农村自杀未遂结局及其相关因素的前瞻性队列研究
发布时间：2018-08-10 07:45
【摘要】：1研究背景自杀是全球关注的公共卫生与社会问题。自杀给社会及家庭造成巨大的经济与精神负担。世界卫生组织2012年全球自杀报告结果显示:①大约有804000人自杀,自杀率为11.4/10万人;②男性与女性的自杀率分别为15.0/10万人与8.0/10万人;③在世界的大部分地区,70岁以上的人群自杀率最高;④15-29岁人群中,自杀是第二位死因;⑤对于全人群来说,自杀未遂的发生率约为自杀死亡的40倍。近几十年来,无论是整个中国,还是山东省,自杀率明显下降,同时自杀死亡率的农村与城市比下降,男性的自杀率开始反超女性,20世纪末呈现的自杀率"双峰"消失,但老年人自杀率依然较高且有升高的趋势。自杀是一个复杂的行为,危险因素主要分为性格特点、个体及社会经济因素、精神心理因素、遗传因素与生物学因素等。据估计,自杀未遂人群重复自杀的发生率大约在10%-30%之间。自杀未遂是未来再次自杀未遂和再次自杀导致死亡最重要的危险因素。许多研究显示重复自杀人群具有精神障碍、年龄相对较小以及负性生活事件多等特征。更有研究显示,初次自杀使用暴力方式更容易出现重复自杀行为。而性别与重复自杀行为的关系并不统一,需要更多的研究来证明。2研究目的(1)对自杀未遂者及其对照随访时所采用的方法进行评价。(2)从基本经济人口学情况与精神心理学因素方面描述自杀未遂者与正常对照在初访以及随访中的区别。(3)探讨自杀未遂的重要危险因素随时间的变化情况。(4)估计自杀未遂者重复自杀行为在各个随访期的发生率,探讨重复自杀行为的危险因素。3研究方法3.1研究对象与调查过程初访从山东省慢病监测点随机选取滕州、宁阳与蓬莱三个县(市)作为调查点。从所选三个县的所有乡镇收集从2009年10月到2011年3月间发生自杀未遂的人群(病例组)的资料。病例组的资料来源于各个乡镇卫生院与县(市)医院的急诊科,当地的疾病预防控制中心负责收集、审核与确认病例。初访的对照同样来自上述的三个县(市),按照1:1配对的原则随机抽取。配对的原则包括相似的年龄(不超过3岁)、同性别、同地区、与自杀未遂者没有血缘关系和无既往自杀史。随访为调查初访时的所有居民,包括自杀未遂者与正常对照。随访时,为了保证随访率,在能采访到本人的情况下对其本人进行访谈,若未采访到本人,则采访本人的信息人。第一次随访在2012年10月到2012年12月展开。第二次随访在2016年10月到2016年12月展开。初访与随访皆采取一对一、面对面的方式进行问卷访谈,由经过统一培训的调查员按照问卷顺序进行。调查地点选取乡镇卫生院、村卫生室或被访人家。进行知情同意时,被访谈对象签署知情同意书后方可进行访谈。3.2访谈工具本研究采用的访谈工具为基本信息问卷、标准化量表与诊断工具的结构,具体包括基本信息问卷、自杀行为情况问卷、扭力量表、生活事件量表、心理量表(包括社会支持、自尊、焦虑与抑郁)以及精神疾病诊断工具。随访问卷增添了重复自杀行为问卷。3.3统计分析使用SPSS 16.0进行统计描述和分析。X2检验、t检验或者U检验用于特征的对比。利用广义估计方程进行自杀未遂危险因素的变化趋势与重复自杀行为的危险因素分析。4主要结果4.1信度评价访谈信息人所得基本信息与心理状况可以较好的反映目标人的真实情况。另外,随访样本的年龄、性别与初访时无差异。所用量表的Cronbach'sα系数大部分在0.7以上,具有较好的内部一致性。以上都反映出所得数据信度较好。4.2初访及随访自杀未遂组与正常对照组的信息比较在第一次随访以及第二次随访时,人口学差异已经不再明显。而负性生活事件发生率、社会支持评分、自尊评分、抑郁感评分、焦虑感评分以及精神障碍患病率等在两组中依然具有显著差异。4.3自杀未遂相关因素的变化情况相对于初访来说,自杀未遂组负性生活事件的发生率在第一次随访时呈下降趋势(RR=0.1 65,95%CI:0.099-0.275),在第二次随访时呈下降趋势(RR=0.238,5%CI:0.142-0.399),且第二次随访相对于第一次随访有上升趋势。对照组的变化趋势没有统计学意义。自杀未遂组精神障碍的患病率随时间呈下降趋势(第一次随访,RR=0.477,95%CI:0.293-0.778;第二次随访,RR=0.290,95%CI:0.181-0.463)。而对于正常对照组,总体趋势也呈现下降趋势,但没有统计学意义。相对于初访来说,第一次随访社会支持评分的升高趋势具有统计学意义(RR=8.742,95%CI:3.214-23.775),而第二次随访时的变化趋势没有统计学意义。相对于第二次随访来说,第一次随访评分的升高趋势也具有统计学意义(RR=12.705,95%CI:3.784-42.656)。另外,对照组社会支持的变化趋势没有统计学意义。自杀未遂组的自尊评分的变化趋势没有统计学意义(P0.05)。对照组中,第一次随访时的减少趋势没有统计学意义。自杀未遂组的抑郁感评分的第一次、第二次随访时减少趋势具有统计学意义(P0.001)。对照组中,抑郁评分的变化趋势没有统计学意义。相对于初访来说,第一次随访焦虑评分的下降趋势具有统计学意义(RR=0.021,95%CI:0.003-0.128),而第二次随访时的变化趋势没有统计学意义。相对于第二次随访来说,第一次随访评分的下降趋势也具有统计学意义(RR=0.021,95%CI:0.003-0.133)。对照组变化趋势与自杀未遂组相似。4.4重复自杀的相关特征及影响因素第一次随访时重复自杀行为发病密度为1.57/100人年,第二次随访时重复自杀行为发病密度为1.41/100人年。老年人重复自杀发病密度大于非老年人。重复自杀以高龄男性为主要特征。将重复自杀者的初次与再次自杀特征进行对比分析发现,两者的基本情况与自杀特征几乎没有差异。同时,对自杀方式进行分析可得,初次自杀方式多以服农药为主(79%);再次自杀方式中服农药虽然仍为分布最多的自杀方式,但比例较小(36%),方式开始呈现多样化,且更倾向于暴力自杀方式(上吊、投河以及割腕)。相比单次自杀者,重复自杀者有年龄大、患有躯体疾病、焦虑感与有精神障碍的特征。本研究中重复自杀行为共发生11例,其中包括7例重复自杀过1次,3例重复自杀过2次,1例重复自杀过3次。年龄大(RR=1.047,95%CI:1.007-1.088)、焦虑感(RR=1.050,95%CI:1.015-1.087)与精神障碍(RR=26.245,95%CI:3.170-217.305)为重复自杀行为的危险因素。5研究结论(1)在找不到本人的情况下,自杀未遂者随访可利用信息人代替本人的采访方式,但要严格入选标准。(2)自杀行为发生后,自杀未遂者的精神心理状况与正常对照人群仍有显著差异,但初访相比,自杀未遂者的精神心理状况总体来说有所好转。(3)农村重复自杀发病密度较高,且老年人的发病密度大于非老年人。(4)与单次自杀的自杀未遂者相比,重复自杀行为者心理精神状况明显较差。(5)重复自杀行为的危险因素主要为精神障碍、高年龄以及焦虑感等。
[Abstract]:1 research background suicide is a global public health and social problem. Suicide poses great economic and mental burdens on society and families. The WHO 2012 global suicide report showed: (1) about 804000 people committed suicide and the suicide rate was 11.4/10 million; and the suicide rate of men and women was 15.0/10 million and 8.0/10, respectively. In most parts of the world, the rate of suicide is the highest in people over 70 years of age; (4) among the 15-29 years old, suicide is the second cause of death; (5) for the whole population, the incidence of attempted suicide is about 40 times the rate of suicide. In recent decades, the suicide rate has decreased significantly in all China and in Shandong Province, and the suicide mortality rate has been reduced. The ratio of village to city decreased, the suicide rate of men began to anti super women. The suicide rate "Shuangfeng" disappeared at the end of twentieth Century, but the suicide rate of the elderly was still higher and higher. The suicide is a complex behavior. The risk factors are mainly divided into character characteristics, individual and socioeconomic factors, psycho psychological factors, genetic factors and biology. It is estimated that the incidence of repeated suicide in attempted suicide is about 10%-30%. Attempted suicide is the most important