精神疾病与意外伤害死亡的关系

摘要

Objective To explore associations between mental disorders and accidental death. Methods A case-control psychological autopsy study was conducted in Fengning county in Hebei province, Kailu county in Inner Mongolia, Meixian county in Shaanxi province, Chongzhou county in Sichuan province. One hundred and fifty-seven accidental death cases were identified, based on detailed interview and cause of death listed as"accidental death"(International Classification of Diseases 10th edition codes V01-X59),"suicide"(X60-X84) or"mental disorder"(F00-F98). We used 2008 census data for three of the four counties (Fengning county in Hebei Province stopped participating in the study in 2009), to select a multistage stratified random sample of adult community residents as the living controls. Finally, 140 living controls were randomly sampled. For each cases or controls, one family member and one associate (neighbor or friend) were interviewed separately by different interviewers. For each cases, socio-demographic data, quality of life, and psychiatric diagnosis 1 month prior to accidental death (or 1 month prior to interview for the living controls), and life events and social support 12 months prior to the death or interview (for controls) were evaluated during the interview. Axis Ⅰ mental disorders, Axis Ⅱ personality disorders were diagnosed based on Structured Clinical Interviews for DSM-Ⅳ-TR Axis Ⅰ Disorders (SCID-I) and Axis Ⅱ Personality Disorders (SCID-Ⅱ). Multivariate logistic regression was used to test the association between accidental death and mental disorders. Results The accidental death group was more likely being male (χ2=37.55, P<0.001) and unmarried (χ2=8.82, P=0.003). The prevalence of Axis Ⅰ mental disorder and of axis Ⅱpersonality disorder were higher in accidental death group than that in control group (19.7%( 31/157) vs. 3.6%(5/140), χ2=18.17, P<0.01; 11.5%(18/157) vs .3.6%(5/140), χ2=6.45, P=0.011; respectively). After adjusted for demographic variables, the adjusted OR was 1.78 (95%CI: 1.26-2.51, P=0.001) for mental disorders, and 1.48(95%CI: 1.02-2.15, P=0.040) for mental disorders other than substance use disorders. Conclusion Mental disorder is an independent risk factor for accidental death, whether or not substance use disorders were excluded.%目的 探讨精神疾病与意外伤害死亡的关系.方法 从河北省丰宁县、内蒙古自治区开鲁县、陕西省眉县、四川省崇州县的人口死亡信息登记管理系统中纳入2008年1月至2011年3月发生的157例意外伤害死亡案例作为意外伤害死亡组,采用多阶段分层随机抽样法从其中3个县抽样140名健在居民作为对照组,2组中各有1名家属和1名亲友完成访谈.访谈主要收集死者死亡前和对照组在访谈前1个月的人口学资料、精神疾病诊断和生命质量情况,以及死前(对照组受访前)1年的生活事件与社会支持等情况.采用多变量Logistic回归分析精神疾病与意外伤害死亡的关系.结果 意外伤害死亡组与对照组精神疾病患病率分别为19.7%(31/157)和3.6%(5/140),人格障碍患病率分别为11.5%(18/157)和3.6%(5/140),2组比较差异均有统计学意义(χ2=18.17,P<0.01;χ2=6.45,P=0.011).多变量Logistic回归分析显示,在控制人口学变量前提下,剔除物质使用障碍前后,精神疾病调整后OR值分别为1.78(95%CI:1.26~2.51,P=0.001)和1.48(95%CI:1.02~2.15,P=0.040).结论无论是否剔除物质使用障碍,精神疾病均为意外伤害死亡的独立危险因素.