背景:尽管研究表明饮食失调患者自杀的风险很高,大多数研究都集中在自杀意念和尝试上。关于因自杀而死亡的饮食失调者的特征的研究很少,也不调查随着时间的推移趋势。我们旨在比较在英格兰因自杀而死亡的饮食失调患者与其他因自杀而死亡的精神健康诊断患者的特征,并检查比率趋势。
方法:在这项全国回顾性队列研究中,所有在英国死于自杀的人(年龄≥10岁)的数据,英国,在1997年1月1日至2021年12月31日期间,在精神卫生服务的照顾下(在过去的12个月内),从国家心理健康自杀和安全保密调查(NCISH)获得,其中临床信息是通过由负责患者护理的心理健康专业人员完成的问卷收集的。自杀的发生率,和人口统计学,临床,和治疗特点,我们使用单变量logistic回归分析比较了在同一时间段内自杀死亡的被诊断为进食障碍(由治疗临床医师记录)的患者与其他精神健康诊断的自杀死亡患者.有相关生活经验的人参与了研究设计,实施,解释,和手稿的写作。
结果:在英格兰,NCISH被告知死于自杀的119446人中,30795人在最近的精神卫生服务机构的照顾下,其中30246人已知诊断,并被纳入分析。在这些人中,10373(34%)为女性,19873(66%)为男性;2236(8%)为少数民族;382(1%)被诊断为进食障碍,29864(99%)被诊断为另一种心理健康。与其他心理健康诊断的自杀患者相比,进食障碍患者年龄较小(中位年龄33岁[范围15-90]vs45岁[10-100]),更常见的是女性(进食障碍组中343[90%]女性和39[10%]男性;其他诊断组中10030[34%]女性和19834[66%]男性),并且不太可能有自杀的常规危险因素的证据,例如单独居住(比值比[OR]0·68,95%CI0·55-0·84)。382人中有22人(6%)来自少数民族。进食障碍患者的特点是临床复杂性更高(例如,自我伤害[OR2·31,95%CI1·78-3·00],合并症[9·79,6·81-14·1],和更长的疾病持续时间[1·95,1·56-2·43]),与其他诊断的患者相比,在用药过量后死亡的可能性更高(2·00,1·62-2·45)。儿童虐待(140人中的52[37%])和家庭暴力(91人中的18[20%])在饮食失调患者中很常见。类似于其他诊断的患者,大多数(326例患者中的244例[75%])因自杀而死亡的饮食失调患者在最后一次接触时被临床医生评为低风险.1997年至2021年间,进食障碍患者的自杀死亡人数上升(发病率比[IRR]1·03,95%CI1·02-1·05;p<0·0001),但是,当考虑到更多的患者进入精神卫生服务时,比率下降(IRR0·97,0·95-1·00;p=0·033)。
结论:这项研究的重点是寻求心理健康服务帮助的人。它没有考虑饮食失调的亚型或包括对照组,但它确实突出了可能的干预领域。全面提供饮食失调和潜在疾病的循证治疗,以解决这些患者的临床复杂性,可能有助于减少自杀。认识到临床风险评估的局限性,解决早期生活经历和当前逆境,适当的处方也可能是有益的。预防自杀必须仍然是饮食失调服务和更广泛的精神保健的优先事项。
背景:医疗质量改善合作伙伴关系。
Although studies have suggested a high risk of suicide in people with eating disorders, most studies have focused on suicidal ideation and attempts. There is little research on the characteristics of people with eating disorders who died by suicide, nor investigation of trends over time. We aimed to compare the characteristics of patients with eating disorders who died by suicide versus patients with other mental health diagnoses who died by suicide in England and to examine the trends in rates.
In this national retrospective cohort
study, data on all people (aged ≥10 years) who died by suicide in England, UK, between Jan 1, 1997, and Dec 31, 2021, while under the care (within the previous 12 months) of mental health services were obtained from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), in which clinical information is collected via a questionnaire completed by the mental health professional responsible for the patient\'s care. Incidence of suicide in, and demographic, clinical, and treatment characteristics of, patients with a diagnosis of eating disorder (as recorded by the treating clinician) who died by suicide were compared with patients with other mental health diagnoses who died by suicide within the same timeframe using univariable logistic regression analysis. People with related lived experience were involved in the
study design, implementation, interpretation, and writing of the manuscript.
Of 119 446 people for whom NCISH were notified of dying by suicide in England, 30 795 were under the recent care of mental health services, of whom 30 246 had known diagnoses and were included in analyses. Of these individuals, 10 373 (34%) were female and 19 873 (66%) were male; 2236 (8%) were of minority ethnicity; 382 (1%) had a diagnosis of eating disorder and 29 864 (99%) had another mental health diagnosis. Compared with patients with other mental health diagnoses who died by suicide, patients with eating disorders were younger (median age 33 years [range 15-90] vs 45 years [10-100]), more often female (343 [90%] female and 39 [10%] male in the eating disorders group; 10 030 [34%] female and 19 834 [66%] male in the other diagnoses group), and less likely to have evidence of conventional risk factors for suicide such as living alone (odds ratio [OR] 0·68, 95% CI 0·55-0·84). 22 (6%) of 382 were from a minority ethnic group. Patients with an eating disorder were characterised by a greater clinical complexity (eg, self-harm [OR 2·31, 95% CI 1·78-3·00], comorbidity [9·79, 6·81-14·1], and longer duration of illness [1·95, 1·56-2·43]), and were more likely to have died following overdoses (2·00, 1·62-2·45) than patients with other diagnoses. Childhood abuse (52 [37%] of 140) and domestic violence (18 [20%] of 91) were common in patients with eating disorders. Similar to patients with other diagnoses, most (244 [75%] of 326) of those with eating disorders who died by suicide were rated as low risk by clinicians at last contact. The number of suicide deaths in patients with eating disorders rose between 1997 and 2021 (incidence rate ratio [IRR] 1·03, 95% CI 1·02-1·05; p<0·0001), but rates fell when accounting for the greater number of patients entering mental health services (IRR 0·97, 0·95-1·00; p=0·033).
This
study was focused on people who sought help from mental health services. It did not consider subtypes of eating disorders or include a control group, but it does highlight possible areas for intervention. The comprehensive provision of evidence-based treatment for eating disorders and underlying conditions to address the clinical complexity in these patients might help to reduce suicide. Recognising limitations in clinical risk assessment, addressing early life experiences and current adversities, and appropriate prescribing might also be of benefit. Suicide prevention must remain a priority for eating disorder services and mental health care more widely.
The Healthcare Quality Improvement Partnership.