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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参考文献(23)

[1]	YATHAM L N, CHAKRABARTY T, BOND D J, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations[J]. Bipolar Disord, 2021, 23(8): 767-788. doi: 10.1111/bdi.13135
[2]	MILLER J N, BLACK D W. Bipolar disorder and suicide: A review[J]. Curr Psychiatry Rep, 2020, 22(2): 6. doi: 10.1007/s11920-020-1130-0
[3]	KALTENBOECK A, WINKLER D, KASPER S. Bipolar and related disorders in DSM-5 and ICD-10[J]. CNS Spectr, 2016, 21(4): 318-323. doi: 10.1017/S1092852916000079
[4]	HAMILTON M. Development of a rating scale for primary depressive illness[J]. Br J Soc Clin Psychol, 1967, 6(4): 278-296. doi: 10.1111/j.2044-8260.1967.tb00530.x
[5]	THOMPSON E. Hamilton rating scale for anxiety(HAM-A)[J]. Occupational Medicine, 2015, 65(7): 601. doi: 10.1093/occmed/kqv054
[6]	COSTA L S, ALENCAR A P, NASCIMENTO N P, et al. Risk factors for suicide in bipolar disorder: A systematic review[J]. J Affect Disord, 2015, 170: 237-254. doi: 10.1016/j.jad.2014.09.003
[7]	DONG M, LU L, ZHANG L, et al. Prevalence of suicide attempts in bipolar disorder: A systematic review and meta-analysis of observational studies[J]. Epidemiol Psychiatr Sci, 2019, 29: e63.
[8]	BALDESSARINI R J, UNDURRAGA J, VAZQUEZ G H, et al. Predominant recurrence polarity among 928 adult international bipolar I disorder patients[J]. Acta Psychiatr Scand, 2012, 125(4): 293-302. doi: 10.1111/j.1600-0447.2011.01818.x
[9]	SCHAFFER A, ISOMETSA E T, TONDO L, et al. International Society for Bipolar Disorders Task Force on Suicide: Meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder[J]. Bipolar Disord, 2015, 17(1): 1-16. doi: 10.1111/bdi.12271
[10]	李鸿, 吕钦谕, 易正辉. 抑郁症合并焦虑症患者自杀态度调查及其与病情、应对方式的关系探讨[J]. 中华全科医学, 2019, 17(12): 2069-2071. doi: 10.16766/j.cnki.issn.1674-4152.001129 LI H, LYU Q Z, YI Z H. Investigation of suicide attitudes and its relationship with illness conditions and coping styles in patients with depression combined with anxiety disorder[J]. Chinese Journal of General Practice, 2019, 17(12): 2069-2071. doi: 10.16766/j.cnki.issn.1674-4152.001129
[11]	陈泓燕. 双相情感障碍患者自杀倾向的影响因素分析[J]. 现代诊断与治疗, 2021, 32(11): 1755-1756. https://www.cnki.com.cn/Article/CJFDTOTAL-XDZD202111037.htm CHEN H Y. Analysis of influencing factors of suicidal tendency in patients with bipolar disorder[J]. Modern Diagnosis and Treatment, 2021, 32(11): 1755-1756. https://www.cnki.com.cn/Article/CJFDTOTAL-XDZD202111037.htm
[12]	谷瀚星. 伴有精神病性症状的双相情感患者自杀风险的临床探索研究[D]. 大连: 大连医科大学, 2020. GU H X. Clinical exploration of suicide risk in bipolar patients with psychotic symptoms[D]. Dalian: Dalian Medical University, 2020.
[13]	PLANS L, BARROT C, NIETO E, et al. Association between completed suicide and bipolar disorder: A systematic review of the literature[J]. J Affect Disord, 2019, 242: 111-122. doi: 10.1016/j.jad.2018.08.054
[14]	时亚杰, 张校明, 王正, 等. 单相与双相抑郁障碍患者自杀未遂相关危险因素对照研究[J]. 精神医学杂志, 2021, 34(6): 552-556. doi: 10.3969/j.issn.2095-9346.2021.06.015 SHI Y J, ZHANG J M, WANG Z, et al. A comparative study of risk factors associated with attempted suicide in patients with unipolar depression and bipolar depression[J]. Journal of Psychiatry, 2021, 34(6): 552-556. doi: 10.3969/j.issn.2095-9346.2021.06.015
[15]	DOME P, RIHMER Z, GONDA X. Suicide risk in bipolar disorder: A brief review[J]. Medicina (Kaunas), 2019, 55(8): 403. doi: 10.3390/medicina55080403
[16]	胡丽, 王玲, 赵楠, 等. 双相抑郁患者药物规范化治疗的回顾性调查与分析[J]. 中国临床药学杂志, 2020, 29(1): 29-34. https://www.cnki.com.cn/Article/CJFDTOTAL-LCZZ202001007.htm HU L, WANG L, ZHAO N, et al. Retrospective investigation and analysis of standardized drug treatment for patients with bipolar depression[J]. Chinese Journal of Clinical Pharmacy, 2020, 29(1): 29-34. https://www.cnki.com.cn/Article/CJFDTOTAL-LCZZ202001007.htm
[17]	MALHI G S, OUTHRED T, DAS P, et al. Modeling suicide in bipolar disorders[J]. Bipolar Disord, 2018, 20(4): 334-348. doi: 10.1111/bdi.12622
[18]	OLFSON M, WALL M, WANG S, et al. Suicide following deliberate Self-Harm[J]. Am J Psychiatry, 2017, 174(8): 765-774. doi: 10.1176/appi.ajp.2017.16111288
[19]	邓荣, 杨健. 非自杀性自伤行为与自杀风险关系的纵向随访分析[J]. 国际精神病学杂志, 2021, 48(6): 984-986. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202106007.htm DENG R, YANG J. A longitudinal study on the relationship between non suicidal self injury and suicide risk[J]. Journal Of International Psychiatry, 2021, 48(6): 984-986. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202106007.htm
[20]	杨艳. 团体认知行为治疗对青少年双相抑郁患者抑郁症状、应对方式及家庭功能的影响[J]. 中华全科医学, 2021, 19(10): 1669-1672. doi: 10.16766/j.cnki.issn.1674-4152.002138 YANG Y. Effect of group cognitive behavioural therapy on depressive symptoms, coping styles and family functions in adolescents with bipolar depression[J]. Chinese Journal of General Practice, 2021, 19(10): 1669-1672. doi: 10.16766/j.cnki.issn.1674-4152.002138
[21]	邢志强, 李玲, 陈贻华. 双相情感障碍患者临床特征与甲状腺功能水平相关性分析[J]. 现代医院, 2019, 19(7): 1044-1045. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYU201907031.htm XING Z Q, LI L, CHEN Y H. Analysis of correlation between clinical features and thyroid function in patients with bipolar disorder[J]. Modern Hospitals, 2019, 19(7): 1044-1045. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYU201907031.htm
[22]	BARBUTI M, CARVALHO A F, KOHLER C A, et al. Thyroid autoimmunity in bipolar disorder: A systematic review[J]. J Affect Disord, 2017, 221: 97-106.
[23]	肖樱艳, 李迪, 李艳. 心境障碍患者自杀倾向与血清FT3、FT4和TSH水平的关系[J]. 武汉大学学报(医学版), 2019, 40(5): 786-790. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYK201905019.htm XIAO Y Y, LI D, LI Y. Correlation between suicidal tendencies and the levels of FT3, FT4, and TSH in patients with mood disorders[J]. Medical Journal of Wuhan University, 2019, 40(5): 786-790. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYK201905019.htm