Program in Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea.
Department of Preventive Medicine, Chung-Ang University College of Medicine, 84 Heukseok-Ro, Dongjak-Gu, Seoul 156-756, Republic of Korea.
J Affect Disord. 2024 Mar 15;349:431-437. doi: 10.1016/j.jad.2024.01.037. Epub 2024 Jan 6.
Chronic diseases including mental disorders have been associated with suicide. This study broadens the approach by incorporating a comprehensive list of chronic diseases and a context of comorbidities and explored their associations with suicide.
Data-linkage between death registry and Korean National Health Insurance data was conducted. Suicide cases (n = 64,099) between 2009 and 2013 were 1:4 matched for gender and age to an alive control (n = 256,396). A total of 92 individual diseases of 9 broad categories were identified from insurance claims data. Conditional logistic regression was applied to assess the associations, adjusting for mental and behavioral disorders and socioeconomic status.
Suicide cases frequently experienced chronic diseases (90.0 %) and comorbidities (74.6 %). Chronic diseases greatly increased suicide risk and, among these, mental and behavioral disorders showed the highest suicide risk (OR = 7.53, 95 % CI = 7.32-7.74) followed by cardiovascular (OR = 3.36, 95 % CI = 3.26-3.47). For individual diseases, gastritis and duodenitis were most prevalent (68.1 %) among suicide cases but depressive disorder showed the highest risk (OR = 4.95, 95 % CI = 4.79-5.12). Suicide risk was strong in comorbid status sometimes comparable to odds for mental and behavioral disorder alone (e.g., OR for cardiovascular and eye vision-related diseases = 4.01, 95 % CI = 3.86-4.17).
Differentiation of comorbidity was limited to pairs between major disease categories, neglecting the heterogeneity within categories.
Chronic diseases, in particular comorbidity, showed strong associations with suicide. This suggests that those with comorbidities feel that they are pushed to the extreme line, supporting comprehensive interventions for them to address wider reasons including psychological and social problems, besides medical problems.
慢性疾病（包括精神障碍）与自杀有关。本研究通过纳入广泛的慢性疾病清单和共病情况，拓宽了研究方法，并探讨了它们与自杀的关联。
对死亡登记处和韩国国家健康保险数据进行了数据链接。2009 年至 2013 年间，自杀病例（n=64099）按性别和年龄与 1:4 配对的存活对照（n=256396）进行了匹配。从保险索赔数据中确定了 9 个广泛类别中的 92 种个体疾病。采用条件逻辑回归评估关联，同时调整了精神和行为障碍以及社会经济地位的因素。
自杀病例经常患有慢性疾病（90.0%）和共病（74.6%）。慢性疾病大大增加了自杀风险，其中精神和行为障碍的自杀风险最高（OR=7.53，95%CI=7.32-7.74），其次是心血管疾病（OR=3.36，95%CI=3.26-3.47）。对于个别疾病，胃炎和十二指肠炎在自杀病例中最为常见（68.1%），但抑郁障碍的风险最高（OR=4.95，95%CI=4.79-5.12）。在共病状态下，自杀风险很强，有时与单独的精神和行为障碍的几率相当（例如，心血管疾病和视力相关疾病的 OR=4.01，95%CI=3.86-4.17）。
共病的区分仅限于主要疾病类别之间的对，忽略了类别内的异质性。
慢性疾病，特别是共病，与自杀有很强的关联。这表明，那些患有共病的人觉得自己被逼到了极限，这支持了对他们进行全面干预，以解决包括心理和社会问题在内的更广泛原因，而不仅仅是医疗问题。
