重庆市大学生自杀未遂的研究
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摘要
目的:①通过病例对照研究(病例:1名自杀未遂的大学生;对照:2名无自杀行为的大学生),探讨大学生发生自杀未遂行为的主要危险因素。②通过比较男女大学生自杀未遂者的特征来了了解我国女性自杀未遂率显著高于男性的原因。
方法:①第一部分:调查于2005年9月开始,在一年内对重庆市大学的所有病例和其相应的对照进行深入调查,测评工具包括:人口学资料、症状自评量表、冲动行为量表、外显攻击行为量表、防御方式问卷、青少年生活事件量表、生命质量量表、美国精神行为障碍分类与诊断标准第四版会谈量表,然后比较病例组与对照组自杀特征。②第二部分:根据性别不同将自杀未遂者分为两组,采用症状自评量表、防御方式问卷、冲动行为量表、外显攻击行为量表、青少年生活事件量表、美国精神行为障碍分类与诊断标准第四版会谈量表,进行评定,然后比较男女自杀未遂者的特征。
结果:第一部分:①被调查的自杀未遂者的特征如下:62.9%服治疗药物,95%在自杀前表现为或轻或重的情绪方面的障碍,65%自杀时有人在场,27%写过者遗书,把35%自杀想法告诉其他人方面,19%制定过周密的计划方面。②自杀未遂者与无自杀行为者症状自评量表评定结果比较:自杀未遂者的躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性因子分高于无自杀行为者,差异有显著性(P〈0.01)。③自杀未遂者与无自杀行为者冲动行为量表结果比较:自杀未遂者在计划分、行动分、认知分因子和总分显著高于对照组,差异有统计学意义(P〈0.01)。④有无自杀行为者在攻击行为方面有较大差异,主要表现在身体的攻击性、语言的攻击性、愤怒、敌意、指向自我的攻击性因子和总分,差异有统计学意义(P〈0.01)。⑤自杀未遂者与无自杀行为者防御方式评定结果比较:自杀未遂者不成熟防御方式得分高于对照组,差异有显著性(P〈0.01)。⑥自杀未遂行为与精神疾病存在统计学联系(P〈0.001)。⑦自杀未遂者与无自杀行为者青少年生活事件量表(ASLEC)的比较:自杀未遂组在生活事件平均刺激量上存在差异,其中人际关系因子、学习压力因子、受惩罚因子、健康适应因子、其他(包括恋爱受挫等)因子差异显著。⑧自杀未遂者自杀前一个月生命质量明显低于无自杀者(P〈0.001)。⑨条件Logistic回归分析说明,行为的无计划性、冲动性、认知缺陷,悲观抑郁,精神病性等指征是发生自杀未遂行为的个体病理心理学因素;人际关系差,学习压力重,健康适应弱,生命质量低是发生自杀未遂行为的社会因素。第二部分:①不同的性别采取的自杀方式不同,女性服镇静药物为最常用的自杀方式。②女性冲动性自杀行为的比例明显高于男性(P〈0.05)③女性对负性事件出现时的心理承受能力远远小于男性(P〈0.05)。
结论:①自杀未遂行为7个重要预测指标,按重要性由大到小排列依次为:自杀未遂者的冲动性人格,自杀未遂前有抑郁症状,自杀未遂前有精神病性指征,自杀未遂前一个月以上生命质量差,自杀未遂前学习压力大,自杀未遂前有人际关系冲突,自杀未遂前与健康相关方面的适应不良,应针对暴露于危险因素的个体进行有效的预防工作。②女大学生产生自杀行为与冲动性个性特征及对事件发生时的负性心理感受过强有关,应积极进行干预。
Objective: To explore risk factors through studying university students of attempted suicide and non-suicidal behavior. To compare the characteristics of suicide attempters between male and female university students with explaining the significantly higher rates of attempted suicide in women.
Method: The investigation was conducted in September 2005.A case control study was carried out between 62 suicide attempters and 124 matched non-suicidal attempters.They were assessed with demographic information questionnaire, symptom checklist 90(SCL-90),defense style questionnaire (DSQ),impulsive behavior scale(IBS), modified overt aggressive behavior scale(MOAS), adolescent self-rating life events check list(ASLEC) ,quality of life scale and structure clinical interview for DSM-IV-R- patient(SCID-P).
