Department of Psychiatry, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea.
Jongno-gu, Seoul, Republic of Korea.
J Clin Psychiatry. 2023 Sep 20;84(6):22m14754. doi: 10.4088/JCP.22m14754.
The knowledge of the common risk factors for suicide attempts may not be simply applicable to patients with amyotrophic lateral sclerosis (ALS). We aimed to identify risk factors associated with suicide attempts in patients with ALS and to determine the annual prevalence and periods of vulnerability associated with attempts. This nationwide cohort study was performed using the Korean National Health Insurance Database. All patients with ALS concomitantly registered for the Exempted Calculation of Health Insurance for rare, incurable diseases between 2011 and 2017 were identified. We used the Cox proportional hazards regression model and competing risk model to identify the risk factors for suicide attempts. The multivariable models were adjusted for potential risk factors from the univariate analysis. Among 2,955 incident patients, 47 attempted suicide. After adjusting for sex, previous attempts, and previous psychiatric disorders, the hazard ratios for psychiatric hospitalization before ALS diagnosis were 3.17 (95% confidence interval [CI], 1.31-7.70; = .01) and 3.02 (95% CI, 1.32-6.90; = .01) in the Cox regression model and the competing risk model, respectively. The annual prevalence of suicide attempts was 0.29%-1.12%. Twenty (42.6%) and 9 (19.1%) attempts occurred within 3 months and 12-18 months after diagnosis, respectively. Psychiatric hospitalization increased the risk of suicide attempts, which clustered at the early stage or on losing autonomy. Those with a history of psychiatric hospitalization should receive an in-depth evaluation and be cautiously monitored.
自杀尝试的常见风险因素的知识可能并不简单适用于肌萎缩侧索硬化症（ALS）患者。我们旨在确定与 ALS 患者自杀尝试相关的风险因素，并确定与尝试相关的年度患病率和脆弱期。这项全国性队列研究使用了韩国国家健康保险数据库进行。确定了 2011 年至 2017 年间同时登记为罕见、不可治愈疾病豁免计算健康保险的所有 ALS 患者。我们使用 Cox 比例风险回归模型和竞争风险模型来确定自杀尝试的风险因素。多变量模型调整了单变量分析中的潜在风险因素。在 2955 名发病患者中，有 47 人试图自杀。在调整了性别、既往尝试和既往精神疾病后，ALS 诊断前精神科住院的风险比分别为 3.17（95%置信区间[CI]，1.31-7.70；=0.01）和 3.02（95% CI，1.32-6.90；=0.01）在 Cox 回归模型和竞争风险模型中。自杀尝试的年患病率为 0.29%-1.12%。20 次（42.6%）和 9 次（19.1%）尝试分别发生在诊断后 3 个月和 12-18 个月内。精神科住院增加了自杀尝试的风险，这些风险集中在早期或失去自主能力时。有精神科住院史的患者应接受深入评估并谨慎监测。
