| Background According to the World Health Organization,about 800000 people die of suicide every year around the world,with an average of one person dying every 40 seconds.Suicide is a huge challenge for health care professionals and society as a whole.It is one of the top 15 causes of death in the world,and the second-largest cause of death in the15-34 age group in some countries.In China,according to previous data,there are 287000people die of suicide every year,and the annual suicide rate has been as high as 23/100000.Suicide is a huge challenge for healthcare professionals and society as a whole.At present,there is no exact figure to explain the direct social loss caused by suicide,but the disease burden caused by suicide can be evaluated according to the disability adjusted life 0years(DALYs).Suicide has become an important public health and mental health problem in the world. Bipolar depression is one of the clinical subtypes of bipolar disorder,named"bipolar depressive episode"by ICD-10.At least 1 episodes of mania or mania were found in the patients with depressive episode,incidence rate was about 1%of the world population.Bipolar disorder has the highest risk of suicide compared to all other mental disorders. However,when considering bipolar subtypes,gender,age,or disease severity,reports of suicide rates in bipolar disorder are inconsistent.Although there are differences in the relative incidence of suicide among patients with bipolar disorder compared with the general population,it is estimated that the annual risk of attempted suicide is 400-1400/100.000,or about 0.9%,which is 30-60 times of the general population risk.About 1/3 to1/2 patients with bipolar disorder have at least one suicide attempt for life,and about 15-20%of them have died of suicide.The quality of life of patients with bipolar disorder who have attempted suicide is also worse than that of patients without attempted suicide.Different research objects,sample size and diagnostic criteria will have a great impact on the results,even the opposite results.Previous studies have found that gender,family history of suicide,suicide ideation,history of attempted suicide,age,attack characteristics,the first onset of depression,substance abuse,personality disorders may be the risk factors of bipolar suicide.To study the risk factors of suicide in bipolar depression patients is helpful to reduce the occurrence of suicide.Contents At present,there are many researches on suicide at home and abroad,but most of the research subjects are the general population.Considering the high incidence of suicidal behaviors in patients with bipolar depression,we have conducted research on factors related to suicide risk of inpatients with bipolar depression in many mental health institutions nationwide Including general demographic data,clinical data and evaluation of related scales,to explore the risk factors of suicide risk in hospitalized bipolar patients and intervention measures for suicide.Method1.Research objects:The research data comes from the national key research project"Precision Medicine Research"-"Chinese Mental Disorder Cohort Research"project.733patients with bipolar depression were studied as subjects.The Suicide Module in the Mini-International Neuropsychiatric Interview(MINI)was divided into a non-suicide risk group(521 cases),a low suicide risk group(100 cases)and a medium/high suicide risk group(112 cases).2.Research tools:use the system"demographic and general clinical data questionnaire","Clinician-Rated Dimensions of Psychosis Symptom Severity(CRDPSS)","Young Mania Rating Scale(YMRS)","Hamilton Depression Scale(HAMD)","Mini-International Neuropsychiatric Interview(MINI)"collected data from three groups of patients. 3.Statistical analysis:SPSS 21 was used for statistical analysis to compare the general socio-demographic data and clinical characteristics of the three groups of patients,using the analysis of variance for continuous variables with normal distribution and rank sum for continuous variables with non-normal distribution For the test,the categorical variable is chi-square test.Ordinal logistic regression was used to analyze the main risk factors of suicidal risk in patients with bipolar depression.The significance test level was set at 0.05.Results1.General situation:in 733 inpatients with bipolar disorder,the age is between 15-70years old,the average is 37.15±1.02 years old.411(56.07%)men,322(43.93%)women,267(36.43%)married,344(46.93%)unmarried,122(16.64%)widowed or divorced,78(10.64)educated at or below primary school,408(55.66%)in junior or senior high school,247(33.70%)college or above,251(34.24%)employed,482(65.76%)retired or unemployed;Smoking was 166(22.65%)and non-smoking was 577(77.35%);There were 521(71.08%)people without suicide risk,212(28.92%)people with suicide risk,including 100(13.64%)people with low suicide risk,and 