Results:①The characteristics of suicide attempters were as follows:62.9% were committed curative,95% had emotion disorder,65% were found someone present on suicidal occasion,27% had ever written dying testament,35% had told someone suicidal idea,19% had formulated careful planning.②Comparison of symptom self-rating scale,there were significant differences from somatization,constraint, anxiety, hostility, interpersonal relationship sensitiveness,depression, paranoia, phobophobia and psychotic fators between two groups.③Compared with non-suicidal university students,suicide attempters were more inclined to adopt immature defense, for example project, passive aggression, latent visualization, complain, splitting,withdrawal and somatization style.④Comparison of impulsive behavior ,differences between two groups were found in planning, motive, cognition factors and total scores.⑤Comparison of aggressive behavior ,there were differences from body attack, words aggression, anger, hostility, self aggression factors and total scores between two groups.⑥mental illnesses were statistical associated with suicide attempted.⑦Comparison of life events,there were differences of interpersonal relationship, learning pressure, suffering punish, healthy accustomization factors and so on.⑧Comparison of life quality,the suicide attempters’group was significantly lower than that in the control group.⑨Conditional logistic regression identified risk factors of suicidal behaviors:less planning, impulsiveness, cognitive deficit, depression,neurosis fators , sensitive interpersonal relationship,higher learning pressure,difficult healthy adaption and poor life quality.⑩Detailed assessments of 18 male and 44 female suicide attempters through questionairs,we found that the rate of impulsive suicide attempters in the female group was higher than that in the male group,and immense psychological effect of negative life events in the female group exceeded to that of the male .
Conclusion:①there were seven predictors of attempted suicide: impulse to cope with an emergence, depressive disorder, psychotic indication, poor life quality ,life events especially heavy learning pressure, tense interpersonal relationship and difficulty to adapt some habits,so it was important to establish suicide prevention plan in order to aim directly at individual with risk factors.②Suicidal behaviors were related to the characteristics of impulsiveness and immense negative psychological effect.Therefore we should positively institute intervention for them.
方法:①第一部分:调查于2005年9月开始,在一年内对重庆市大学的所有病例和其相应的对照进行深入调查,测评工具包括:人口学资料、症状自评量表、冲动行为量表、外显攻击行为量表、防御方式问卷、青少年生活事件量表、生命质量量表、美国精神行为障碍分类与诊断标准第四版会谈量表,然后比较病例组与对照组自杀特征。②第二部分:根据性别不同将自杀未遂者分为两组,采用症状自评量表、防御方式问卷、冲动行为量表、外显攻击行为量表、青少年生活事件量表、美国精神行为障碍分类与诊断标准第四版会谈量表,进行评定,然后比较男女自杀未遂者的特征。
结果:第一部分:①被调查的自杀未遂者的特征如下:62.9%服治疗药物,95%在自杀前表现为或轻或重的情绪方面的障碍,65%自杀时有人在场,27%写过者遗书,把35%自杀想法告诉其他人方面,19%制定过周密的计划方面。②自杀未遂者与无自杀行为者症状自评量表评定结果比较:自杀未遂者的躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性因子分高于无自杀行为者,差异有显著性(P〈0.01)。③自杀未遂者与无自杀行为者冲动行为量表结果比较:自杀未遂者在计划分、行动分、认知分因子和总分显著高于对照组,差异有统计学意义(P〈0.01)。④有无自杀行为者在攻击行为方面有较大差异,主要表现在身体的攻击性、语言的攻击性、愤怒、敌意、指向自我的攻击性因子和总分,差异有统计学意义(P〈0.01)。⑤自杀未遂者与无自杀行为者防御方式评定结果比较:自杀未遂者不成熟防御方式得分高于对照组,差异有显著性(P〈0.01)。⑥自杀未遂行为与精神疾病存在统计学联系(P〈0.001)。⑦自杀未遂者与无自杀行为者青少年生活事件量表(ASLEC)的比较:自杀未遂组在生活事件平均刺激量上存在差异,其中人际关系因子、学习压力因子、受惩罚因子、健康适应因子、其他(包括恋爱受挫等)因子差异显著。⑧自杀未遂者自杀前一个月生命质量明显低于无自杀者(P〈0.001)。⑨条件Logistic回归分析说明,行为的无计划性、冲动性、认知缺陷,悲观抑郁,精神病性等指征是发生自杀未遂行为的个体病理心理学因素;人际关系差,学习压力重,健康适应弱,生命质量低是发生自杀未遂行为的社会因素。第二部分:①不同的性别采取的自杀方式不同,女性服镇静药物为最常用的自杀方式。②女性冲动性自杀行为的比例明显高于男性(P〈0.05)③女性对负性事件出现时的心理承受能力远远小于男性(P〈0.05)。