risk factor for the future suicide attempt and again suicide. Many studies show that the repeated suicide population is characterized by mental disorders, relatively small age and more negative life events. It is shown that the use of violence in the first suicide is more prone to repeated suicides. The relationship between sex and repeated suicides is not uniform. More research is needed to prove the purpose of.2 Research (1) to evaluate the methods adopted in the suicide attempt and its control during the control follow-up. (2) from the basic economic demography and psycho psychological factors. The difference between the attempted suicide attempt and the normal control during the first visit and the follow-up. (3) to explore the changes in the important risk factors of suicide attempt (4) to estimate the incidence of repeated suicides in each follow-up period, and to explore the risk factors of the repeated suicide behavior, the.3 study method 3.1 subjects and the investigation process. From three counties (cities) of Tengzhou, Ningyang and Penglai, three counties (cities) were selected to collect data from all villages and towns of three counties from October 2009 to March 2011. The data of the case group were derived from the emergency department of the township hospitals and the county (city) hospitals. The center for Disease Control and prevention is responsible for collecting, examining and confirming cases. The initial visits are also from three counties (cities) above, randomly selected according to the principle of 1:1 pairing. The principle of matching includes similar age (not more than 3 years), sex, area, and suicide attempt. All residents at the time of first visit, including those who had attempted suicide, were compared with normal persons. In order to ensure follow-up, they interviewed him and interviewed myself in order to ensure the follow-up. The first follow-up was from October 2012 to December 2012. The second follow-up was from October 2016 to December 2016. First visit and follow-up are one to one, face-to-face way to conduct a questionnaire interview, conducted by a unified trainer in the order of the questionnaire. The survey site selects the township hospital, the village health room or the visiting family. When the informed consent is carried out, the interview object can be interviewed by the interview.3.2 interview tool. The interview tools were used as basic information questionnaire, standardized scale and diagnostic tool structure, including basic information questionnaire, suicide questionnaire, torsion scale, life event scale, psychological scale (including social support, self-esteem, anxiety and depression) and diagnostic tools for mental illness. The follow-up questionnaire added repeated suicide behavior. Questionnaire.3.3 statistical analysis used SPSS 16 to perform statistical description and analysis of.X2 test, t test or U test for the comparison of characteristics. Use the generalized estimation equation to analyze the change trend of attempted suicide risk factors and the risk factors of repeated suicides; the main results of the 4.1 reliability assessment interview information and psychology The status can reflect the real situation of the target people better. In addition, there is no difference between the age, sex and the first visit of the follow-up sample. The Cronbach's alpha coefficient of the dosage form is most above 0.7 and has better internal consistency. All of these reflect the information of the data obtained from the first visit and the information of the suicidal attempted group and the normal control group. The difference in demography was no longer obvious at the first follow-up and second follow-up. The incidence of negative life events, social support score, self-esteem score, depression score, anxiety score, and the prevalence of mental disorders in the two groups were still significantly different in the.4.3 suicide attempt. The incidence of negative life events in the attempted suicide group showed a downward trend (RR=0.1 65,95%CI:0.099-0.275) at the first follow-up (RR=0.1 65,95%CI:0.099-0.275), and a downward trend (RR=0.238,5%CI:0.142-0.399) at the time of follow-up (RR=0.238,5%CI:0.142-0.399), and there was a rising trend compared with the first follow up. The trend of the