Ruben Johnson-Pradeep, Ekstrand Maria L, Heylen Elsa, Srinivasan Krishnamachari
Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka, India.
Division of Mental Health and Neurosciences, St. John's Research Institute, St. John's Medical College, Bengaluru, Karnataka, India.
Indian J Psychiatry. 2023 Jun;65(6):687-693. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_41_23. Epub 2023 Jun 19.
Suicide is on the rise in low- and middle-income countries (LMICs), including India. There are limited studies assessing factors linked to the severity of suicidal risk in patients with depression and comorbid chronic medical disorders in primary healthcare (PHC) settings.
This study examines factors linked to suicidal risk among participants in a cluster randomized controlled trial of collaborative care intervention (Healthier Options through Empowerment (HOPE Study)).
The setting was at 49 PHC in the rural Ramanagara District of Karnataka State in southern India. Study eligibility criteria included being ≥30 years with at least mild depression or generalized anxiety disorder and at least one medical condition (cardiovascular disorder or type 2 diabetes mellitus).
The severity of suicidal risk at baseline was assessed using the Mini International Neuropsychiatric Interview (MINI), and other measures included the severity of depression (Patient Health Questionnaire-9-items (PHQ-9)), the severity of anxiety (Generalized Anxiety Disorder Scale-7-items (GAD-7)), disability, social support, quality of life, number of comorbid chronic medical illnesses, and body mass index (BMI).
Chi-square tests and independent-samples t-tests were used to compare the demographic and clinical characteristics of the no-low and mod-high suicidal risk groups. Logistic regression analysis was used to identify correlates associated with the mod-high suicidal risk group.
Mod-high suicidal risk was significantly positively associated with the severity of depression and disability and significantly negatively associated with social support.
The severity of depression, higher disability scores, and lower social support were found to be independent correlates of mod-high suicidal risk. Screening, managing depression, and facilitating social support for patients with chronic medical illness in PHC settings may reduce suicidal risk.
包括印度在内的低收入和中等收入国家（LMICs）的自杀率正在上升。在初级卫生保健（PHC）环境中，评估与抑郁症和合并慢性疾病患者自杀风险严重程度相关因素的研究有限。
本研究调查了协作护理干预（通过赋权实现更健康选择（HOPE研究））整群随机对照试验参与者中与自杀风险相关的因素。
研究地点位于印度南部卡纳塔克邦农村拉马纳加拉区的49个初级卫生保健中心。研究纳入标准包括年龄≥30岁，至少患有轻度抑郁症或广泛性焦虑症，以及至少一种疾病（心血管疾病或2型糖尿病）。
使用迷你国际神经精神访谈（MINI）评估基线时自杀风险的严重程度，其他测量指标包括抑郁严重程度（患者健康问卷9项（PHQ-9））、焦虑严重程度（广泛性焦虑障碍量表7项（GAD-7））、残疾、社会支持、生活质量、合并慢性疾病的数量以及体重指数（BMI）。
采用卡方检验和独立样本t检验比较无低自杀风险组和中度高自杀风险组的人口统计学和临床特征。采用逻辑回归分析确定与中度高自杀风险组相关的因素。
中度高自杀风险与抑郁严重程度和残疾显著正相关，与社会支持显著负相关。
抑郁严重程度、较高的残疾评分和较低的社会支持是中度高自杀风险的独立相关因素。在初级卫生保健环境中对慢性疾病患者进行筛查、管理抑郁并促进社会支持可能会降低自杀风险。
