Socio-demographic and clinical correlates of lifetime suicide attempts and their impact on quality of life in Chinese schizophrenia patients ?????????????????? ???????????????????

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Socio-demographic and clinical correlates of
lifetime suicide attempts and their impact on
quality of life in Chinese schizophrenia
patients?????????????????????????????????????

• Xiang Yu-Tao, MD, PhD
• Dep. of Psychiatry, CUHK Beijing Anding
  Hospital, China
• ???
• ???????????? ? ??????????????

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Background (1)???? (1)

• Suicide is the chief cause of premature death in
  schizophrenia patients and 10-15 of them die by
  suicide (Caldwell et al., 1990)
• ?????????????????????????,?10-15????????????
  (Caldwell et al., 1990)
• Occurrence of lifetime suicide attempts in
  schizophrenia patients ranged from 18 to 55
  (Roy, 1982)
• ??????,???????????????18 to 55 (Roy, 1982)
• Majority of schizophrenia patients who commit
  suicide have at least one previous attempt
  (Harkavy-Friedman et al, 1999)
• ???????????????,?????????????? (Harkavy-Friedman
  et al, 1999)
• ---?????????,?????????

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Background (2)???? (2)

• Risk factors of suicide attempts included male
  gender, younger age, unmarried status, presence
  of depression and hopelessness, history of
  substance abuse, unemployment, and positive
  family history of suicide (Addington et al.,
  1992)
• ????????,????????????????????????????????????,????
  ?????? (Addington et al., 1992)
• No study focuses on socio-demographic and
  clinical correlates of lifetime suicide attempts
  in Chinese schizophrenia patients and the impact
  on their quality of life (QOL).
• ??,?????????????????????????????????????????????

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Aims????

• Aim To investigate the rate of lifetime suicide
  attempts in Chinese schizophrenia patients, and
  determine their correlates
• ?? ??????????????????????????,??????

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Hypotheses????

• Hypothesis 1 Rates of lifetime suicide attempts
  would significantly differ between Hong Kong and
  Beijing due to the differences between the two
  sites in socio-cultural and economic contexts and
  access to psychiatric care
• ??-1 ??????????????????? ??????????????,???????
  ?????
• Hypothesis 2 Severity of depressive and
  psychotic symptoms and characteristic of
  psychotropic drug use would significantly
  correlate with suicide attempts
• ??-2 ?????????,??????????,????????????
• Hypothesis 3 Lifetime suicide attempts would
  negatively correlate with patients QOL
• ??-3??????????????????

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Methods (1) ?? (1)

• Study settings and subjects
• ?????????
• Subjects in HK were randomly selected from
  schizophrenia patients attending the Psychiatric
  Outpatient Clinic at Prince of Wales Hospital
• ???????????????????????????????
• Their counterparts in Beijing, matched according
  to age, sex, age at onset, and length of illness,
  were recruited from the Psychiatric Outpatient
  Clinic at Beijing Anding Hospital
• ?????,?????????????????,????(??,??,????,??)???,???
  ?

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Methods (2) ?? (2)

• Study criteria ????
• Diagnosis of schizophrenia according to DSM-IV
• ??DMS-IV??????????
• Age between 18 to 60 years length of illness
  gt/5 years
• ????18-60??? ?? ???5????
• Outpatients who have been clinically stable for
  at least 3 months before recruitment according to
  Lobana s criteria (2001)
• ????3????????? (Lobana et al., 2001)
• Patients with history of or ongoing major medical
  conditions / past or current significant
  drug/alcohol abuse were excluded
• ??????????????

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Methods (3) ?? (3)

• Data collection ????
• Socio-demographic and clinical data were
  extracted from medical notes and confirmed during
  the interview
• ???????????????????,??????????
• Suicide attempt was defined as a
  self-destructive act carried out with at least
  some intent to end ones life (Grunebaum et al.,
  2001).
• ???????????????????,??????????(Grunebaum et
  al., 2001)
• History of suicide attempts were confirmed by a
  review of medical records supplemented by a
  diagnostic interview
• ?????????????,??????????????

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Methods (4) ???? (4)

• Outcome measures ????
• The Hong Kong and Chinese versions of the WHO
  Quality of Life scale-brief version
• ??????WHO??????-???
• Brief Psychiatric Rating Scale (BPRS)
• Simpson and Angus Scale of Extrapyramidal
  Symptoms (SAS) and Barnes Akathisia Rating Scale
  (BARS)
• The 17-item Hamilton Depression Rating Scale
  (HAM-D)
• ????????

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Methods (5)???? (5)

• Statistical analysis ????
• Comparisons between the HK and BJ groups, and
  between the attempter and non-attempter groups
  with regard to socio-demographic and clinical
  characteristics were performed by independent
  sample t-test, Mann-Whitney U test and chi-square
  test as appropriate
• ????t??,Mann-Whitney U test, ????
• Multiple logistic regression analysis was used to
  determine the predictors of lifetime suicide
  attempts
• ??logistic??

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Results (1)?? (1)

• Of the 298 (HK) and 288 (BJ) patients who were
  eligible and approached, 43 and 38 patients,
  respectively, refused to participate in the study
• ??298? (??) ? 288? (??) ???????????,??43??38??????
  ?
• No significant difference was found between the
  study subjects and those who refused to
  participate with regard to age, sex, and length
  of illness
• ????????????,???????????????