control group was not statistically significant. The prevalence of mental disorders in the attempted group decreased with time (first follow-up, RR=0.477,95%CI:0.293-0.778, second follow-up, RR=0.290,95%CI:0.181-0.463). For the normal control group, the overall trend also showed a downward trend, but there was no statistical significance. There was statistical significance (RR=8.742,95%CI:3.214-23.775), but there was no statistical significance in the second follow-up. Compared with the second follow-up, the trend of the first follow up score was also statistically significant (RR=12.705,95%CI:3.784-42.656). In addition, the trend of social support in the control group was not statistically significant. There was no statistical significance in the change trend of the self-respect score in the attempted group (P0.05). The reduction trend in the first follow-up was not statistically significant in the control group. The first time of the depression score in the attempted suicide group was statistically significant (P0.001) during the second follow-up. The trend of the depression score was not statistically significant in the control group. Compared with the first visit, the downward trend of the first follow-up anxiety score was statistically significant (RR=0.021,95%CI:0.003-0.128), but the trend of the change at the second follow-up was not statistically significant. Compared with the second follow-up, the decline trend of the first follow-up score was also statistically significant (RR=0.021,95%CI:0.003-0.133). The change trend in the control group was similar to that of the attempted suicide group. The related characteristics of.4.4 repeated suicide and the factors affecting the incidence of repeated suicides at the first follow-up were 1.57/100 years, and the density of repeated suicides was 1.41/100 years at the second follow up. The repetition rate of repeated suicide in the elderly was greater than that in the non elderly. The primary and secondary suicide characteristics of repeated suicides were compared and analyzed to find that the basic situation of the two was almost no difference from the characteristics of suicide. At the same time, the analysis of the mode of suicide could be obtained, and the first way of suicide was mainly to take pesticide (79%). But the proportion was small (36%), and the mode began to diversify, and more inclined to violent suicide (hanging, throwing, and wrists). Compared with single suicide, the repeated suicides were older, suffering from somatic disease, anxiety and mental disorders. In this study, 11 cases of repeated suicides included 7 cases of repeated suicide 1. 2 times, 3 cases of repeated suicide, 1 cases of repeated suicide 3 times. Age (RR=1.047,95%CI:1.007-1.088), anxiety (RR=1.050,95%CI:1.015-1.087) and mental disorder (RR=26.245,95%CI:3.170-217.305) as a risk factor for repeated suicides..5 study (1) in the case of unable to find myself, suicidal attempted follow-up can be used for information generation. (2) after the suicide, the mental state of the attempted suicide was significantly different from that of the normal control group, but the mental state of the attempted suicide was better than that of the suicide attempt. (3) the incidence of repeated suicide in rural areas was higher and the density of the elderly was larger. (4) the psychological and mental status of repeated suicides was significantly lower than those of suicide attempted suicide attempts. (5) the main risk factors for repeated suicide were mental disorder, high age and anxiety.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D669.9
[Abstract]:1 research background suicide is a global public health and social problem. Suicide poses great economic and mental burdens on society and families. The WHO 2012 global suicide report showed: (1) about 804000 people committed suicide and the suicide rate was 11.4/10 million; and the suicide rate of men and women was 15.0/10 million and 8.0/10, respectively. In most parts of the world, the rate of suicide is the highest in people over 70 years of age; (4) among the 15-29 years old, suicide is the second cause of death; (5) for the whole population, the incidence of attempted suicide is about 40 times the rate of suicide. In recent decades, the suicide rate has decreased significantly