Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
Psychiatry Res. 2024 Oct;340:116087. doi: 10.1016/j.psychres.2024.116087. Epub 2024 Jul 15.
The role of psychiatric comorbidity as a confounder between asthma and subsequent suicide mortality in adolescents remained unclarified.
This study used a 20-year community-based cohort in Taiwan. Adolescents aged 11 to 16 from 123 schools were classified into three subgroups: current asthma (symptoms present in the past year), previous asthma (history of asthma but no symptoms in the past year), and no asthma. The mortality and medical care utilizations until the end of follow-up in 2015 were obtained. Cox proportional hazard and competing risk models were performed. Different adjustment models that included covariates of demographic status, allergy, cigarette smoking, psychiatric diagnoses, alcohol or substance misuse, and attention deficit and hyperactivity disorders were compared.
During the follow-up, 285 out of 153,526 participants died from suicide. The crude hazard ratio for suicide was 1.95 (95 % CI=1.46∼2.60) in the current asthma subgroup and 2.01 (1.36∼2.97) in the previous asthma subgroup. The adjusted hazard ratios (aHR) attenuated to 1.67 (1.25∼2.24) and 1.72 (1.16∼2.54) respectively after further adjustment for all mental disorders, ADHD, substance, and alcohol use disorders.
Our adjustment analyses stratified by different models highlight evidence of asthma as an independent risk factor that predicts suicide among adolescents. Depression and mental disorders were potential confounders and identifications of asthma and psychiatric disorders might help decrease suicide risk.
精神共病作为哮喘与青少年后续自杀死亡之间的混杂因素的作用仍不清楚。
本研究使用了台湾一项为期 20 年的基于社区的队列研究。将 123 所学校的 11 至 16 岁青少年分为三组：当前哮喘（过去一年有症状）、既往哮喘（有哮喘病史但过去一年无症状）和无哮喘。获得了截至 2015 年随访结束时的死亡率和医疗保健利用情况。采用 Cox 比例风险和竞争风险模型进行分析。比较了包含人口统计学状况、过敏、吸烟、精神科诊断、酒精或物质滥用以及注意缺陷多动障碍等协变量的不同调整模型。
在随访期间，153526 名参与者中有 285 人死于自杀。当前哮喘组的自杀粗风险比为 1.95（95%CI=1.46∼2.60），既往哮喘组为 2.01（1.36∼2.97）。进一步调整所有精神障碍、ADHD、物质和酒精使用障碍后，调整后的风险比（aHR）分别减弱至 1.67（1.25∼2.24）和 1.72（1.16∼2.54）。
我们按不同模型进行的调整分析突出了哮喘作为独立风险因素的证据，可预测青少年自杀。抑郁和精神障碍可能是潜在的混杂因素，识别哮喘和精神障碍可能有助于降低自杀风险。