结论:①自杀未遂行为7个重要预测指标,按重要性由大到小排列依次为:自杀未遂者的冲动性人格,自杀未遂前有抑郁症状,自杀未遂前有精神病性指征,自杀未遂前一个月以上生命质量差,自杀未遂前学习压力大,自杀未遂前有人际关系冲突,自杀未遂前与健康相关方面的适应不良,应针对暴露于危险因素的个体进行有效的预防工作。②女大学生产生自杀行为与冲动性个性特征及对事件发生时的负性心理感受过强有关,应积极进行干预。
Objective: To explore risk factors through studying university students of attempted suicide and non-suicidal behavior. To compare the characteristics of suicide attempters between male and female university students with explaining the significantly higher rates of attempted suicide in women.
Method: The investigation was conducted in September 2005.A case control study was carried out between 62 suicide attempters and 124 matched non-suicidal attempters.They were assessed with demographic information questionnaire, symptom checklist 90(SCL-90),defense style questionnaire (DSQ),impulsive behavior scale(IBS), modified overt aggressive behavior scale(MOAS), adolescent self-rating life events check list(ASLEC) ,quality of life scale and structure clinical interview for DSM-IV-R- patient(SCID-P).
Results:①The characteristics of suicide attempters were as follows:62.9% were committed curative,95% had emotion disorder,65% were found someone present on suicidal occasion,27% had ever written dying testament,35% had told someone suicidal idea,19% had formulated careful planning.②Comparison of symptom self-rating scale,there were significant differences from somatization,constraint, anxiety, hostility, interpersonal relationship sensitiveness,depression, paranoia, phobophobia and psychotic fators between two groups.③Compared with non-suicidal university students,suicide attempters were more inclined to adopt immature defense, for example project, passive aggression, latent visualization, complain, splitting,withdrawal and somatization style.④Comparison of impulsive behavior ,differences between two groups were found in planning, motive, cognition factors and total scores.⑤Comparison of aggressive behavior ,there were differences from body attack, words aggression, anger, hostility, self aggression factors and total scores between two groups.⑥mental illnesses were statistical associated with suicide attempted.⑦Comparison of life events,there were differences of interpersonal relationship, learning pressure, suffering punish, healthy accustomization factors and so on.⑧Comparison of life quality,the suicide attempters’group was significantly lower than that in the control group.⑨Conditional logistic regression identified risk factors of suicidal behaviors:less planning, impulsiveness, cognitive deficit, depression,neurosis fators , sensitive interpersonal relationship,higher learning pressure,difficult healthy adaption and poor life quality.⑩Detailed assessments of 18 male and 44 female suicide attempters through questionairs,we found that the rate of impulsive suicide attempters in the female group was higher than that in the male group,and immense psychological effect of negative life events in the female group exceeded to that of the male .
Conclusion:①there were seven predictors of attempted suicide: impulse to cope with an emergence, depressive disorder, psychotic indication, poor life quality ,life events especially heavy learning pressure, tense interpersonal relationship and difficulty to adapt some habits,so it was important to establish suicide prevention plan in order to aim directly at individual with risk factors.②Suicidal behaviors were related to the characteristics of impulsiveness and immense negative psychological effect.Therefore we should positively institute intervention for them.