in all China and in Shandong Province, and the suicide mortality rate has been reduced. The ratio of village to city decreased, the suicide rate of men began to anti super women. The suicide rate "Shuangfeng" disappeared at the end of twentieth Century, but the suicide rate of the elderly was still higher and higher. The suicide is a complex behavior. The risk factors are mainly divided into character characteristics, individual and socioeconomic factors, psycho psychological factors, genetic factors and biology. It is estimated that the incidence of repeated suicide in attempted suicide is about 10%-30%. Attempted suicide is the most important risk factor for the future suicide attempt and again suicide. Many studies show that the repeated suicide population is characterized by mental disorders, relatively small age and more negative life events. It is shown that the use of violence in the first suicide is more prone to repeated suicides. The relationship between sex and repeated suicides is not uniform. More research is needed to prove the purpose of.2 Research (1) to evaluate the methods adopted in the suicide attempt and its control during the control follow-up. (2) from the basic economic demography and psycho psychological factors. The difference between the attempted suicide attempt and the normal control during the first visit and the follow-up. (3) to explore the changes in the important risk factors of suicide attempt (4) to estimate the incidence of repeated suicides in each follow-up period, and to explore the risk factors of the repeated suicide behavior, the.3 study method 3.1 subjects and the investigation process. From three counties (cities) of Tengzhou, Ningyang and Penglai, three counties (cities) were selected to collect data from all villages and towns of three counties from October 2009 to March 2011. The data of the case group were derived from the emergency department of the township hospitals and the county (city) hospitals. The center for Disease Control and prevention is responsible for collecting, examining and confirming cases. The initial visits are also from three counties (cities) above, randomly selected according to the principle of 1:1 pairing. The principle of matching includes similar age (not more than 3 years), sex, area, and suicide attempt. All residents at the time of first visit, including those who had attempted suicide, were compared with normal persons. In order to ensure follow-up, they interviewed him and interviewed myself in order to ensure the follow-up. The first follow-up was from October 2012 to December 2012. The second follow-up was from October 2016 to December 2016. First visit and follow-up are one to one, face-to-face way to conduct a questionnaire interview, conducted by a unified trainer in the order of the questionnaire. The survey site selects the township hospital, the village health room or the visiting family. When the informed consent is carried out, the interview object can be interviewed by the interview.3.2 interview tool. The interview tools were used as basic information questionnaire, standardized scale and diagnostic tool structure, including basic information questionnaire, suicide questionnaire, torsion scale, life event scale, psychological scale (including social support, self-esteem, anxiety and depression) and diagnostic tools for mental illness. The follow-up questionnaire added repeated suicide behavior. Questionnaire.3.3 statistical analysis used SPSS 16 to perform statistical description and analysis of.X2 test, t test or U test for the comparison of characteristics. Use the generalized estimation equation to analyze the change trend of attempted suicide risk factors and the risk factors of repeated suicides; the main results of the 4.1 reliability assessment interview information and psychology The status can reflect the real situation of the target people better. In addition, there is no difference between the age, sex and the first visit of the follow-up sample. The Cronbach's alpha coefficient of the dosage form is most above 0.7 and has better internal consistency. All of these reflect the information of the data obtained from the first visit and the information of the suicidal attempted group and the normal control group. The difference in demography was no longer