【摘要】 背景中国农村的自杀率是城市自杀率的2~3倍,但造成城乡自杀率之巨大差异的原因并不清楚。目的评估国内农村严重自杀未遂者的特征及危险因素。方法精神科医生采用结构式问卷对山东郓城县人民医院急诊室收治的297例严重自杀未遂者(至少在医院6小时者)及其陪伴的家属分别进行访谈。该问卷内容详尽,完成问卷需要2~3h。对照组选取同一居住地中年龄、性别与自杀未遂组相匹配的、既往无自杀未遂史的居民及其同住家庭成员,分别进行同样的结构式访谈。使用Cox回归模型来识别自杀未遂的危险因素。结果 297例自杀未遂者中,74%为女性,78%是农民,平均(标准差)年龄为33.2(14.6),平均受教育年限为4.8(3.1)年,80%为口服农药自杀,57%的自杀未遂者报告在采取自杀行动之前考虑自杀只有或不足5分钟,76%的自杀意图量表中计划分量表得分不足50分(0~100分),11%有过自杀未遂史,只有38%存在符合DSM-IV诊断标准的精神障碍。在控制性别、年龄、居住地以及之前的自杀未遂史(在配对分析中控制该变量)后,通过多因素分析,自杀未遂的危险因素包括:受教育水平低、与有过自杀行为的人交往、之前1年中至少有4次负性生活事件、之前1个月中生活质量低且家庭不够和睦、之前2周内的抑郁症状得分高以及冲动性和攻击性高(最后一项仅在小样本中进行评估)。结论我国农村严重自杀未遂者多数不符合精神障碍的诊断标准,冲动性和攻击性高、自杀意图并不强烈,多采用口服农药的方式。这些特点与高收入发达国家的特点不同,因而需要采取不同的方法来预防自杀行为。这些方法应更多的关注如何降低获取农药的便利性,并教育冲动性个体如何自我调整情绪和行为,而不是过度地关注精神障碍的识别和治疗。更多还原

【Abstract】 Background: Suicide rates in rural China are two-fold to three-fold those in urban China but the reasons for this large difference remain unclear. Aim: Assess the characteristics and risk factors of medically serious suicide attempts in rural China. Methods: A comprehensive 2 to 3 hour structured interview was administered by psychiatrists to 297 medically serious suicide attempters (defined as those who remained in hospital for 6 hours or longer) treated in the emergency room of the People’s Hospital of Yuncheng County in Shandong Province and, separately, to their accompanying co-resident family members. A parallel interview was administered to control subjects matched for age and gender from the same village who had never made a suicide attempt and to their co-resident family members. Risk factors for attempted suicide were identified using Cox regression models. Results: Among the 297 suicide attempters, 74% were female, 78% were farmers, their mean (sd) age was 33.2 (14.6) years, their mean length of formal schooling was 4.8 (3.1) years, 80% had attempted suicide by ingesting pesticides, 57% reported considering suicide for five minutes or less before acting, 76% had a score of less than 50 (range, 0 to 100) on the planning subscale of the Suicide Intent Scale, 11% had made prior attempts, and only 38% met DSM-IV criteria for a current mental disorder. After controlling for gender, age, location of residence and prior suicide attempt (in the matched analysis), risk factors identified in the multivariate analysis included a low level of education, having relatives or associates with prior suicidal behavior, experiencing four or more negative life events in the prior year, a low quality of life and low family cohesion over the prior month, high depressive symptom scores over the prior two weeks, and (only assessed in a subsample) high impulsivity and aggression. Conclusion: Many of the medically treated suicide attempts in rural China are low-intent attempts by the ingestion of pesticides in persons who do not meet criteria of a mental disorder but have high levels of impulsiveness and aggression. This profile is different from that seen in high-income countries so it will require a different approach to the prevention of suicidal behavior, an approach that is less focused on the identification and treatment of mental disorders and more focused on limiting access to agricultural poisons and training impulsive individuals about self-regulation of their emotions and behaviors.更多还原