Lin Yueh-Pin, Chen Wen-Yin, Pan Chun-Hung, Su Sheng-Shiang, Tsai Shang-Ying, Chen Chiao-Chicy, Kuo Chian-Jue
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Acta Psychiatr Scand. 2024 Dec;150(6):530-542. doi: 10.1111/acps.13747. Epub 2024 Aug 14.
Schizophrenia is associated with an increased risk of suicide. Few studies have investigated the risk of suicide across different ages, likely due to limitations around sample size.
From the National Health Insurance Research Database in Taiwan, this study identified 195,787 patients with schizophrenia from January 1, 2000, to December 31, 2019. During the study period, 3848 patients died from suicide. We calculated the standardized mortality ratio (SMR) for suicide stratified by age. In this age-stratified, nested case-control study, risk set sampling was used to match each case with 4 living controls by age, sex, and the year of the first diagnosis with schizophrenia. Conditional logistic regression was used for estimating age-stratified risk profiles.
The SMR was the highest in the <25 years age group (52.8) and inversely correlated with age. Unemployment was associated with an increased risk of suicide in the 25 to 34, 35 to 44, 45 to 54, and 55 to 64 years age groups. Depressive and sleep disorders before suicide were more common among suicide cases with schizophrenia than among controls across all age groups. Drug-induced and alcohol-induced mental disorders were significantly associated with suicide but were observed only in the age group younger than 54. Heart disease, pneumonia, and moderate or severe renal disease were risk factors for suicide in the age groups less than 65.
The risk factors for suicide differ by age. This study's findings can be used to optimize health-care interventions for preventing suicide in patients with schizophrenia.
精神分裂症与自杀风险增加有关。由于样本量的限制，很少有研究调查不同年龄段的自杀风险。
本研究从台湾国民健康保险研究数据库中，识别出2000年1月1日至2019年12月31日期间的195787例精神分裂症患者。在研究期间，3848例患者死于自杀。我们计算了按年龄分层的自杀标准化死亡率（SMR）。在这项年龄分层的巢式病例对照研究中，采用风险集抽样按年龄、性别和首次诊断为精神分裂症的年份，为每个病例匹配4名存活对照。使用条件逻辑回归估计年龄分层的风险概况。
SMR在<25岁年龄组中最高（52.8），且与年龄呈负相关。在25至34岁、35至44岁、45至54岁和55至64岁年龄组中，失业与自杀风险增加有关。在所有年龄组中，精神分裂症自杀病例中自杀前的抑郁和睡眠障碍比对照组更常见。药物性和酒精性精神障碍与自杀显著相关，但仅在54岁以下年龄组中观察到。心脏病、肺炎和中度或重度肾病是65岁以下年龄组自杀的危险因素。
自杀的危险因素因年龄而异。本研究的结果可用于优化预防精神分裂症患者自杀的医疗干预措施。
