农村15～34岁自杀死亡者生活事件的心理解剖研究
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摘要
研究背景:自杀已经成为我国重要的公共卫生问题。我国农村的自杀率是城市的3倍,在生命最旺盛的15～34岁的人群中,自杀是第一位的死因。研究显示自杀死亡者自杀前生活事件是增加的,负性生活事件增加了自杀的危险性。但国内外对自杀者生活事件的研究包括对象、方法以及设计和结果良莠不齐。目前我国关于年轻自杀死亡者生前的生活事件研究,尤其是在农村地区运用心理解剖方法的病例对照研究还很少。
目的:本研究选取了辽宁地区农村15～34岁自杀死亡者为病例组,通过病例对照设计的心理解剖方法,对自杀前一年内生活事件及在一年前发生而对近一年仍有精神影响的事件进行研究,根据事件的性质、类型、发生时间等方面分别比较自杀组与对照组刺激量的差别,深入探究生活事件在自杀死亡中的重要作用。
方法:抽取辽宁省六个县自2005年10月1日起序贯自杀死亡的全部年龄为15～34周岁的病例,直到2007年7月1日。同时按人口比率抽取同年龄段正常对照为被试,病例与对照匹配年龄及性别,并分别选取两个知情信息人以及对照本人进行半结构式心理解剖访谈,纳入本研究的病例及对照各120例。
结果:自杀组死前一年里负性生活事件发生频数明显多于对照组(Z=6.962,P=0.000),且年负性生活事件的刺激量亦大于对照组(Z=-7.439,P=0.000)。自杀组在家庭生活、健康以及婚姻恋爱和法律纠纷方面相关负性事件的年刺激量均显著高于对照组。自杀死亡者自杀前1个月内以及2、3和6个月时点及长期性负性事件的刺激量都显著高于对照组。自杀的男性被试年负性生活事件的刺激量明显高于女性(Z=-2.450,P=0.014),尤其是工作与学习相关问题及法律纠纷相关问题负性刺激量男性显著高于女性。多因素Logistic回归分析显示与婚姻恋爱(OR=1.177,95%CI 1.063-1.302)、健康(OR=1.092,95%CI 1.028-1.161)及法律纠纷(OR=1.110, 95%CI 1.002-1.230)方面相关的负性生活事件增加了自杀的危险性。
结论:负性生活事件是农村15～34岁年轻人自杀死亡的危险因素。与家庭生活、婚姻恋爱、健康及法律纠纷方面相关的事件是农村年轻男性自杀死亡的危险因素;尤其是本人得绝症和重病是农村年轻人自杀死亡的重要危险因素。发生在自杀者行动前1个月内以及2、3和6个月四个时点的负性生活事件及长期性负性事件应该积极干预。农村年轻男性自杀死亡者年负性生活事件刺激量明显高于女性,尤其是与工作和学习及法律纠纷相关的负性生活事件是年轻男性自杀的严重应激事件。
Background: In our country, suicide has already become an important public health problem, the rural suicide rate is three-fold the urban rate. Among persons aged 15-34 years, suicide is the leading cause of death. Life events are often reported to precede suicide. Negative life events contribute to the increased risk of suicide. Previous domestic research on life events for suicide have been basically limited to single case studies or case-control study which the control group of people is who died of other injuries. Until now, there is little detailed information from controlled psychological autopsy studies on life events in young adults who commit suicide, especially in rural area.
Objectives: This study compared of cases of committed suicide with living controls using psychological autopsy in rural area in Liaoning Province. Cases and controls both aged 15-34 years were assessed for life events that occurred in the year before the suicide or the administration of the interview, or that occurred earlier but continued to have a psychological effect on the subject during these 12 months. The stress scores between cases and controls were compared from the respects of characteristic, timing and type of life events. This study aims to identify the role of life events in committed suicide.
