目标:以前没有研究调查精神科医生密度与自杀之间的关系,考虑个人和地区层面的特征。
方法:2007-2017年的所有自杀病例均来自全国死因数据文件,每个自杀病例按年龄和性别与十个对照相匹配,每个自杀病例/对照分配给台湾355个乡镇之一。我们的主要结果是通过多水平模型估计的自杀比值比(OR),其中包括个人层面和地区层面的特征。将没有精神科医生的乡镇与有精神科医生的乡镇的四分位数进行比较(每100,000人的密度):Q1(0.01-3.02);Q2(3.02-7.20);Q3(7.20-13.82);和Q4(>13.82)。
结果:共纳入40,930例自杀病例和409,300例年龄性别匹配的对照。我们发现精神科医生密度增加与自杀风险降低相关(Q1:调整后OR[aOR]=0.95[95%CI0.90-1.01];Q2:aOR=0.90[95%CI0.85-0.96];Q3:aOR=0.89[95%CI0.83-0.94];Q4:aOR=0.89[95%CI0.83-0.95])月收入,身体合并症,和精神疾病的诊断)和地区社会经济特征。
结论:精神科医生密度-自杀关联表明提供精神科服务对预防自杀有影响。自杀预防战略可以有效地侧重于增加当地获得精神科服务的机会。本文受版权保护。保留所有权利。
OBJECTIVE: No previous studies, to our knowledge, have investigated the association between psychiatrist density and suicide, accounting for individual- and area-level characteristics.
METHODS: We investigated all suicide cases in 2007-2017 identified from the national cause-of-death data files, with each suicide
case matched to 10 controls by age and sex and each suicide
case/control assigned to one of the 355 townships across Taiwan. Our primary outcome was the odds ratio (OR) of suicide and its 95% confidence interval (CI) estimated via multilevel models, which included both individual- and area-level characteristics. Townships with no
psychiatrists were compared with the quartiles of townships with
psychiatrists (density per 100,000 population): quartile 1 (Q1) (0.01-3.02); quartile 2 (Q2) (3.02-7.20); quartile 3 (Q3) (7.20-13.82); and quartile 4 (Q4) (>13.82).
RESULTS: A total of 40,930 suicide cases and 409,300 age- and sex-matched controls were included. We found that increased psychiatrist density was associated with decreased suicide risk (Q1: adjusted OR [aOR], 0.95 [95% CI, 0.90-1.01]; Q2: aOR, 0.90 [95% CI, 0.85-0.96]; Q3: aOR, 0.89 [95% CI, 0.83-0.94]; Q4: aOR, 0.89 [95% CI, 0.83-0.95]) after adjusting for individual-level characteristics (employment state, monthly income, physical comorbidities, and the diagnosis of psychiatric disorders) and area socioeconomic characteristics.
CONCLUSIONS: The psychiatrist density-suicide association suggests an effect of increased availability of psychiatric services on preventing suicide. Suicide prevention strategies could usefully focus on enhancing local access to psychiatric services.