農(nóng)村自殺未遂結(jié)局及其相關(guān)因素的前瞻性隊列研究
發(fā)布時間：2018-08-10 07:45
【摘要】：1研究背景自殺是全球關(guān)注的公共衛(wèi)生與社會問題。自殺給社會及家庭造成巨大的經(jīng)濟與精神負(fù)擔(dān)。世界衛(wèi)生組織2012年全球自殺報告結(jié)果顯示:①大約有804000人自殺,自殺率為11.4/10萬人;②男性與女性的自殺率分別為15.0/10萬人與8.0/10萬人;③在世界的大部分地區(qū),70歲以上的人群自殺率最高;④15-29歲人群中,自殺是第二位死因;⑤對于全人群來說,自殺未遂的發(fā)生率約為自殺死亡的40倍。近幾十年來,無論是整個中國,還是山東省,自殺率明顯下降,同時自殺死亡率的農(nóng)村與城市比下降,男性的自殺率開始反超女性,20世紀(jì)末呈現(xiàn)的自殺率"雙峰"消失,但老年人自殺率依然較高且有升高的趨勢。自殺是一個復(fù)雜的行為,危險因素主要分為性格特點、個體及社會經(jīng)濟因素、精神心理因素、遺傳因素與生物學(xué)因素等。據(jù)估計,自殺未遂人群重復(fù)自殺的發(fā)生率大約在10%-30%之間。自殺未遂是未來再次自殺未遂和再次自殺導(dǎo)致死亡最重要的危險因素。許多研究顯示重復(fù)自殺人群具有精神障礙、年齡相對較小以及負(fù)性生活事件多等特征。更有研究顯示,初次自殺使用暴力方式更容易出現(xiàn)重復(fù)自殺行為。而性別與重復(fù)自殺行為的關(guān)系并不統(tǒng)一,需要更多的研究來證明。2研究目的(1)對自殺未遂者及其對照隨訪時所采用的方法進(jìn)行評價。(2)從基本經(jīng)濟人口學(xué)情況與精神心理學(xué)因素方面描述自殺未遂者與正常對照在初訪以及隨訪中的區(qū)別。(3)探討自殺未遂的重要危險因素隨時間的變化情況。(4)估計自殺未遂者重復(fù)自殺行為在各個隨訪期的發(fā)生率,探討重復(fù)自殺行為的危險因素。3研究方法3.1研究對象與調(diào)查過程初訪從山東省慢病監(jiān)測點隨機選取滕州、寧陽與蓬萊三個縣(市)作為調(diào)查點。從所選三個縣的所有鄉(xiāng)鎮(zhèn)收集從2009年10月到2011年3月間發(fā)生自殺未遂的人群(病例組)的資料。病例組的資料來源于各個鄉(xiāng)鎮(zhèn)衛(wèi)生院與縣(市)醫(yī)院的急診科,當(dāng)?shù)氐募膊☆A(yù)防控制中心負(fù)責(zé)收集、審核與確認(rèn)病例。初訪的對照同樣來自上述的三個縣(市),按照1:1配對的原則隨機抽取。配對的原則包括相似的年齡(不超過3歲)、同性別、同地區(qū)、與自殺未遂者沒有血緣關(guān)系和無既往自殺史。隨訪為調(diào)查初訪時的所有居民,包括自殺未遂者與正常對照。隨訪時,為了保證隨訪率,在能采訪到本人的情況下對其本人進(jìn)行訪談,若未采訪到本人,則采訪本人的信息人。第一次隨訪在2012年10月到2012年12月展開。第二次隨訪在2016年10月到2016年12月展開。初訪與隨訪皆采取一對一、面對面的方式進(jìn)行問卷訪談,由經(jīng)過統(tǒng)一培訓(xùn)的調(diào)查員按照問卷順序進(jìn)行。調(diào)查地點選取鄉(xiāng)鎮(zhèn)衛(wèi)生院、村衛(wèi)生室或被訪人家。進(jìn)行知情同意時,被訪談對象簽署知情同意書后方可進(jìn)行訪談。3.2訪談工具本研究采用的訪談工具為基本信息問卷、標(biāo)準(zhǔn)化量表與診斷工具的結(jié)構(gòu),具體包括基本信息問卷、自殺行為情況問卷、扭力量表、生活事件量表、心理量表(包括社會支持、自尊、焦慮與抑郁)以及精神疾病診斷工具。隨訪問卷增添了重復(fù)自殺行為問卷。3.3統(tǒng)計分析使用SPSS 16.0進(jìn)行統(tǒng)計描述和分析。X2檢驗、t檢驗或者U檢驗用于特征的對比。利用廣義估計方程進(jìn)行自殺未遂危險因素的變化趨勢與重復(fù)自殺行為的危險因素分析。4主要結(jié)果4.1信度評價訪談信息人所得基本信息與心理狀況可以較好的反映目標(biāo)人的真實情況。另外,隨訪樣本的年齡、性別與初訪時無差異。所用量表的Cronbach'sα系數(shù)大部分在0.7以上,具有較好的內(nèi)部一致性。以上都反映出所得數(shù)據(jù)信度較好。