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• 青少年抑郁障碍 •
ENGLISH ABSTRACT
青少年抑郁症住院患者自杀行为发生率及其相关风险因素分析
彭婉嫕
邓金平
刘惟蜻
冀二妮
何红波
作者及单位信息
·
DOI： 10.3760/cma.j.cn113661-20230818-00038
Study on the incidence of suicidal behavior and related risk factors in adolescents with depression
Peng Wanyi
Deng Jinping
Liu Weiqing
Ji Erni
He Hongbo
Authors Info & Affiliations
Peng Wanyi
Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518000, China
Deng Jinping
Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518000, China
Liu Weiqing
Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518000, China
Ji Erni
Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518000, China
He Hongbo
Guangdong General Hospital/Guangdong Provincial Mental Health Center, Guangzhou 510120, China
·
DOI： 10.3760/cma.j.cn113661-20230818-00038
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摘要

目的探究青少年抑郁症住院患者的自杀行为发生率及其相关风险因素。

方法回顾性分析2016年1月至2022年12月深圳市康宁医院收治的442例青少年抑郁症住院患者的病例资料，男64例，女358例，年龄10~17岁。以入院当天的简明国际神经精神访谈（International Neuropsychiatric Interview，MINI）自杀模块评估结果为指标，根据既往1个月内是否有自杀行为分为自杀未遂组（ n=140）和非自杀未遂组（ n=302）。比较2组患者的社会人口特征、临床特征、内分泌指标及艾森克个性测验（Eysenck Personality Questionnaire，EPQ）、家庭环境量表简式中文版（The Chinese Version of Family Environment Scale Symptoms Questionnaire，FES-F）、青少年生活事件量表（Adolescent Self-rating Life Events Checklist，ASLEC）、童年期虐待问卷（Childhood Trauma Questionnaire，CTQ）、青少年多维焦虑量表（The Multidimensional Anxiety Scale for Children，MASC）、儿童抑郁量表（Child Depression Inventory，CDI）的评分。使用logistic回归分析近1个月内自杀行为的风险因素。

结果青少年抑郁症住院患者入院前1个月内的自杀行为发生率为31.67%（140/442），既往总体自杀行为发生率为53.8%（238/442）。相比非自杀未遂组患者，自杀未遂组患者在精神病性症状、共病躯体疾病、既往有过自杀行为更常见，分别为46%（64/140）比26%（77/302）、34%（47/140）比21%（65/302）、81%（114/140）比32%（98/302）（χ 2=18.00、7.34、91.94，均 P<0.05）。量表评分方面，自杀未遂组患者比非自杀未遂组患者，ASLEC中的健康适应因子得分更高［ M（ Q 1， Q 3）］［6（4，9）比5（3，8）］（χ 2=2.13， P<0.05）；MASC中的躯体症状因子得分更高［26（19.25，31）比24（16，29）］（χ 2=2.50， P<0.05）；CDI中的负性情绪、低自尊、人际问题因子得分以及CDI总分评分也更高（χ 2=2.35、2.96、2.09、2.17；均 P<0.05）。回归分析显示，精神病性症状（ OR=1.85，95% CI：1.13~3.02）、共病躯体疾病（ OR=1.85，95% CI：1.09~3.14）、既往有过自杀行为（ OR=8.34，95% CI：5.01~13.88）是近1个月内自杀行为的风险因素（均 P<0.05）。

结论青少年抑郁症住院患者入院前1个月的自杀行为发生率和既往总体自杀行为发生率较高。既往有过自杀行为、存在精神病性症状、共病躯体疾病是近1个月内自杀行为的风险因素。

抑郁症;青少年;自杀行为;发生率;风险因素;精神病性症状;共病躯体疾病
ABSTRACT

ObjectiveTo investigate the prevalence of suicidal behaviors and their associated risk factors among adolescent inpatients with depression.

MethodsA retrospective analysis of the medical records of 442 adolescent inpatients diagnosed with depression at Shenzhen Kangning Hospital from January 2016 to December 2022 was conducted. Among them, 64 were male and 358 were female. They range in age from 10 to 17. The MINI suicidal module assessment on the day of admission was employed. Based on the presence or absence of suicidal behavior in the past month, patients were divided into the attempted suicide group ( n=140) and the non-attempted suicide group ( n=302). Comparative analysis was performed on the sociodemographic characteristics, clinical features, endocrinological indices, and scores from the Eysenck Personality Questionnaire (EPQ), Short Form of the Family Environment Scale (FES-F), Adolescent Self-Rating Life Events Checklist (ASLEC), Childhood Trauma Questionnaire (CTQ), Multidimensional Anxiety Scale for Children (MASC), and Child Depression Inventory (CDI) between the two groups. Logistic regression was utilized to identify risk factors associated with suicidal behavior.

