伴忧郁特征抑郁症患者自杀未遂的危险因素

Abstract

目的分析伴忧郁特征抑郁症患者发生自杀未遂的社会人口学及临床特征方面危险因素。方法来自全国13个研究中心的626例伴忧郁特征抑郁症患者,通过简明国际神经精神访谈(Mini International Neuropsychiatric Interview,MINI)5.0中文版自杀模块评估,分为自杀未遂组和无自杀未遂组。采用多因素logistic回归,分析伴忧郁特征抑郁症患者在社会人口学及临床特征方面可能与自杀未遂相关的因素。结果伴忧郁特征抑郁症患者自杀未遂的发生率为19.2%(120/626)。自杀未遂组相较无自杀未遂组的患者,既往住院次数多,抑郁发作频繁,更常伴非典型症状、伴自杀观念、伴不切实际的罪恶感,更多患者接受抗抑郁剂治疗(均P<0.05)。logistic回归分析显示,抑郁发作频繁(OR=2.06,95%CI:1.23～3.47)、伴自杀观念(OR=2.34,95%CI:1.44～3.79)、既往住院次数多(OR=1.21,95%CI:1.04～1.42)、伴不切实际的罪恶感(OR=2.21,95%CI:1.38～3.54)与伴忧郁特征抑郁症患者的自杀未遂相关联(均P<0.05)。结论发作频繁、既往住院次数多、有自杀观念或伴不切实际的罪恶感可能是伴忧郁特征抑郁症患者自杀未遂的危险因素。

Objective To analyze the risk factors for suicidal attempt regarding socio-demographic and clinical characteristics in major depressive disorder(MDD) patients with melancholic features. Methods The data were obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China, which was initiated by the Chinese Society of Psychiatry(CSP) and conducted in 13 major psychiatric hospitals or the psychiatric units of general hospitals. A total of 626 patients were diagnosed as melancholia depression based on the melancholic features module of Mini International Neuropsychiatric Interview(MINI). These patients were classified as suicide and non-suicide attempt groups according to the suicide module of MINI. Comparison was made on difference of the socio-demographic and clinical characteristics between the two groups. Results Among melancholia MDD patients, 120(19.2%) of them had suicide attempt. Compared to the non-suicide attempters, the attempters had more numbers of admissions and frequent depressive episodes, more atypical features, more suicide ideation, more antidepressant use, and more excessive or inappropriate guilt(P <0.05). Logistic regression analysis showed that frequent depressive episodes(OR =2.06, 95% CI:1.23～3.47), numbers of admissions(OR=1.21, 95%CI:1.04～1.42), comorbid suicidal ideation(OR=2.34, 95%CI:1.44～3.79) and excessive or inappropriate guilt(OR =2.21, 95% CI:1.38 ～3.54) were associated with suicidal attempt in melancholia MDD patients. Conclusion Frequent depressive episodes, high comorbid with suicide ideation and number of admissions as well as excessive or inappropriate guilt may be the risk factors for suicidal attempt in melancholia MDD patients.