引文
[1]李建军.中日两国青少年自杀行为比较研究[J].中国青年研究,2000,32(2):97~102
[2]Kuo W H,Gal1o JJ,Tien AY.Incidence of suicide ideation and attempts in adults:the 13-year follow-up of a community sample in Baltimore[J]. Maryland. Psychol Med, 2001,31(2):1181~1191
[3]Phillips MR,Xianyun Li,,Yanping Zhang.Suicide rates in China,1995-99[J].The lancet.2002,359:835~840
[4]殷大奎.齐心协力、脚踏实地、全面推进新世纪精神卫生工作-全国第三次精神卫生工作会议报告[J].中国心理卫生杂志.2002,16(2):4~8
[5]王家良.临床流行病学[M].上海:上海科学技术出版社,2001.155
[6]Jenkins R,Singh B.General population strategies of suicide prevention[M].In:Hawton K,van Heering K.The international handbook of suicide and attempted suicide.New York: British publishers,2000.587~615
[7]Esposito C,Spifito A,Boergers J,et al.Afective,behavioral,and cognitive functioning in adolescents with multiple suicide attempts[J].Suicide Life Threat Behav.2003,33(4):389~399
[8]张艳萍,李献云,费力鹏,等.农村地区有、无精神障碍自杀未遂者及其自杀特征的比较[J].中华精神科杂志.2003,36(4):234~237
[9]王登勤,张敬悬.自杀未遂者抑郁症状及其相关因素的研究[J].中国心理卫生杂志.2001,15(6):409~410
[10]Moiler HJ.Suicide,suicidality and suicide prevention in affective disorders[J].Acta Psychiatr Scand Suppl.2003,(418):73~80
[11]Cheng ATA,Lee CS.Suicide in Asia and the Far East[M].In:Hawton K,van Heering K.The international handbook of suicide and attempted suicide.Chichester: British publishers,2000.29~48
[12]Cantor CH.Suicide in the western world[M].In:Hawton K,van Heering K.The international handbook of suicide and attempted suicide. NewYork: British publishers,2000.9~28
[13]Maris RW,Berman AL,Silverman MM.Comprehensive textbook of suicidology[M]. New York: British publishers,2000.284~308
[14]Hawton K,Heeringen KV.The international handbook of suicide and attempted[M]. NewYork: British publishers,2000.49~64
[15]李献云,许永臣,王玉萍,等.农村地区综合医院诊治的自杀未遂病人的特征[J].中国心理卫生杂志.2002,16(10):681~684
[16]王法鑫,孙月吉,刘启贵,等.自杀未遂相关因素分析[J].中国行为医学科学.2002,11(3):288~290
[17]Phillips MR,Yang GH,Zhang YP,et al.Risk factors for suicide in China:a national case-control psychological autopsy study[J].the lancet.2002,(360):1728~1726
[1]沈渔邨.精神病学[M].北京:人民卫生出版社,2001.609~612
[2]Williams JMC,Pollock LR.The psychology of suicidal behavior[M]. International handbook of suicide and attempted suicide. NewYork:British publishers,2000.81~85
[3] 孙 彦 杰 . 自 杀 行 为 与 心 理 社 会 因 素 的 关 系 [J]. 中 国 现 代 实 用 医 学 杂志.2005,4(7):10~12
[4]Traskman Berdz .Biological aspects of suicidal behavior[M].International handbook of suicide and attempted suicide. NewYork:British publishers,2000.65~67
[5]Roy A,Rylander G,Forslund K,et al.Excess tryptophan hydroxylase 17A779C allele in surviving cotwins of monozygotic twin suicide victms[J].Neuropsychology biol.2001,43(4):233~235
[6]Nielsen DA,Virkkunen M,Lappalainen J,et al.Tryptophan hydroxylase gene marker for suicidality and alcoholism[J].Arch Gen Psychiatry.1998,55(2):593~596
[7]Bennett PJ,Mcmahon WM,Watabe J,et al.Tryptophan hydroxylase polymorphisms in suicide victims[J].Psychiatr Genet.2000,10(1):13~15
[8]Ono H.Serotonin 2A receptor gene polymorphism is not associated with completed suicide[J].Psychiatry Res.2001,35(3):173~176
[9]Du L,Faludi G, Palkovits M.Serotonergic genes and suicidality[J].Crisis.2001,22(2):5