Methods: Completed suicide cases aged 15-34 years were from six counties in Liaoning Province between October 1, 2005 and July 1, 2007. Living controls were selected from the six counties according to the population ratio. Cases and controls were matched for gender and age. For each suicide case, there were two formants. For each normal control, two informants and the control himself /herself served as the sources of information. The subjects were 120 cases of completed suicide and 120 living controls.
Results: Cases had significantly more negative life events(Z=6.962, P=0.000) and the stress score for the year (Z=-7.439,P=0.000) than controls overall. The categories accounting for these differences were family life related negative events, marriage/loving related negative life events, physical health-related negative events and legal-related problems. Assessment of the relation between the stress score of negative life events for each month and suicide revealed significant correlation. The negative life events that occurred in one month, 1-2 month,2-3 month and 5-6 month prior to the index date increased the risks of committed suicide. Male suicides had more work/study related negative events and legal-related negative events than female ones. The logistic regression model has found the significant factors contributed for suicide were marriage/loving related negative life events (OR=1.177,95%CI 1.063-1.302), physical health- related negative events (OR=1.092,95%CI 1.028-1.161) and legal-related problems (OR=1.110,95%CI 1.002-1.230).
Conclusions: Negative life events are risk factors of suicide among persons aged 15-34 years in rural area. Family life related negative events, marriage/loving related negative life events, physical health-related negative life events and legal-related problems contribute to the increased risk of suicide. Chronic negative life events and negative life events happened in periods of one month, 1-2 month, 2-3 month, 5-6 month prior to suicide should be intervened. Work/study related negative events and legal-related negative events increased risk of male suicide.
目的:本研究选取了辽宁地区农村15～34岁自杀死亡者为病例组,通过病例对照设计的心理解剖方法,对自杀前一年内生活事件及在一年前发生而对近一年仍有精神影响的事件进行研究,根据事件的性质、类型、发生时间等方面分别比较自杀组与对照组刺激量的差别,深入探究生活事件在自杀死亡中的重要作用。
方法:抽取辽宁省六个县自2005年10月1日起序贯自杀死亡的全部年龄为15～34周岁的病例,直到2007年7月1日。同时按人口比率抽取同年龄段正常对照为被试,病例与对照匹配年龄及性别,并分别选取两个知情信息人以及对照本人进行半结构式心理解剖访谈,纳入本研究的病例及对照各120例。
结果:自杀组死前一年里负性生活事件发生频数明显多于对照组(Z=6.962,P=0.000),且年负性生活事件的刺激量亦大于对照组(Z=-7.439,P=0.000)。自杀组在家庭生活、健康以及婚姻恋爱和法律纠纷方面相关负性事件的年刺激量均显著高于对照组。自杀死亡者自杀前1个月内以及2、3和6个月时点及长期性负性事件的刺激量都显著高于对照组。自杀的男性被试年负性生活事件的刺激量明显高于女性(Z=-2.450,P=0.014),尤其是工作与学习相关问题及法律纠纷相关问题负性刺激量男性显著高于女性。多因素Logistic回归分析显示与婚姻恋爱(OR=1.177,95%CI 1.063-1.302)、健康(OR=1.092,95%CI 1.028-1.161)及法律纠纷(OR=1.110, 95%CI 1.002-1.230)方面相关的负性生活事件增加了自杀的危险性。
结论:负性生活事件是农村15～34岁年轻人自杀死亡的危险因素。与家庭生活、婚姻恋爱、健康及法律纠纷方面相关的事件是农村年轻男性自杀死亡的危险因素;尤其是本人得绝症和重病是农村年轻人自杀死亡的重要危险因素。发生在自杀者行动前1个月内以及2、3和6个月四个时点的负性生活事件及长期性负性事件应该积极干预。农村年轻男性自杀死亡者年负性生活事件刺激量明显高于女性,尤其是与工作和学习及法律纠纷相关的负性生活事件是年轻男性自杀的严重应激事件。
Background: In our country, suicide has already become an important public health problem, the rural suicide rate is three-fold the urban rate. Among persons aged 15-34 years, suicide is the leading cause of death. Life events are often reported to precede suicide. Negative life events contribute to the increased risk of suicide. Previous domestic research on life events for suicide have been basically limited to single case studies or case-control study which the control group of people is who died of other injuries. Until now, there is little detailed information from controlled psychological autopsy studies on life events in young adults who commit suicide, especially in rural area.