4.2初訪及隨訪自殺未遂組與正常對照組的信息比較在第一次隨訪以及第二次隨訪時,人口學(xué)差異已經(jīng)不再明顯。而負(fù)性生活事件發(fā)生率、社會支持評分、自尊評分、抑郁感評分、焦慮感評分以及精神障礙患病率等在兩組中依然具有顯著差異。4.3自殺未遂相關(guān)因素的變化情況相對于初訪來說,自殺未遂組負(fù)性生活事件的發(fā)生率在第一次隨訪時呈下降趨勢(RR=0.1 65,95%CI:0.099-0.275),在第二次隨訪時呈下降趨勢(RR=0.238,5%CI:0.142-0.399),且第二次隨訪相對于第一次隨訪有上升趨勢。對照組的變化趨勢沒有統(tǒng)計學(xué)意義。自殺未遂組精神障礙的患病率隨時間呈下降趨勢(第一次隨訪,RR=0.477,95%CI:0.293-0.778;第二次隨訪,RR=0.290,95%CI:0.181-0.463)。而對于正常對照組,總體趨勢也呈現(xiàn)下降趨勢,但沒有統(tǒng)計學(xué)意義。相對于初訪來說,第一次隨訪社會支持評分的升高趨勢具有統(tǒng)計學(xué)意義(RR=8.742,95%CI:3.214-23.775),而第二次隨訪時的變化趨勢沒有統(tǒng)計學(xué)意義。相對于第二次隨訪來說,第一次隨訪評分的升高趨勢也具有統(tǒng)計學(xué)意義(RR=12.705,95%CI:3.784-42.656)。另外,對照組社會支持的變化趨勢沒有統(tǒng)計學(xué)意義。自殺未遂組的自尊評分的變化趨勢沒有統(tǒng)計學(xué)意義(P0.05)。對照組中,第一次隨訪時的減少趨勢沒有統(tǒng)計學(xué)意義。自殺未遂組的抑郁感評分的第一次、第二次隨訪時減少趨勢具有統(tǒng)計學(xué)意義(P0.001)。對照組中,抑郁評分的變化趨勢沒有統(tǒng)計學(xué)意義。相對于初訪來說,第一次隨訪焦慮評分的下降趨勢具有統(tǒng)計學(xué)意義(RR=0.021,95%CI:0.003-0.128),而第二次隨訪時的變化趨勢沒有統(tǒng)計學(xué)意義。相對于第二次隨訪來說,第一次隨訪評分的下降趨勢也具有統(tǒng)計學(xué)意義(RR=0.021,95%CI:0.003-0.133)。對照組變化趨勢與自殺未遂組相似。4.4重復(fù)自殺的相關(guān)特征及影響因素第一次隨訪時重復(fù)自殺行為發(fā)病密度為1.57/100人年,第二次隨訪時重復(fù)自殺行為發(fā)病密度為1.41/100人年。老年人重復(fù)自殺發(fā)病密度大于非老年人。重復(fù)自殺以高齡男性為主要特征。將重復(fù)自殺者的初次與再次自殺特征進(jìn)行對比分析發(fā)現(xiàn),兩者的基本情況與自殺特征幾乎沒有差異。同時,對自殺方式進(jìn)行分析可得,初次自殺方式多以服農(nóng)藥為主(79%);再次自殺方式中服農(nóng)藥雖然仍為分布最多的自殺方式,但比例較小(36%),方式開始呈現(xiàn)多樣化,且更傾向于暴力自殺方式(上吊、投河以及割腕)。相比單次自殺者,重復(fù)自殺者有年齡大、患有軀體疾病、焦慮感與有精神障礙的特征。本研究中重復(fù)自殺行為共發(fā)生11例,其中包括7例重復(fù)自殺過1次,3例重復(fù)自殺過2次,1例重復(fù)自殺過3次。年齡大(RR=1.047,95%CI:1.007-1.088)、焦慮感(RR=1.050,95%CI:1.015-1.087)與精神障礙(RR=26.245,95%CI:3.170-217.305)為重復(fù)自殺行為的危險因素。5研究結(jié)論(1)在找不到本人的情況下,自殺未遂者隨訪可利用信息人代替本人的采訪方式,但要嚴(yán)格入選標(biāo)準(zhǔn)。(2)自殺行為發(fā)生后,自殺未遂者的精神心理狀況與正常對照人群仍有顯著差異,但初訪相比,自殺未遂者的精神心理狀況總體來說有所好轉(zhuǎn)。(3)農(nóng)村重復(fù)自殺發(fā)病密度較高,且老年人的發(fā)病密度大于非老年人。(4)與單次自殺的自殺未遂者相比,重復(fù)自殺行為者心理精神狀況明顯較差。(5)重復(fù)自殺行為的危險因素主要為精神障礙、高年齡以及焦慮感等。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：D669.9
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