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[2]Kuo W H,Gal1o JJ,Tien AY.Incidence of suicide ideation and attempts in adults:the 13-year follow-up of a community sample in Baltimore[J]. Maryland. Psychol Med, 2001,31(2):1181~1191
[3]Phillips MR,Xianyun Li,,Yanping Zhang.Suicide rates in China,1995-99[J].The lancet.2002,359:835~840
[4]殷大奎.齐心协力、脚踏实地、全面推进新世纪精神卫生工作-全国第三次精神卫生工作会议报告[J].中国心理卫生杂志.2002,16(2):4~8
[5]王家良.临床流行病学[M].上海:上海科学技术出版社,2001.155
[6]Jenkins R,Singh B.General population strategies of suicide prevention[M].In:Hawton K,van Heering K.The international handbook of suicide and attempted suicide.New York: British publishers,2000.587~615
[7]Esposito C,Spifito A,Boergers J,et al.Afective,behavioral,and cognitive functioning in adolescents with multiple suicide attempts[J].Suicide Life Threat Behav.2003,33(4):389~399
[8]张艳萍,李献云,费力鹏,等.农村地区有、无精神障碍自杀未遂者及其自杀特征的比较[J].中华精神科杂志.2003,36(4):234~237
[9]王登勤,张敬悬.自杀未遂者抑郁症状及其相关因素的研究[J].中国心理卫生杂志.2001,15(6):409~410
[10]Moiler HJ.Suicide,suicidality and suicide prevention in affective disorders[J].Acta Psychiatr Scand Suppl.2003,(418):73~80
[11]Cheng ATA,Lee CS.Suicide in Asia and the Far East[M].In:Hawton K,van Heering K.The international handbook of suicide and attempted suicide.Chichester: British publishers,2000.29~48
[12]Cantor CH.Suicide in the western world[M].In:Hawton K,van Heering K.The international handbook of suicide and attempted suicide. NewYork: British publishers,2000.9~28
[13]Maris RW,Berman AL,Silverman MM.Comprehensive textbook of suicidology[M]. New York: British publishers,2000.284~308
[14]Hawton K,Heeringen KV.The international handbook of suicide and attempted[M]. NewYork: British publishers,2000.49~64
[15]李献云,许永臣,王玉萍,等.农村地区综合医院诊治的自杀未遂病人的特征[J].中国心理卫生杂志.2002,16(10):681~684
[16]王法鑫,孙月吉,刘启贵,等.自杀未遂相关因素分析[J].中国行为医学科学.2002,11(3):288~290
[17]Phillips MR,Yang GH,Zhang YP,et al.Risk factors for suicide in China:a national case-control psychological autopsy study[J].the lancet.2002,(360):1728~1726
[1]沈渔邨.精神病学[M].北京:人民卫生出版社,2001.609~612
[2]Williams JMC,Pollock LR.The psychology of suicidal behavior[M]. International handbook of suicide and attempted suicide. NewYork:British publishers,2000.81~85
[3] 孙 彦 杰 . 自 杀 行 为 与 心 理 社 会 因 素 的 关 系 [J]. 中 国 现 代 实 用 医 学 杂志.2005,4(7):10~12
[4]Traskman Berdz .Biological aspects of suicidal behavior[M].International handbook of suicide and attempted suicide. NewYork:British publishers,2000.65~67
[5]Roy A,Rylander G,Forslund K,et al.Excess tryptophan hydroxylase 17A779C allele in surviving cotwins of monozygotic twin suicide victms[J].Neuropsychology biol.2001,43(4):233~235
[6]Nielsen DA,Virkkunen M,Lappalainen J,et al.Tryptophan hydroxylase gene marker for suicidality and alcoholism[J].Arch Gen Psychiatry.1998,55(2):593~596
[7]Bennett PJ,Mcmahon WM,Watabe J,et al.Tryptophan hydroxylase polymorphisms in suicide victims[J].Psychiatr Genet.2000,10(1):13~15
[8]Ono H.Serotonin 2A receptor gene polymorphism is not associated with completed suicide[J].Psychiatry Res.2001,35(3):173~176
[9]Du L,Faludi G, Palkovits M.Serotonergic genes and suicidality[J].Crisis.2001,22(2):5
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