Østergaard Søren Dinesen, Momen Natalie C, Heide-Jørgensen Uffe, Plana-Ripoll Oleguer
Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
JAMA Psychiatry. 2024 Dec 1;81(12):1198-1206. doi: 10.1001/jamapsychiatry.2024.2561.
According to the World Health Organization, more than 700 000 individuals worldwide die by suicide each year. Medical conditions likely increase the risk of suicide.
To (1) provide age- and sex-specific pairwise estimates of the risk of suicide across a comprehensive range of medical conditions, (2) investigate whether there is a dose-response-like relationship at play (ie, the higher the disability burden due to medical morbidity, the higher the risk of suicide), and (3) determine if the risk of suicide with medical conditions is particularly pronounced among those who had mental disorder preceding the medical conditions.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was an observational study of population-based data for all individuals living in Denmark at some point between 2000 and 2020. The data analysis took place from September 2023 to May 2024.
Thirty-one specific medical conditions as well as prior mental disorder.
The main outcome was suicide. Associations between the 31 specific medical conditions, nested within 9 categories, and suicide were examined via Poisson regression, yielding incidence rate ratios (IRRs). Subsequent analyses included an interaction term to assess whether a previous hospital-treated mental disorder modified the associations. Finally, the association between the disability burden of medical conditions and suicide was examined for those with and without prior mental disorder, respectively.
A total of 6 635 857 individuals (3 337 613 females and 3 298 244 males) were included in the analyses of the associations between medical conditions and suicide. Except for endocrine disorders, all categories of medical conditions were associated with a statistically significant increased risk of suicide (which was most pronounced for gastrointestinal conditions [IRR, 1.7; 95% CI,1.5-1.8], cancer [IRR, 1.5; 95% CI, 1.4-1.6], and hematological conditions [IRR, 1.5; 95% CI, 1.3-1.6]). Interaction between mental disorder and individual medical conditions did not seem to play a major role for suicide risk. For those without but not for those with mental disorder, there was a dose-response-like relationship between the disability burden of medical conditions and suicide.
Medical conditions are generally associated with increased risk of suicide in a dose-response-like manner. Individuals with hospital-treated mental disorder appear to be at such elevated risk of suicide that additional disability associated with medical conditions has little impact in this regard.
根据世界卫生组织的数据，全球每年有超过70万人死于自杀。医疗状况可能会增加自杀风险。
（1）针对一系列广泛的医疗状况，提供按年龄和性别划分的自杀风险的两两估计值；（2）调查是否存在类似剂量反应的关系（即，由于医疗发病导致的残疾负担越高，自杀风险越高）；（3）确定在患有医疗状况之前就患有精神障碍的人群中，患有医疗状况时的自杀风险是否特别明显。
设计、背景和参与者：这项队列研究是一项基于丹麦2000年至2020年期间某个时间点所有居民的人口数据的观察性研究。数据分析于2023年9月至2024年5月进行。
31种特定的医疗状况以及既往精神障碍。
主要结局是自杀。通过泊松回归分析了9个类别中的31种特定医疗状况与自杀之间的关联，得出发病率比（IRR）。后续分析包括一个交互项，以评估既往住院治疗的精神障碍是否会改变这种关联。最后，分别检查了有和没有既往精神障碍的人群中，医疗状况的残疾负担与自杀之间的关联。
共有6635857人（3337613名女性和329824名男性）纳入了医疗状况与自杀关联的分析。除内分泌疾病外，所有类别的医疗状况都与自杀风险在统计学上显著增加相关（胃肠道疾病最为明显[IRR，1.7；95%CI，1.5 - 1.8]、癌症[IRR，1.5；95%CI，1.4 - 1.6]和血液系统疾病[IRR，1.5；95%CI，1.3 - 1.6]）。精神障碍与个体医疗状况之间的相互作用似乎对自杀风险没有主要影响。对于没有精神障碍的人而言，医疗状况的残疾负担与自杀之间存在类似剂量反应的关系，但对于有精神障碍的人则不然。
医疗状况通常以类似剂量反应的方式与自杀风险增加相关。接受过住院治疗的精神障碍患者的自杀风险似乎如此之高，以至于与医疗状况相关的额外残疾在这方面影响不大。