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Results (2)
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Results (3)
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Results (4)
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Discussion (1)?? (1)

• Difference in socio-demographic and clinical
  characteristics between the two sites
• ??????????????????
• Discrepancy in monthly income, employment status
  and health insurance coverage between the two
  sites is the consequence of the different
  social-cultural and economical contexts and
  public health policies
• ????????????????????,????????,?????????
• The difference between the two sites in type and
  doses of antipsychotics could be due to the
  different characteristics of prescription
  influenced by costs of treatment, mental health
  policies, health insurance, and different
  symptomatology (Sim et al., 2004)
• ???????????????,???????????????????????????????(Si
  m et al., 2004)

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Discussion (2) ?? (2)

• Hypothesis 1-supported
• ?? 1 ??
• Discrepancy in rate of lifetime suicide attempts
  between HK and BJ (20 in HK vs 33.6 in BJ)
  could be partly due to the differences in mental
  health care system
• ??,?????????????????? (20 in HK vs 33.6 in BJ)
  ????????????????????
• E.g, In HK, follow-up clinics and community
  mental health services are both well developed.
  Patients could be soon identified once their
  mental health status become unstable, which could
  effectively lower the risk of suicide attempts.
  In BJ, there are only maintenance psychiatric
  clinics (patients need to see psychiatrists
  voluntarily) and no community mental health
  services are available. Thus, under such
  circumstances probably patients with suicide
  attempts could not be found in time by mental
  health professionals (Xiang et al., 2007)
• ??, ???, ????????????????????????????????,????????
  ,????????????????????????????,????????,??????????
  ????????,???????????????,?????????????

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Discussion (2) ?? (2)

• Hypothesis 2-supported
• ?? 2 ??
• Severity of positive, and depressive symptoms,
  anxiety, and EPS was all positively correlated
  with presence of suicide attempts, which was
  consistent with previous findings (Walker et al.,
  1997 Grunebaum et al, 2001)
• ??????????????????????????????? ????????(Walker
  et al., 1997 Grunebaum et al, 2001)
• The higher doses of APs in suicide attempters
  could be explained by the fact that these drugs
  were used to control severe positive symptoms
• ??????????????????????? ??????????
• More frequent hospitalizations in the attempter
  group - The risk of suicide is one of most common
  reasons for the admission of schizophrenia
  patients (Addington Addington 1992 Meltzer
  2005)
• ???????????????? ??????????????????? (Addington
  Addington 1992 Meltzer 2005)
• More attempters than non-attempters were taking
  clozapine
• ---Clozapine could reduce rate of suicide
  attempts in schizophrenia patients (Keck et al.,
  2000 Meltzer et al, 2003)
• ???????????????????? ???,???????????????
  (Keck et al., 2000 Meltzer et al, 2003)

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Discussion (3) ?? (3)

• Hypothesis 2 (Contd)
• ?? 2
• Depot APs were less frequently administered in
  the attempter group. Inadequate or infrequent
  use of depot APs could lead to poor symptom
  control and more suicide attempts (Barnes
  Curson 1994)
• ??????????????????????? ?????????????????????,??
  ????? (Barnes Curson 1994)
• More attempters than non-attempters were
  taking BZDs - no clear explanation for this
  finding Speculation BZDs could lead to
  behavioral dis-inhibition which might contribute
  to the increased number of suicide attempts
  (Michel Lang 2003)
• ????????????????????? ???????????????????????b
  ehavioral disinhibition ??,????????????? (Michel
  Lang 2003)
• Patients with suicide attempts had an earlier age
  at onset in this sample, confirming the finding
  of a previous study from China (Ran et al., 2003)
  
• ---schizophrenia patients in urban regions
  who fall ill at an early age are less likely to
  find satisfactory jobs or a spouse due to the
  stigma and discrimination related to
  schizophrenia (Phillips et al., 2002). This could
  lead to higher risk of suicide
• ?????????????? ??????? (Ran et al., 2003)
• ---????????????,???????????,????????
  (Phillips et al., 2002)

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Discussion (4) ?? (4)

• Hypothesis 3-supported
• ?? 3??
• Patients with a history of suicide attempts were
  less satisfied than non-attempters with each QOL
  domain
• ???????????????????????????????
• The differences between the two groups in
  physical and social QOL domains remained
  significant after adjusting for clinical
  variables -- supports the conclusion of a study
  of Caucasian schizophrenia inpatients (Ponizovsky
  et al., 2003), even though suicide and QOL are
  both culture sensitive (Heinze et al., 1997)
• ??????????????????,??????????????????????????????
  ???????? (Ponizovsky et al., 2003),
  ????????????????? (Heinze et al., 1997)

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Limitations of the study??

• the study was cross-sectional therefore the
  causality of relationship between suicide
  attempts and socio-demographic and clinical
  variables could not be explored
• ????,???????????????
• The results are applicable only to clinically
  stable schizophrenia outpatients in the two of
  developed big cities in China
• ????,???????????

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Clinical implications??

• The differences in social-cultural and economic
  contexts and in the access to psychiatric care
  between the two cities are likely to contribute
  to the discrepancy in the rate of suicide
  attempts
• ??????????????????????????,?????????????????????
• The judicious use of psychotropic drugs and
  psychosocial interventions are very important to
  achieve more effective control over psychotic and
  depressive symptoms and EPS to reduce suicide
  risk and to improve QOL in schizophrenia patients
• ??????????????,??????????????,??????????,?????????
  ???
• follow-up psychiatric clinics and comprehensive
  community mental health services should be
  established in mainland China, which would be
  also expected to reduce the risk of suicide of
  schizophrenia patients
• ???????????????????,?????????????????

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• ????????
• Journal of Psychiatric Research
• ???PubMed / Medline??

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