Beautrais A L, Joyce P R, Mulder R T
Canterbury Suicide Project, Christchurch, School of Medicine, New Zealand.
Psychol Med. 1998 Jan;28(1):209-18. doi: 10.1017/s0033291797005990.
This study used a case-control design to examine the association between unemployment and risk of medically serious suicide attempt.
A sample of 302 individuals who made serious suicide attempts was contrasted with 1028 randomly selected community control subjects.
Individuals who made serious suicide attempts reported higher rates of current unemployment (OR = 4.2) than control subjects. This association was similar for males and females. However, even before adjustment for confounding factors it was evident that exposure to unemployment made only a small contribution to suicide attempt risk. The population attributable risk for exposure to unemployment was 7.3%. After adjustment for antecedent childhood, family and educational factors the association between unemployment and risk of serious suicide attempt was reduced but remained significant (OR = 2.1), suggesting that common antecedent factors made a large contribution to risks of both unemployment and serious suicide attempt. When both antecedent family and childhood factors, and psychiatric morbidity were taken into account, unemployment was not significantly related to risks of serious suicide attempt.
The results of this study provide support for the contention that much of the association between unemployment and suicidal behaviour is non-causal, and reflects common or correlated factors that contribute to risks of both unemployment and suicidal behaviour. Any remaining association between unemployment and suicide attempt risk appears to arise from the correlation that exists between unemployment and psychiatric disorder.
本研究采用病例对照设计,以检验失业与严重自杀未遂风险之间的关联。
将302例有严重自杀未遂行为的个体样本与1028例随机选取的社区对照对象进行对比。
有严重自杀未遂行为的个体报告的当前失业率(比值比=4.2)高于对照对象。这种关联在男性和女性中相似。然而,即使在对混杂因素进行调整之前,明显的是,失业对自杀未遂风险的影响很小。失业的人群归因风险为7.3%。在对童年、家庭和教育等先前因素进行调整后,失业与严重自杀未遂风险之间的关联有所降低,但仍然显著(比值比=2.1),这表明常见的先前因素对失业和严重自杀未遂风险都有很大影响。当同时考虑先前的家庭和童年因素以及精神疾病发病率时,失业与严重自杀未遂风险没有显著关联。
本研究结果支持这样的观点,即失业与自杀行为之间的大部分关联是非因果性的,反映了导致失业和自杀行为风险的共同或相关因素。失业与自杀未遂风险之间任何剩余的关联似乎都源于失业与精神障碍之间存在的相关性。