医学
萧条(经济学)
危险系数
毒物控制
自杀意念
精神科
相对风险
置信区间
队列研究
比例危险模型
混淆
伤害预防
自杀预防
队列
内科学
医疗急救
经济
宏观经济学
作者
Tapio Paljärvi,Jari Tiihonen,Markku Lähteenvuo,Antti Tanskanen,Seena Fazel,Heidi Taipale
标识
DOI:10.1016/j.jad.2022.10.035
摘要
The purpose of this study was to establish the risk of suicide associated with incident psychotic depression (PD) compared to incident non-psychotic severe depression (NPD).This cohort study used routine data from nationwide health registers in Finland. Eligible participants were aged 18-59 years at the index diagnosis. Causes of death were defined by the International Classification of Diseases, 10th revision codes. The follow-up time was up to five years. Adjusted Cox regression models were used to analyse risk of death by method of suicide.We included 17,331 individuals with incident PD and 85,989 individuals with incident NPD. Most of the deaths due to suicides occurred within the first two years after the index diagnosis. Compared to NPD, PD was associated with an overall two-fold increased risk of suicide (adjusted hazard ratio, (aHR) 2.19, 95 % confidence interval (CI) 1.95, 2.46), after adjusting for psychiatric comorbidities. In PD, the highest relative risks were for impact-related suicides (aHR 3.03, 95%CI 2.23, 4.13) and for suffocation-related suicides (aHR 2.72, 95%CI 2.23, 3.30), whereas the lowest relative risk was for intentional poisonings (aHR 1.66, 95%CI 1.37, 2.02).Information on all potential confounders is not available in studies using routine data.Psychotic symptoms doubled the risk of suicides over and above of the risk that was associated with severe depression, after controlling for comorbid psychiatric disorders. The severity of suicidal ideation may be higher in PD than in NPD, which then leads to more lethal methods of self-harm.
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