Objectives: This study compared of cases of committed suicide with living controls using psychological autopsy in rural area in Liaoning Province. Cases and controls both aged 15-34 years were assessed for life events that occurred in the year before the suicide or the administration of the interview, or that occurred earlier but continued to have a psychological effect on the subject during these 12 months. The stress scores between cases and controls were compared from the respects of characteristic, timing and type of life events. This study aims to identify the role of life events in committed suicide.
Methods: Completed suicide cases aged 15-34 years were from six counties in Liaoning Province between October 1, 2005 and July 1, 2007. Living controls were selected from the six counties according to the population ratio. Cases and controls were matched for gender and age. For each suicide case, there were two formants. For each normal control, two informants and the control himself /herself served as the sources of information. The subjects were 120 cases of completed suicide and 120 living controls.
Results: Cases had significantly more negative life events(Z=6.962, P=0.000) and the stress score for the year (Z=-7.439,P=0.000) than controls overall. The categories accounting for these differences were family life related negative events, marriage/loving related negative life events, physical health-related negative events and legal-related problems. Assessment of the relation between the stress score of negative life events for each month and suicide revealed significant correlation. The negative life events that occurred in one month, 1-2 month,2-3 month and 5-6 month prior to the index date increased the risks of committed suicide. Male suicides had more work/study related negative events and legal-related negative events than female ones. The logistic regression model has found the significant factors contributed for suicide were marriage/loving related negative life events (OR=1.177,95%CI 1.063-1.302), physical health- related negative events (OR=1.092,95%CI 1.028-1.161) and legal-related problems (OR=1.110,95%CI 1.002-1.230).
Conclusions: Negative life events are risk factors of suicide among persons aged 15-34 years in rural area. Family life related negative events, marriage/loving related negative life events, physical health-related negative life events and legal-related problems contribute to the increased risk of suicide. Chronic negative life events and negative life events happened in periods of one month, 1-2 month, 2-3 month, 5-6 month prior to suicide should be intervened. Work/study related negative events and legal-related negative events increased risk of male suicide.
引文
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53. Heikkinen M, Aro H, L?nnqvist J. Recent life events, social support and suicide. Acta Psychiatr Scand Suppl. 1994;377:65-72.
54. Cheng AT, Chen TH, Chen CC, Jenkins R. Psychosocial and psychiatric risk factors for suicide. Case-control psychological autopsy study.Br J Psychiatry. 2000 Oct;177:360-365.
55. Shaffer D, Pfeffer CR, Bernet W, et al. Practice parameter for the assessment and treatment of children and adolescents with suicidal behaviour. J Am Acad Child Adolesc Psychiatry. 2001;40(7 Suppl):24S–51S.
56. Morano CD, Cisler RA, Lemerond J.Risk factors for adolescent suicidal behavior: loss, insufficient familial support, and hopelessness. Adolescence. 1993 Winter;28(112):851-865.
57. Kerfoot M, Dyer E, Harrington V, et al. Correlates and short-term course of self-poisoning in adolescents. Br J Psychiatry. 1996;168:38–42.
58. Brent D, Perper J, Moritz C, et al. Suicide in affectively ill adolescents: a case control study. J Affect Disord. 1994;31:193–202.
59. Hall RC, Platt DE, Hall RC.Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of managed care.Psychosomatics. 1999 Jan-Feb;40(1):18-27.
60. Steele MM, Doey T.Suicidal behaviour in children and adolescents. part 1: etiology and risk factors. Can J Psychiatry. 2007 Jun;52(6 Suppl 1):21S-33S. Review.
61. Borowsky IW, Resnick MD, Ireland M, et al. Suicide attempts among American Indian and Alaska Native youth: risk and protective factors. Arch Pediatr Adolesc Med. 1999; 153:573–580.
