Holley H L, Fick G, Love E J
Department of Community Health & Epidemiology, Queen's University, Kingston, Ontario, Canada.
Soc Psychiatry Psychiatr Epidemiol. 1998 Nov;33(11):543-51. doi: 10.1007/s001270050092.
This study contributes a Canadian perspective to a growing body of international studies examining suicide among cohorts of suicide attempters, and a much more limited literature on the epidemiology of suicide in Canada. We evaluated the 13-year mortality experience of a regional cohort of 876 first-ever inpatient hospital admissions for a suicide attempt admitted between 1979 and 1981. Compared to the general population, study subjects were 4 times more likely to die of any cause, but 25 times more likely to commit suicide and 15 times more likely to die of accidental or adverse causes. Ten years after then first hospitalization for attempted suicide, 5.9% of study subjects had committed suicide. Baseline age appeared to be a risk factor for women, but not for men. Women under 60 years had the best 10-year survival (3.6% had committed suicide) and women over 60 years had the poorest (17.5%). A total of 8.7% of men under 60 years and 10% of those over 60 years committed suicide within 10 years. The remainder of the analysis focused on those under 60 years of age at the time of their index inpatient hospitalization. Three factors were prognostic for suicide: being male, which had a relative risk (RR) of 5.0, living in a lower income area (RR = 3.2), and having used a violent method during the index attempt (RR = 2.5). The periods of greatest risk for suicide were within the 1st and 4th years following first-ever inpatient hospitalization, with the 4th year representing the time of highest risk. The identification of time periods subsequent to first-ever hospitalization when patients are at greatest risk of suicide can be used to guide the timing and duration of clinical interventions and aftercare to ensure that patients are appropriately supported during periods of highest risk.
本研究为日益增多的关于自杀未遂人群自杀情况的国际研究提供了加拿大视角，也为加拿大自杀流行病学领域更为有限的文献做出了贡献。我们评估了1979年至1981年间首次因自杀未遂而住院的876名患者组成的区域队列的13年死亡情况。与普通人群相比，研究对象死于任何原因的可能性高出4倍，但自杀的可能性高出25倍，死于意外或不良原因的可能性高出15倍。首次因自杀未遂住院十年后，5.9%的研究对象自杀。基线年龄似乎是女性的一个风险因素，但对男性不是。60岁以下女性的10年生存率最佳（3.6%自杀），60岁以上女性最差（17.5%）。60岁以下男性中有8.7%，60岁以上男性中有10%在10年内自杀。分析的其余部分聚焦于首次住院时年龄在60岁以下的人群。有三个因素对自杀具有预后意义：男性，相对风险（RR）为5.0；生活在低收入地区（RR = 3.2）；以及在首次自杀未遂时使用了暴力手段（RR = 2.5）。自杀风险最高的时期是首次住院后的第1年和第4年，第4年风险最高。确定首次住院后患者自杀风险最高的时间段，可用于指导临床干预和后续护理的时间及持续时间，以确保患者在风险最高的时期得到适当的支持。
