Hawton K, Fagg J, Platt S, Hawkins M
University Department of Psychiatry, Warneford Hospital, Oxford.
BMJ. 1993 Jun 19;306(6893):1641-4. doi: 10.1136/bmj.306.6893.1641.
To determine factors associated with completed suicide in young parasuicide patients.
Case-control study.
Regional poisoning treatment centre in a teaching general hospital.
Patients who, between 1968 and 1985 when aged 15-24 years, were admitted to the regional poisoning treatment centre because of deliberate self poisoning or self injury. Cases (n = 62) consisted of those who by the end of 1985 had died locally from either suicide (n = 41) or possible suicide (n = 21). Controls (n = 124) were patients who were known not to have died locally during the study period. Two controls were selected for each case, matched by sex, age (within two years), and length of follow up.
Possible predictors of completed suicide.
Univariate analysis (conditional logistic regression) showed that risk of death due to suicide and possible suicide was associated with six factors: social class V (odds ratio 2.7, 95% confidence interval 1.1 to 6.7), unemployment (2.8, 1.4 to 5.8), previous inpatient psychiatric treatment (4.9, 2.2 to 10.9), substance misuse (3.3, 1.6 to 6.8), personality disorder (2.1, 1.03 to 4.4), and previous attempted suicide (2.3, 1.2 to 4.4). Multivariate analysis identified two factors as significantly contributing to the model that best discriminated between the cases and controls: substance misuse (alcohol or drugs, or both) (adjusted odds ratio 3.9) and previous inpatient psychiatric treatment (3.7). These factors seemed to be associated with suicide after attempted suicide in both the short term (less than 12 months) and the long term (one year or more) and were also identified when the analysis was restricted to subjects who definitely died by suicide and their controls.
Suicide after parasuicide in young people is associated with substance misuse. This suggests that prevention of suicide in young people who attempt suicide might be improved by close liaison between general hospital services for patients who have attempted suicide and services for young substance misusers and by measures aimed at preventing substance misuse in young people.
确定与年轻的蓄意自伤患者最终自杀相关的因素。
病例对照研究。
一所教学综合医院的地区中毒治疗中心。
1968年至1985年间，年龄在15至24岁因蓄意自我中毒或自我伤害而入住地区中毒治疗中心的患者。病例组（n = 62）包括那些截至1985年底在当地死于自杀（n = 41）或可能自杀（n = 21）的患者。对照组（n = 124）是在研究期间已知未在当地死亡的患者。为每个病例选择两名对照，按性别、年龄（相差两年内）和随访时间进行匹配。
最终自杀的可能预测因素。
单因素分析（条件逻辑回归）显示，自杀及可能自杀导致死亡的风险与六个因素相关：社会阶层V（比值比2.7，95%置信区间1.1至6.7）、失业（2.8，1.4至5.8）、既往住院精神科治疗史（4.9，2.2至10.9）、物质滥用（3.3，1.6至6.8）、人格障碍（2.1，1.03至4.4）以及既往自杀未遂史（2.3，1.2至4.4）。多因素分析确定了两个因素对最能区分病例组和对照组的模型有显著贡献：物质滥用（酒精或药物，或两者兼有）（调整后比值比3.9）和既往住院精神科治疗史（3.7）。这些因素似乎在短期（少于12个月）和长期（一年或更长时间）自杀未遂后均与自杀相关，并且在分析仅限于明确死于自杀的受试者及其对照时也被识别出来。
年轻人蓄意自伤后的自杀与物质滥用有关。这表明，通过综合医院为自杀未遂患者提供的服务与为年轻物质滥用者提供的服务之间的密切联络，以及采取旨在预防年轻人物质滥用的措施，可能会改善对有自杀未遂行为的年轻人的自杀预防工作。