obvious at the first follow-up and second follow-up. The incidence of negative life events, social support score, self-esteem score, depression score, anxiety score, and the prevalence of mental disorders in the two groups were still significantly different in the.4.3 suicide attempt. The incidence of negative life events in the attempted suicide group showed a downward trend (RR=0.1 65,95%CI:0.099-0.275) at the first follow-up (RR=0.1 65,95%CI:0.099-0.275), and a downward trend (RR=0.238,5%CI:0.142-0.399) at the time of follow-up (RR=0.238,5%CI:0.142-0.399), and there was a rising trend compared with the first follow up. The trend of the control group was not statistically significant. The prevalence of mental disorders in the attempted group decreased with time (first follow-up, RR=0.477,95%CI:0.293-0.778, second follow-up, RR=0.290,95%CI:0.181-0.463). For the normal control group, the overall trend also showed a downward trend, but there was no statistical significance. There was statistical significance (RR=8.742,95%CI:3.214-23.775), but there was no statistical significance in the second follow-up. Compared with the second follow-up, the trend of the first follow up score was also statistically significant (RR=12.705,95%CI:3.784-42.656). In addition, the trend of social support in the control group was not statistically significant. There was no statistical significance in the change trend of the self-respect score in the attempted group (P0.05). The reduction trend in the first follow-up was not statistically significant in the control group. The first time of the depression score in the attempted suicide group was statistically significant (P0.001) during the second follow-up. The trend of the depression score was not statistically significant in the control group. Compared with the first visit, the downward trend of the first follow-up anxiety score was statistically significant (RR=0.021,95%CI:0.003-0.128), but the trend of the change at the second follow-up was not statistically significant. Compared with the second follow-up, the decline trend of the first follow-up score was also statistically significant (RR=0.021,95%CI:0.003-0.133). The change trend in the control group was similar to that of the attempted suicide group. The related characteristics of.4.4 repeated suicide and the factors affecting the incidence of repeated suicides at the first follow-up were 1.57/100 years, and the density of repeated suicides was 1.41/100 years at the second follow up. The repetition rate of repeated suicide in the elderly was greater than that in the non elderly. The primary and secondary suicide characteristics of repeated suicides were compared and analyzed to find that the basic situation of the two was almost no difference from the characteristics of suicide. At the same time, the analysis of the mode of suicide could be obtained, and the first way of suicide was mainly to take pesticide (79%). But the proportion was small (36%), and the mode began to diversify, and more inclined to violent suicide (hanging, throwing, and wrists). Compared with single suicide, the repeated suicides were older, suffering from somatic disease, anxiety and mental disorders. In this study, 11 cases of repeated suicides included 7 cases of repeated suicide 1. 2 times, 3 cases of repeated suicide, 1 cases of repeated suicide 3 times. Age (RR=1.047,95%CI:1.007-1.088), anxiety (RR=1.050,95%CI:1.015-1.087) and mental disorder (RR=26.245,95%CI:3.170-217.305) as a risk factor for repeated suicides..5 study (1) in the case of unable to find myself, suicidal attempted follow-up can be used for information generation. (2) after the suicide, the mental state of the attempted suicide was significantly different from that of the normal control group, but the mental state of the attempted suicide was better than that of the suicide attempt. (3) the incidence of repeated suicide in rural areas was higher and the density of the elderly was larger. (4) the psychological and mental status of repeated suicides was significantly lower than those of suicide attempted suicide attempts. (5) the main risk factors for repeated suicide were mental disorder, high age and anxiety.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D669.9
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