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首页> 外文期刊>BMC Family Practice >Suicide risk in primary care patients diagnosed with a personality disorder: a nested case control study
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Suicide risk in primary care patients diagnosed with a personality disorder: a nested case control study

机译：被诊断为人格障碍的初级保健患者的自杀风险：一项嵌套病例对照研究

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Background Personality disorder (PD) is associated with elevated suicide risk, but the level of risk in primary care settings is unknown. We assessed whether PD among primary care patients is linked with a greater elevation in risk as compared with other psychiatric diagnoses, and whether the association is modified by gender, age, type of PD, and comorbid alcohol misuse. Methods Using data from the UK Clinical Practice Research Datalink, 2384 suicides were matched to 46,899 living controls by gender, age, and registered practice. Prevalence of PD, other mental disorders, and alcohol misuse was calculated for cases and controls separately and conditional logistic regression models were used to estimate exposure odds ratios. We also fitted gender interaction terms and formally tested their significance, and estimated gender age-specific effects. Results We found a 20-fold increase in suicide risk for patients with PD versus no recorded psychiatric disorder, and a four-fold increase versus all other psychiatric illnesses combined. Borderline PD and PD with comorbid alcohol misuse were associated with a 37- and 45-fold increased risk, respectively, compared with those with no psychiatric disorders. Relative risks were higher for female than for male patients with PD. Significant risks associated with PD diagnosis were identified across all age ranges, although the greatest elevations were in the younger age ranges, 16–39 years. Conclusions The large elevation in suicide risk among patients diagnosed with PD and comorbid alcohol misuse is a particular concern. GPs have a potentially key role to play in intervening with patients diagnosed with PD, particularly in the presence of comorbid alcohol misuse, which may help reduce suicide risk. This would mean working with specialist care, agreed clinical pathways and availability of services for comorbidities such as alcohol misuse, as well as opportunities for GPs to develop specific clinical skills.
机译：背景人格障碍（PD）与自杀风险升高相关，但初级保健机构中的风险水平尚不清楚。我们评估了与其他精神病学诊断相比，初级保健患者中的PD是否与更大的风险升高相关，并且该关联是否因性别，年龄，PD类型和合并性酒精滥用而改变。方法使用来自英国临床实践研究数据链的数据，按性别，年龄和注册实践将2384例自杀与46,899例活体对照进行了配对。分别计算病例和对照的PD，其他精神障碍和酒精滥用的患病率，并使用条件逻辑回归模型来估计接触几率。我们还拟合了性别互动术语，并正式测试了它们的重要性，并估算了针对性别的特定年龄效应。结果我们发现PD患者的自杀风险增加了20倍，而没有记录到任何精神疾病，而所有其他精神疾病加起来则增加了4倍。与无精神病患者相比，临界PD和合并滥用酒精的PD患病风险分别增加37和45倍。女性PD的相对风险高于男性PD。尽管在所有年龄段，PD诊断的重大风险都得到了确认，但最大的升高发生在16-39岁的年轻年龄段。结论在诊断为PD和合并滥用酒精的患者中，自杀风险大幅上升是一个特别需要关注的问题。全科医生可能会在干预诊断为PD的患者中发挥潜在的关键作用，尤其是在存在合并酒精滥用的情况下，这可能有助于降低自杀风险。这意味着要与专人护理，商定的临床途径和针对合并症（如滥用酒精）的服务的可用性合作，以及全科医生发展特定临床技能的机会。

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