62. Hallfors D, Cho H, Brodish PH, et al. Identifying high school students“at risk”for substance use and other behavioral problems: implications for prevention. Subst Use Misuse. 2006;41:1–15.
63. Gould, M. S., King, R., Greenwald, S., Fisher, P., Schwab-Stone, M., Kramer, R., Flisher, A. J., Goodman, S., Canino, G. & Shaffer, D. Psychopathology associated with suicidal ideation and attempts among children and adolescents. Journal of the American Academy of Adolescent Psychiatry,.1998; 37(9), 915-922.
64. Molnar, B. E., Shade, S. B., Kral, A. H., Booth, R. E., Walters, J. K. Suicidalbehaviors and sexual/physical abuse among street youth. Child Abuse and Neglect. 1998; 22, 213-222.
65. Kaltiala-Heino R, Rimpela M, Marttunen M, et al. Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. BMJ. 1999;319:348–351.
66. Brown J, Cohen P, Johnson JG, et al. Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality. J Am Acad Child Adolesc Psychiatry.1999;38:1490–1496.
67. Johnson JG, Cohen P, Gould MS, et al. Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood. Arch Gen Psychiatry. 2002;59:741–749.
68. Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.JAMA. 2001 Dec 26;286(24):3089-3096.
69. Haarasilta L, Marttunen M, Kaprio J, et al. Major depressive episode and physical health in adolescents and young adults: results from a population-based interview survey. Eur J Public Health. 2005;15:489–493.
70. Brent DA, Baugher M, Bridge J, et al. Age- and sex-related risk factors for adolescent suicide. J Am Acad Child Adolesc Psychiatry. 1999;38:1497–1505.
71. Conrad N. Stress and knowledge of suicidal others as factors in suicidal behavior of high school adolescents. Issues Ment Health Nurs. 1992;13:95–104.
72. Harkavy FJ, Asnis G, Boeck M, DiFiore J. Prevalence of specific suicidal behaviours in a high school sample. Am J Psychiatry. 1987;144:1203–1206.
73. Hazell P, Lewin T. Friends of adolescent suicide attempters and completers. J Am Acad Child Adolesc Psychiatry. 1993;32:76–81.
74. Phillips M R, Li X, Zhang Y. Suicide rates in China, 1995—1999. Lancet,2002,359:835—840
75. Harris EC, Barraclough BM. Suicide as an outcome for medical disorders. Medicine 1994;73:281-296.
76. Beautrais AL. A case control study of suicide and attempted suicide in older adults. Suicide Life Threat Behav 2002;32:1-9.
77. Conwell Y, Lyness JM, Duberstein P, Cox C, Seidlitz L, Di Giorgio A, et al. Completed suicide among older patients in primary care practices: a controlled study. J Am Geriatr Soc 2000;48:23-29.
78. Conwell Y, Olsen K, Caine ED, Flannery C. Suicide in later life: psychological autopsy findings. Int Psychogeriatr 1991;3:59-66.
79. Waern M, Runeson B, Allebeck P, Beskow J, Rubenowitz E, Skoog I, et al. Mental disorder in elderly suicides: a case-control study. Am J Psychiatry 2002;159:450-455.
80. O'Connell H, Chin AV, Cunningham C, Lawlor BA.Recent developments: suicide in older people.BMJ. 2004 Oct 16;329(7471):895-899. Review.
81. Cattell H. Suicide in the elderly. Adv Psychiatr Treatment 2000;6:102-108.
82. Erlangsen A, Bille-Brahe U, Jeune B. Differences in suicide between the old and the oldest old. J Gerontol B Psychol Sci Soc Sci 2003;58:S314-22.
83.周脉耕,张艳萍等.304例老年自杀死亡者死前负性生活事件分析.中华流行病学杂志. 2004;25(4):292-295.
84. Ang RP, Chia BH, Fung DS.Gender differences in life stressors associated with child and adolescent suicides in Singapore from 1995 to 2003.Int J Soc Psychiatry. 2006 Nov;52(6):561-570.
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