH 的严重程度（HR 4.31，95%CI 3.55-5.26）是自杀死亡的最重要因素，其次是精神科诊断状态（HR 1.84，95%CI 1.47-2.30）。
接受医疗保健专业人员的精神评估，尤其是精神科医生的评估，可降低以前故意伤害自己的个体的自杀死亡风险。自杀的 DSH 行为个体的关键特征是男性、中年、合并身体残疾和较高的社会经济地位。
