BMC Psychiatry最新文献

Background: The period immediately following psychiatric inpatient care is recognized as a time of elevated risk of suicide, yet little is known about factors that influence how soon suicide occurs after discharge.

Aim: To examine the timing of suicide among persons after psychiatric discharge and identify sociodemographic and clinical factors associated with a shorter time to death by suicide.

Methods: We included all adults in Sweden who died by suicide in 2015 and who had been discharged from psychiatric inpatient care during the last three months of life (n = 140). Sociodemographic and clinical variables were extracted from electronic medical records, including contextual factors from the last hospitalization (involuntary care, documented suicide risk, unplanned discharge). Time to suicide was modelled using stratified Cox proportional hazards regression.

Results: The median time from discharge to death was 32 days. Older age was the only background factor independently associated with a shorter time to suicide; each additional 10 years of age was associated with shorter time to suicide, as indicated by an increased unadjusted hazard ratio (uHR) of 1.26 (95% CI: 1.12-14.2, p < .001). A diagnosed neurotic, stress-related and somatoform disorder (ICD-10 code F40-F49) was associated with a longer time to suicide (uHR = 0.68 (0.47-0.98), p = .036), although this association was not statistically significant when adjusting for age (aHR 0.82, 0.56-1.20, p = .310). Previous suicide attempts, sex, substance use disorder and depressive disorders were not associated with time to suicide. Neither involuntary care nor the presence or absence of a formal suicide risk assessment during inpatient stay predicted earlier suicide. Unplanned discharges were likewise unrelated to the time to suicide.

Conclusions: Among people who died by suicide within three months of psychiatric discharge, only older age independently predicted a shorter time to suicide. The absence of clear signals-particularly from routinely collected risk assessments-suggests that timely, universal follow-up may be more appropriate than attempts to target aftercare on the basis of standard risk markers.

Clinical trial number: Not applicable.

Background: Hazardous alcohol use frequently occurs among individuals with psychiatric disorders and may complicate clinical outcomes. However, there is limited evidence on its prevalence and associated factors in Sub-Saharan African psychiatric outpatient settings. This study aimed to estimate the prevalence of hazardous alcohol use and identify associated sociodemographic and clinical factors among patients receiving psychiatric care in Kinshasa, Democratic Republic of the Congo.

Methods: A cross-sectional analytical study was conducted at the Neuro-Psycho-Pathological Centre of Kinshasa over a period of 3 months (November 2023 to January 2024). Adults (≥ 18 years) with a documented psychiatric diagnosis attending outpatient follow-up were consecutively recruited. Data were collected via a structured questionnaire including the French version of the Alcohol Use Disorders Identification Test (AUDIT). Hazardous alcohol use was defined as an AUDIT score ≥ 10. Univariate logistic regression was used to screen variables; those with p-value < 0.20 entered a multivariate logistic regression model (forward stepwise). Multicollinearity was assessed (VIF < 2). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) and p-values were reported.

Results: Of 204 participants, 190 (94.1%) reported regular alcohol consumption, and 121 (59.3%) met the threshold for hazardous alcohol use. In multivariate analysis, three variables were independently associated with hazardous alcohol use: increased alcohol consumption during the acute phase of psychiatric illness (aOR 5.21; 95% CI 2.40-11.34; p < 0.001), being in paid employment (aOR 2.28; 95% CI 1.01-5.14; p = 0.048), and having experienced a change or cessation of professional activity due to illness (aOR 2.15; 95% CI 1.02-4.52; p = 0.043).

Conclusions: More than half of psychiatric outpatients in Kinshasa exhibited hazardous alcohol use. Elevated consumption during symptomatic episodes, employment status, and occupational disruption were key correlates. These findings underscore the need for routine alcohol use screening and integrated psychosocial interventions in psychiatric services in low-resource settings.

Objectives: To examine the prevalence of comorbidities and the use of psychiatric comedication among individuals in medical treatment for attention deficit hyperactivity disorder (ADHD), in comparison to a matched control group from the general population.

Methods: This nationwide case-control study included 1,082,378 Danish individuals aged 7-64 of whom 98,398 had at least one prescription of ADHD medication during 2023. Data was collected over an observation period spanning from 2013 to 2023. Cases were matched to controls (1:10) from the general population on birth year and sex. Data were obtained and accessed through The Danish Health Data Authority. Associations were estimated using conditional logistic regression models.

Results: Somatic and particularly psychiatric comorbidities were more common among individuals in ADHD treatment across all age groups. Among those in ADHD treatment 46.7% had at least one comorbidity compared to 23.3% in the control group. The use of psychiatric comedications (besides ADHD medication) was likewise more common among individuals in ADHD treatment (32.7%) compared to the controls (7.2%). The association estimates from conditional logistic regression revealed a higher likelihood of somatic and psychiatric comorbidities among those in ADHD treatment in all age groups. Females in ADHD treatment had 4.48-4.50 times higher odds of comorbidities compared to females not in ADHD treatment (OR_{7 - 17 years} = 4.48, 95% CI: 4.27-4.70; OR_{18 - 29 years} = 4.50, 95% CI: 4.37-4.64). Similar patterns were observed for males but with slightly lower ORs (OR_{7 - 17 years} = 2.35, 95% CI: 2.27-2.44; OR_{18 - 29 years} = 3.38, 95% CI: 3.28-3.50).

Conclusion: This study reveals that both prevalence of somatic and psychiatric comorbidities and the use of psychiatric comedication are significantly higher among individuals in ADHD treatment. The highest occurrence is seemingly among females aged 7-17 year and 18-29 years. The coexistence of ADHD with other somatic and psychiatric conditions can constitute a more complex disease burden, necessitating enhanced disease management strategies to reduce complications and enhance quality of life. Longitudinal studies are needed to confirm the temporal association of these results.