Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder.

IF 22.5 1区 医学 Q1 PSYCHIATRY JAMA Psychiatry Pub Date : 2024-09-04 DOI:10.1001/jamapsychiatry.2024.2561
Søren Dinesen Østergaard, Natalie C Momen, Uffe Heide-Jørgensen, Oleguer Plana-Ripoll
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Abstract

Importance: According to the World Health Organization, more than 700 000 individuals worldwide die by suicide each year. Medical conditions likely increase the risk of suicide.

Objective: To (1) provide age- and sex-specific pairwise estimates of the risk of suicide across a comprehensive range of medical conditions, (2) investigate whether there is a dose-response-like relationship at play (ie, the higher the disability burden due to medical morbidity, the higher the risk of suicide), and (3) determine if the risk of suicide with medical conditions is particularly pronounced among those who had mental disorder preceding the medical conditions.

Design, setting, and participants: This cohort study was an observational study of population-based data for all individuals living in Denmark at some point between 2000 and 2020. The data analysis took place from September 2023 to May 2024.

Exposures: Thirty-one specific medical conditions as well as prior mental disorder.

Main outcomes and measures: The main outcome was suicide. Associations between the 31 specific medical conditions, nested within 9 categories, and suicide were examined via Poisson regression, yielding incidence rate ratios (IRRs). Subsequent analyses included an interaction term to assess whether a previous hospital-treated mental disorder modified the associations. Finally, the association between the disability burden of medical conditions and suicide was examined for those with and without prior mental disorder, respectively.

Results: A total of 6 635 857 individuals (3 337 613 females and 3 298 244 males) were included in the analyses of the associations between medical conditions and suicide. Except for endocrine disorders, all categories of medical conditions were associated with a statistically significant increased risk of suicide (which was most pronounced for gastrointestinal conditions [IRR, 1.7; 95% CI,1.5-1.8], cancer [IRR, 1.5; 95% CI, 1.4-1.6], and hematological conditions [IRR, 1.5; 95% CI, 1.3-1.6]). Interaction between mental disorder and individual medical conditions did not seem to play a major role for suicide risk. For those without but not for those with mental disorder, there was a dose-response-like relationship between the disability burden of medical conditions and suicide.

Conclusions and relevance: Medical conditions are generally associated with increased risk of suicide in a dose-response-like manner. Individuals with hospital-treated mental disorder appear to be at such elevated risk of suicide that additional disability associated with medical conditions has little impact in this regard.

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各种医疗状况下的自杀风险以及先前精神障碍的作用。
重要性:据世界卫生组织统计,全世界每年有 70 多万人死于自杀。医疗条件可能会增加自杀风险:目的:(1) 对各种医疗状况下的自杀风险进行按年龄和性别配对的估算;(2) 研究是否存在剂量-反应关系(即医疗疾病导致的残疾负担越重,自杀风险越高);(3) 确定医疗状况导致的自杀风险是否在医疗状况之前患有精神障碍的人群中尤为明显:这项队列研究是一项基于人口数据的观察性研究,研究对象是 2000 年至 2020 年间居住在丹麦的所有人。数据分析时间为 2023 年 9 月至 2024 年 5 月:主要结果和测量指标:主要结果是自杀:主要结果是自杀。通过泊松回归检验了 31 种特定病症(嵌套在 9 个类别中)与自杀之间的关联,得出了发病率比 (IRR)。随后的分析中加入了交互项,以评估曾在医院接受过治疗的精神障碍是否会改变两者之间的关系。最后,我们还分别研究了曾患有和未患有精神障碍的患者的医疗条件残疾负担与自杀之间的关联:共有 6 635 857 人(女性 3 337 613 人,男性 3 298 244 人)参与了病情与自杀之间的关联分析。除内分泌失调外,所有类别的病症都与自杀风险的增加有显著的统计学关联(其中胃肠道疾病[IRR,1.7;95% CI,1.5-1.8]、癌症[IRR,1.5;95% CI,1.4-1.6]和血液病[IRR,1.5;95% CI,1.3-1.6]最为明显)。精神障碍与个体医疗条件之间的相互作用似乎并没有对自杀风险产生重大影响。对于没有精神障碍的人来说,医疗条件的残疾负担与自杀之间存在剂量-反应关系,而对于有精神障碍的人来说则没有这种关系:医疗状况通常与自杀风险的增加呈剂量反应关系。接受过医院治疗的精神障碍患者的自杀风险似乎很高,因此与医疗状况相关的额外残疾对其影响不大。
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来源期刊
JAMA Psychiatry
JAMA Psychiatry PSYCHIATRY-
CiteScore
30.60
自引率
1.90%
发文量
233
期刊介绍: JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.
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