37(5.05%)people with moderate suicide risk,severe There were 75(10.23%)in the risk group;697(95.09%)people with bipolar I disorder and 36(4.91%)people with bipolar II disorder;78.17%of patients used mood stabilizers,and 80.08%of patients used antipsychotic drugs,14.19%of patients use antidepressant drugs,14.19%of patients use anti-anxiety drugs.2.Demographic characteristics:compared among the three groups,the age of moderate/severe suicide risk group is smaller than that of non suicide risk group and mild suicide risk group,F=10.47,P=0.035;the prevalence of women in moderate/severe suicide risk group is higher than that of non suicide risk group and mild suicide risk group,X~2=7.68,P=0.022.3.Clinical characteristics:compared among the three groups,the age of onset in the moderate/severe suicide risk group was lower than that in the non suicide risk group and the mild suicide risk group,F=3.05,P=0.048.The positive rate of family history in the mild suicide risk group was higher than that in the non suicide risk group,X~2=8.08,P=0.018.The positive rate of family history in the mild suicide risk group was higher than that in the non suicide risk group,F=7.41,P=0.002.The middle/high suicide risk group was higher The number of previous depressive episodes in the group was higher than that in the group without suicide risk,z=-4.57,P<0.001.The number of hospitalizations in the group with moderate/severe suicide risk was lower than that in the group without suicide risk and the group with low suicide risk,F=8.1,P<0.001.It suggested that the course of disease in the group with moderate/severe suicide risk was shorter than that in the group without suicide risk and the group with low suicide risk,F=7.23,P=0.001.There was statistical difference in drug side effects among the three groups,suicide risk The higher the degree,the higher the incidence of side effects,X~2=15.23,P<0.001.The ratio of biphasic type II patients in the moderate/severe suicide risk group was higher than that in the non suicide risk group,X~2=7.82,P=0.02.The use of antipsychotic drugs in the moderate/severe suicide risk group was higher than that in the non-suicide risk group and the low suicide risk group,X~2=4.91,P=0.044;the moderate/severe suicide risk group used antidepressants than the non-suicide risk group and the low suicide risk group High,X~2=19.91,P<0.001.4.Scale score:compared among the three groups,the fantasy score of moderate/severe suicide risk group was higher than that of non suicide risk group and low suicide risk group,F=3.59,P=0.028.The HAMD score of moderate/severe suicide risk group was higher than that of non suicide risk group and low suicide risk group,F=56.84,P<0.001.The anxiety somatization score of moderate/severe suicide risk group was higher than that of non suicide risk group and low suicide risk group,F=109.72,P<0.001.Cognitive impairment factor score of moderate/severe suicide risk group was higher than that of non suicide risk group and low suicide risk group,F=18.23,P<0.001.Delay factor score of moderate/severe suicide risk group was higher than that of non suicide risk group and mild suicide risk group,F=43.43,P<0.001.Sleep factor score of high suicide risk group was higher,F=6.92,P=0.001.Mild suicide risk group and moderate/severe suicide risk group The score of YMRS in suicide risk group was higher than that in non suicide risk group,z=-5.9,P<0.001.5.Ordinal logistic regression analysis showed that female,drug side effects,antipsychotic use,young’s manic score,and anxiety somatization factor score were the risk factors for suicide in hospitalized bipolar patients(1)The risk of suicide increased by 25%(OR=1.25,95%CI:1.18-1.61)for each score increase of anxiety somatic factor score of inpatients with bipolar depression;(2)The risk of suicide increased by 8%for each score increase of delay factor score of inpatients with bipolar depression,(OR=1.08,95%CI:1.03-1.13);(3)The risk of suicide increased by4%(OR=0.96,95%CI=0.94-0.98)for each score reduction of YMRS in inpatients with bipolar depression;(4)The risk of suicide in patients with side effects of drugs was 1.49times(OR=1.49,95%CI 1.06-2.10)than that in patients without side effects;(5)The risk of suicide in women was 1.53 times(OR=1.53,95%CI 1.09-2.15)than that in men.(6)The suicide risk rate of patients using antipsychotic drugs is 1.8 times higher than that of patients not using antipsychotic drugs(OR=1.80,95%CI 1.01-3.20).Conclusions1.The suicide risk rate of inpatients with bipolar depression was 28.92%,mild suicide risk accounted for 13.64%,moderate suicide risk accounted for 5.05%,and severe suicide risk accounted for 10.23%.2.Female,drug side effects,antipsychotic use,severe somatization of anxiety,and severe retardation disorders were the influencing factors for suicide risk of hospitalized bipolar depression. |
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