A Study Of Attempted Suicide In Psychoses Patients

BackgroundAccording to the estimation of World Health Organization(WHO) in 2002, there are 870 thousand people committed suicide every year, accounting for 1.5% of the global burden of disease and caused more than 2 million years of disability-adjusted life years lost, more than 10 million people attempted suicide. By 2020, the disease burden caused by suicide will be about 2.4% among the global burden of disease, about 1.5 million people committed suicide each year. A national suicide rate in China is reported about 23 per 100 000, accounting for 3.6% of people die every year, and about 287 thousand people died by suicide. In China, suicide is the 5th cause of death, China has 21% of the world's population, however 44% of suicides in the world happened in China, further more 56% of female suicide victims are Chinese. According to WHO's data, suicide and self-injury led to 8.8 million disability-adjusted life years (DALYs) loss in 1998, accounting for 4.2% of total disease burden, which makes suicide become the 4th important mental health issues, following chronic obstructive pulmonary disease (8.1% of total DALYs), major depression (6.9% of total DALYs) and cerebrovascular disease (5.7% of total DALYs). Overseas researches shown that more than 90% of people who committed suicide suffered from at least one mental disorder during their lifetime, most of them are psychoses, such as mood disorders, schizophrenia, and so on.Psychosis is the main reason for suicide, Psychosis refers to such mental disorders often with characteristics of psychotic symptoms, severe impaired of social function, poor insight, and harmfulness to society, including mood disorder, schizophrenia, paranoid disorder, schizoaffective disorder and so on. Among psychosis, Depression is the main disorder lead to suicide, the suicide rate among depression patients up to 650 per 100 000, 15% of depression patients die of suicide; followed by schizophrenia. Suicide has a certain personality characteristics, Brezo pointed out that suicide attempters have higher levels of hostility, anxiety, neuroticism, outgoing, impulsive. History of suicide attempts is a risk factor for suicide, in western countries, about 10% of suicide attempters eventually die of suicide, 30%-40% of suicide deaths with previous history of suicide attempts. In China, there are more than 2 million attempted suicide every year, about 10%-14% of suicide attempters die of suicide. There are many risk factors for suicide, such as history of attempted suicide, major depression, schizophrenia, life events caused by severe acute or chronic stress, interpersonal tensions, contradictions, intense personality defects, living in difficult circumstances, Marital status, long-term unemployment, under enormous pressure of social life. The risk of suicide will increase with more exposure to risk factors. Therefore, further research of the risk factors in suicide would help to reduce the incidence of suicidal behavior.Objective1.To explore the risk factors of suicide attempt in psychosis patients.2.To explore the prevention and intervention measures of suicide behavior in psychosis patients.Methods1.Study object: (1)Patients group: psychosis patients who were treating in Guangzhou Psychiatric Hospital because of attempted suicide from Sep, 2009 to Aug, 2010 were enrolled, age≥16 years, informed consent signed; Such subjects were excluded: refused to investigate, a disturbance of consciousness, leaving too fast, unable to get in touch. 50 cases of psychosis suicide attempters were recruited. (2)Control group: controls were psychosis patients without suicide attempts in the same hospital, who was individually matched with each case by sex, diagnosis, age (±5 years), time of hospitalization. exclusive criteria was consistent with study group's.2.Instrument of survey: self-made General Information Questionnaire, structured clinical interview for DSM-IV axisⅠdisorders-patient edition, Hamilton Depression Rating Scale24, Hamilton Anxiety Rating Scale, Life Event Scale, Eysenck Personality Questionnaire, WHO-Five Well-being Index, Life Satisfaction Scale.3.Methods of investigation: subjects and their families were interviewed within 48 hours after admission to Hospotial, requiring about 1-2 hours.Results1. Paired T test and Non-parametric Test:Significant difference between the two groups were: HAMD24 total scores, cognitive disorder factor scores, Sleep disturbance factor scores, Hopelessness factor scores, HAMA total scores, Somatic anxiety factor scores, Mental anxiety factor scores, N and E scale scores in the EPQ, WHO-5C total scores, LSS scores and life events (P<0.05).2. Univariate and Multivariate Logistic Regression Analysis:After Univariate Logistic Regression Analysis, we pick up 9 variables including HAMD24 total scores, cognitive disorder factor scores, hopelessness factor scores, HAMA total scores, Somatic anxiety factor scores, Mental anxiety factor scores, negative life events within a month, negative life events of more than one year, negative effectiveness of life events, then, we conducted Logistic Regression Analysis of Multiple Factors, finding that cognitive disorder factor scores and hopelessness factor scores in Hamilton Depression Rating Scale are related to psychosis suicide attempters(a=0.05). ConclusionThis study shows that cognitive deviation and hopelessness are risk factors of suicidal behavior, clinical staff should pay attention to this, and comprehensive measures should be adopted to prevent suicidal behavior of psychosis, In addition to providing timely and effective drug treatment, psychological treatment should also be strengthened with the appropriate social support to build their hope in life.