双相情感障碍抑郁发作患者自杀行为危险因素分析

孙世帮; 朱春燕; 夏泳

doi:10.16766/j.cnki.issn.1674-4152.002586

双相情感障碍抑郁发作患者自杀行为危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002586

浙江大学附属精神卫生中心，杭州市第七人民医院精神科，浙江杭州 310013

基金项目:

浙江省卫生健康科技计划项目 2021KY914

详细信息

通讯作者:
孙世帮, E-mail: sunshibang@yeah.net

中图分类号: R749R395.2
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出版历程
- 收稿日期: 2022-03-08

Risk factors for suicidal behaviour in patients with depressive episodes of bipolar disorder

Department of Psychiatry, Mental Health Centre Affiliated to Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang 310013, China

摘要

摘要: 目的自杀是双相情感障碍抑郁发作患者高死亡率的关键因素之一，本研究探讨双相情感障碍抑郁发作患者自杀行为的危险因素，以期减少该类患者自杀行为的发生。方法采用横截面研究的方法，纳入2018年1月—2021年12月在杭州市第七人民医院住院治疗的182例双相情感障碍抑郁发作患者，根据有无自杀行为分为伴自杀行为组(80例)和不伴自杀行为组(102例)，分别比较2组患者人口学特征、临床特征及甲状腺功能指标，将差异有统计学意义的因素纳入二分类logistic回归模型，分析双相情感障碍抑郁发作患者自杀行为的危险因素。结果与不伴自杀行为组比较，伴自杀行为组年龄、首次发病年龄更低，既往自杀未遂次数、既往非自杀性自伤次数更高，既往有自杀未遂行为、既往有非自杀性自伤行为的比例更高，外周血游离三碘甲状腺原氨酸(FT3)、总三碘甲状腺原氨酸(TT3)水平更低(均P＜0.05)；Logistic回归分析显示，既往存在自杀未遂行为(OR=3.399)、既往存在非自杀性自伤行为(OR=4.190)是双相情感障碍重度抑郁发作患者自杀行为的危险因素；较大的首发年龄(OR=0.874)、较高的FT3(OR=0.153)是该类患者自杀行为的保护因素(均P < 0.05)。结论既往自杀未遂行为、既往非自杀性自伤行为是双相抑郁患者自杀行为的风险因子，较大的首发年龄、较高的FT3为保护因子，在临床需加以关注。
- 双相抑郁 /
- 自杀行为 /
- 风险因素
Abstract: Objective Suicide is one of the key factors for high mortality in patients with depressive episodes of bipolar disorder. This study explored the risk factors of suicidal behaviour in patients with depressive episodes of bipolar disorder to reduce the occurrence of suicidal behaviour in such patients. Methods Using the method of cross-sectional study, 182 patients with depressive episodes of bipolar disorder who were hospitalised in Hangzhou Seventh People's Hospital from January 2018 to December 2021 were enrolled. They were classified into the suicidal behaviour group (n=80) and non-suicide behaviour group (n=102). The demographic characteristics, clinical features and thyroid function parameters of the two groups were compared. The statistically significant factors were analysed by logistic regression to determine the risk factors of suicidal behaviour in patients with depressive episodes of bipolar disorder. Results Compared with the non-suicide behaviour group, the suicidal behaviour group showed decreased age and age of onset, the number of previous suicide attempts, the number of non-suicidal self-injury in the past were higher. The proportion of previous suicide attempts and non-suicidal self-injury in the past was higher. The levels of free triiodothyronine (FT3) and total triiodothyronine (TT3) in peripheral blood were lower (all P < 0.05). Binary logistic regression showed, previous suicide attempt (OR=3.399), and non-suicidal self-injury (OR=4.190) were risk factors for suicidal behaviour in patients with bipolar in patients with major depressive episode of bipolar disorder, older age at first onset (OR=0.874) and higher FT3 (OR=0.153) were protective factors (all P < 0.05). Conclusion Previous attempted suicide behavior and previous non-suicidal self-injury behavior were risk factors of suicidal behavior in bipolar depression patients. Older age at first onset and higher FT3 were protective factors, which need to be paid attention to in clinic.
- Bipolar depression /
- Suicidal behaviour /
- Risk factors
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表 1 2组双相情感障碍抑郁发作患者社会人口学、临床资料及实验室资料比较

Table 1. Sociodemographic, clinical and laboratory data of bipolar disorder patients with depressive episode were compared between the two groups

项目	伴自杀行为组(n=80)	不伴自杀行为组(n=102)	统计量	P值
性别(男/女，例)	17/63	32/70	2.335^a	0.126
年龄(x ±s, 岁)	23.39±10.70	29.75±11.33	-3.849^b	＜0.001
首发年龄(x ±s, 岁)	17.64±5.72	24.55±9.17	-5.902^b	＜0.001
职业状态(有/无，例)	44/36	55/47	0.021^a	0.885
伴侣(有/无，例)	32/48	48/54	0.907^a	0.341
家庭关系(好/坏，例)	42/38	56/46	0.104^a	0.747
家族史(有/无，例)	7/73	11/91	0.208^a	0.648
既往有无自杀未遂(有/无，例)	24/56	10/92	12.038^a	＜0.001
既往自杀未遂次数[ M(P₂₅, P₇₅)，次]	0(0，1)	0(0，0)	-3.515^c	＜0.001
既往有无非自杀性自伤(有/无，例)	40/40	18/84	21.614^a	＜0.001
既往非自杀性自伤次数[ M(P₂₅, P₇₅)，次]	0.5(0，2)	0(0，0)	-4.499^c	＜0.001
伴有精神症状(有/无，例)	24/56	26/76	0.458^a	0.499
TSH[ M(P₂₅, P₇₅), mIU/L]	1.72(0.92，2.45)	1.56(1.08，2.52)	-0.089^c	0.929
TT4[ M(P₂₅, P₇₅), pmol/L]	87.35(72.78，100.80)	90.50(79.43，101.15)	-1.433^c	0.152
FT4[ M(P₂₅, P₇₅), pmol/L]	15.61(13.64，13.92)	15.62(13.92，17.68)	-0.496^c	0.620
TT3[ M(P₂₅, P₇₅), pmol/L]	1.47(1.23，1.72)	1.54(1.43，1.79)	-2.295^c	0.022
FT3[ M(P₂₅, P₇₅), pmol/L]	4.71(4.20，5.26)	5.04(4.59，5.39)	-2.048^c	0.041
HAMD-24(x ±s, 分)	26.73±2.65	24.30±2.16	3.631^b	＜0.001
HAMD-23(x ±s, 分)	22.73±2.65	22.95±2.15	-1.134^b	0.754
HAMA-14(x ±s, 分)	24.93±7.54	24.17±4.75	0.828^b	0.409
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 双相情感障碍重度抑郁发作患者自杀行为二元logistic回归分析

Table 2. Bipolar disorder in patients with severe depressive episode suicide binary logistic regression analysis

变量	B	SE	Wald χ²	P值	OR值	95% CI
首发年龄	-0.135	0.029	21.886	＜0.001	0.874	0.826~0.925
既往存在自杀未遂行为	1.224	0.491	6.217	0.013	3.399	1.299~8.893
既往存在非自杀性自伤行为	1.433	0.396	13.114	＜0.001	4.190	1.930~9.100
FT3	-1.875	0.625	8.990	0.003	0.153	0.045~0.522

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