CAJ | 학술논문

目的综合分析自杀未遂者自杀风险及与6年内再次自杀的关系.方法采用涉及自杀风险的评定量表或调查条目对人院抢救治疗的1 15例自杀未遂者进行调查后并随访6年.6年内再次出现自杀行为的21例与未出现自杀的94例患者比较,凡受试者工作特征(ROC)曲线下面积＞0.5,且差异有统计学意义(P＜0.05)的评定量表或调查条目作为再次自杀风险评估项目.连续变量评估项目依其ROC最佳诊断临界值转换2分变量后,统计有、无再次自杀在项目上的OR值作为影响权重并作为单项得分.累计自杀未遂者各项评估项目得分作为综合评估结果,分析其与6年内再次自杀的关系.结果 (1)世界卫生组织量表评分、贝克抑郁问卷评分、自杀未遂史、自杀强度得分、精神疾病、无望感、健康自我评价、年龄及困扰1年以上疾病残疾9项检验变量ROC曲线下面积为0.642～0.790,差异均有统计学意义,列为再次自杀风险评估项目.(2)115例自杀未遂者在综合评估9个项目累计得分(32.2±31.0)分,最小得分为0分,最高93.2分.综合评估分数的ROC曲线下面积为0.887.(3)综合累计评估的2个明显诊断临界值分别为30.5分和57.5分,以此临界值分3组,≤30.5分组59例中再次自杀者1例(1.7％);30.5～57.5分组24例中再次自杀者2例(8.3％);≥57.5分组32例中再次自杀者18例(56.4％),且有5例自杀死亡.3组间再次自杀分布显著不同,差异有统计学意义(Fisher精确检验,x2=39.45,P=0.000).结论对自杀未遂者进行自杀风险综合评估其结果与自杀未遂者出院后6年内再次出现自杀有关.
목적 종합분석자살미수자자살풍험급여6년내재차자살적관계.방법 채용섭급자살풍험적평정량표혹조사조목대인원창구치료적1 15례자살미수자진행조사후병수방6년.6년내재차출현자살행위적21례여미출현자살적94례환자비교,범수시자공작특정(ROC)곡선하면적＞0.5,차차이유통계학의의(P＜0.05)적평정량표혹조사조목작위재차자살풍험평고항목.련속변량평고항목의기ROC최가진단림계치전환2분변량후,통계유、무재차자살재항목상적OR치작위영향권중병작위단항득분.루계자살미수자각항평고항목득분작위종합평고결과,분석기여6년내재차자살적관계.결과 (1)세계위생조직량표평분、패극억욱문권평분、자살미수사、자살강도득분、정신질병、무망감、건강자아평개、년령급곤우1년이상질병잔질9항검험변량ROC곡선하면적위0.642～0.790,차이균유통계학의의,렬위재차자살풍험평고항목.(2)115례자살미수자재종합평고9개항목루계득분(32.2±31.0)분,최소득분위0분,최고93.2분.종합평고분수적ROC곡선하면적위0.887.(3)종합루계평고적2개명현진단림계치분별위30.5분화57.5분,이차림계치분3조,≤30.5분조59례중재차자살자1례(1.7％);30.5～57.5분조24례중재차자살자2례(8.3％);≥57.5분조32례중재차자살자18례(56.4％),차유5례자살사망.3조간재차자살분포현저불동,차이유통계학의의(Fisher정학검험,x2=39.45,P=0.000).결론 대자살미수자진행자살풍험종합평고기결과여자살미수자출원후6년내재차출현자살유관.
Objective To analyze the relationship between the results of comprehensive assessment of suicide attempters and their suicidal repetition within 6 years after discharge from hospital.Methods Suicide risk rating scale or questionnaire were used to assess 115 cases of hospitalized suicide attempters after treatment at the emergency room; follow-up studies were also carried out on the same subjects for six years.Twenty-one cases with repetitive suicidal behavior in the meantime were compared with the remaining 94 cases without such behavior.If the area under the curve (AUC) for the receiver operating characteristic (ROC) curve was larger than 0.5 and the difference was statistically significant (P ＜ 0.05),the corresponding rating scales or questionnaire were regarded as factors for repeated suicide risk assessment.A continuous outcome variable was converted to a dichotomous variable according to the best cut-off values of the factor's ROC curve,odds ratio was used as weight value to calculate scores for all factors based on whether there was repeated suicide behavior.Attempters' scores of all the factors were summed up as a comprehensive assessment result.The relationship of the result and repeated suicide behavior within 6 years was then evaluated.Results (1) Nine factors were selected for suicide repetition assessment because their AUC values were over 0.5 and their differences were statistically significant (P ＜ 0.05),including WHO (FIVE) Well-Being Index,Beck depression inventory,mental illness etc.(2) The total scores for all factors of the 115 suicide attempters ranged from 0 to 93.2,the average was 32.2 ± 31.0,the area under the ROC curve was 0.887.(3) One hundred and fifteen suicide attempters were divided into three groups based on their scores according to the cut-off values of ROC.The first group containing 59 attempters with scores lower than 30.5 only had 1 (1.7％) repeated suicide case; the second group containing 24 attempters with scores from 30.5 to 57.5 only had 2 (8.3％) repeated suicide cases; the third group containing the remaining 32 attempters with scores higher than 57.5 had 18 (56.4％) repeated suicide cases,including 5 fatalities.There were statistically significant differences (x2 =39.45,P =0.000) among the three groups.Conclusion Many risk factors derive from the comprehensive assessment of suicide attempters can be associate with their repetition of suicide behaviors within 6 years after discharge from hospitalization.