ResultsThe prevalence of suicidal behavior in the past month among adolescent inpatients with depression was 31.67% (140/442), and the lifetime prevalence was 53.8% (238/442). Compared to patients in the non-suicidal attempt group, those in the suicidal attempt group showed higher occurrences of psychotic symptoms, comorbid physical diseases, and past suicidal behaviors, respectively, at 46% (64/140) vs 26%(77/302), 34%(47/140) vs 21%(65/302), and 81% (114/140) vs 32%(98/302) (χ 2=18.00, 7.34, 91.94; all P<0.05). In terms of scale scores, patients in the suicidal attempt group, compared to those in the non-suicidal attempt group, had higher scores in the health adaptation factor in ASLEC, with[ M( Q 1, Q 3)] 6 (4, 9) vs 5(3, 8) (χ 2=2.13, P<0.05); higher scores in the somatic symptom factor in MASC, with 26 (19.25, 31) vs 24 (16, 29) (χ 2=2.50; P<0.05); and higher scores in the negative emotions, low self-esteem, interpersonal problems factors, and overall CDI score (χ 2=2.35; P<0.05). Regression analysis showed that psychotic symptoms ( OR=1.85, 95% CI: 1.13-3.02), comorbid physical illnesses ( OR=1.85, 95% CI: 1.09-3.14), and past suicidal behaviors ( OR=8.34, 95% CI: 5.01-13.88) were risk factors for recent suicidal behavior (all P<0.05).

ConclusionsAmong adolescent inpatients with depression, the past-month suicidal behavior and any suicidal behaviors in the past are pretty high. Previous suicidal behavior, presence of psychotic symptoms, and comorbid physical disease could be the risk factors for near-future suicidal behavior.

Depressive disorder;Adolescents;Suicidal behavior;Incidence;Risk factors;Psychotic symptoms;Comorbid somatic diseases
He Hongbo, Email: mocdef.6ab212tulgv
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引用本文

彭婉嫕,邓金平,刘惟蜻,等. 青少年抑郁症住院患者自杀行为发生率及其相关风险因素分析[J]. 中华精神科杂志,2024,57(01)：33-40.

DOI:10.3760/cma.j.cn113661-20230818-00038

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青少年自杀是一个日益严重的问题，与多种因素有关，如曾经的自杀企图、性虐待经历和自杀行为的家族史 ［ 1 , 2 , 3 ］ 。失眠、绝望和消极经历也可能导致自杀 ［ 4 ］ 。但最为明显的风险是精神疾病，尤其是抑郁症 ［ 3 ， 5 ］ ，其可能导致幻觉、妄想和自杀 ［ 6 ］ 。研究表明，抑郁症的自杀率为4%~10.6% ［ 7 ］ 。青少年期是精神疾病的高发期，尤其是抑郁症 ［ 8 ］ 。据一项Meta分析研究结果显示全球青少年抑郁障碍的流行率为 8%（95% CI：2%~13%） ［ 9 ］ ，该疾病会降低生活质量并增加自杀风险 ［ 10 ］ 。住院青少年抑郁症患者的自杀风险尤其高，其自杀率是一般人群的25倍，甚至可能更高 ［ 11 , 12 ］ 。
自杀行为的生物学机制尚未明确。研究表明，血液中的激素水平与自杀有关 ［ 13 , 14 , 15 ］ 。Meta分析发现，促甲状腺激素（thyroid stimulating hormone，TSH）与自杀企图有关 ［ 13 ］ 。一项大型样本研究指出，有自杀企图的抑郁症患者血清中TSH、总胆固醇（total cholesterol，TC）、甘油三酯（triglycerides，TG）和低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-C）水平相较于无自杀企图的抑郁症患者差异具有统计学意义 ［ 15 ］ 。这些参数可能是抑郁症患者自杀风险的生物指标，并强调了血脂和甲状腺功能参数的重要性。另一研究发现，青少年抑郁症患者的自杀未遂与TSH和LDL-C水平相关，并建议定期检测 ［ 14 ］ 。了解抑郁症患者住院自杀风险因素是解决这一公共卫生的关键 ［ 16 ］ 。先前研究虽探讨了自杀与多种因素的关系，但少有涉及青少年抑郁症住院患者。本研究通过大样本的回顾性分析，旨在分析这一特定群体的自杀风险因素，为临床提供更多干预线索，以期望降低这一群体的自杀风险。
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备注信息
A
何红波，Email： mocdef.6ab212tulgv
B

何红波：研究指导、论文修改、经费支持；彭婉嫕：试验设计、统计学分析、论文撰写；邓金平、刘惟蜻、冀二妮：数据收集、临床支持

C
彭婉嫕, 邓金平, 刘惟蜻, 等. 青少年抑郁症住院患者自杀行为发生率及其相关风险因素分析[J]. 中华精神科杂志, 2024, 57(1): 33-40. DOI: 10.3760/cma.j.cn113661-20230818-00038.
D
所有作者声明无利益冲突
E
广东省高水平临床重点专科 (SZGSP013)
深圳市医学重点学科建设经费 (SZXK043)
广州市卫生健康科技项目 (2022A0310030)
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