Analysis of Multiple Suicide Risk Factors of Psychiatric Inpatients by Severity Using the SAD PERSONS and Modifi ed SAD PERSONS Scale in Taiwan

使用SAD PERSONS及Modified SAD PERSONS量表分析自殺嚴重性的相關因子

張簡德璋(Te-Chang Changchien)；江允志(Yung-Chih Chiang)；顏永杰(Yung-Chieh Yen)；竇秀蘭(Shiou-Lan Dou)；齊美婷(Mei-Ting Chi)；陸悌(Ti Lu)

自殺企圖 ； 自殺意念 ； 嚴重度 ； 危險因子 ； attempted suicide ； risk factors ； severity ； suicidal ideation

台灣精神醫學

29卷3期（2015 / 09 / 01）

155 - 162+i

英文

目的：自殺在台灣是個重大公共衛生議題，因此，我們需要分析從Modified SAD PERSONS以及SAD PERSONS量表篩選的十三個評估項目與本土自殺資料的關聯性。方法：此回朔性研究收案210個住院病人，以病歷回顧的方式，將病人分為三組：非自殺組、自殺意念組以及自殺企圖組，分配給精神科專科醫師進行十三個項目的的評分後，以卡方分析檢驗三組不同自殺嚴重度的個案在一般人口學、此十三個自殺風險項目的差異性，再進一步以邏輯式回歸方法檢驗自殺與這些風險項目的相關性。結果：年齡（p＜0.01）、憂鬱症狀（p＜0.001）、自殺史（p＜0.001）、思考障礙（p＜0.001）、自殺計畫（p＜0.001）、自己陳述未來自殺企圖（p＜0.001）與目前生活壓力（p＜0.001）等項目在三組個案間達到顯著地差異性，而更進一步可發現這些項目與自殺嚴重度呈現正相關性。結論：除了年齡以及思考障礙兩個項目以外，其他項目在本土資料的發現與國外文獻的發現相似。

Background: Suicide risk evaluation is a public health priority in Taiwan. In this preliminary study, we intended to do a correlation study between 13 individual items derived from the Modified SAD PERSONS scale and the SAD PERSONS scale relative to suicide among ethnic Chinese subjects. Methods: We retrospectively reviewed 210 inpatient medical records and classified patients' suicidal severity into three groups: (A) non-suicide group, (B) suicidal ideation group, and (C) attempted suicide group for analysis. Results: Seven items-age (p＜0.01), depression (p＜0.001), previous attempt (p＜0.001), rational thought loss (p＜0.001), organized plan (p＜0.001), stated future intent (p＜0.001), and current life stressor (p＜0.001) were significant, indicating that these seven risk factors are distinctly important among these groups. Further group-to-group relationships showed that the ＂the proportion of the suicidal ideation group or attempted suicide group was always significantly greater than that of the non-suicide group＂ in most factors, except those correlated to ＂age＂ and ＂rational thought loss＂ factors. Conclusion: Five factors-depression (p＜0.05), previous attempt (p＜0.01), organized plan (p＜0.01), stated future intent (p＜0.01), and current life stressor (p＜0.01) were significantly to be strongly associated with suicide in our study. Among the factors, ＂organized plan＂ and ＂previous attempt＂ were strongest significant predictors.

1. Top 10 Most Common Cause of Death in Taiwan. Taipei: Department of Health, 2009.
2. Chen, WJ,Chen, CC,Ho, CK,Lee, MB,Lin, GG,Chou, FH(2012).Community-based case management for the prevention of suicide reattempts in Kaohsiung, Taiwan.Comm Mental Health,48,786-791.
3. Cochrane-Brink, KA,Lofchy, JS,Sakinofsky, I(2000).Clinical rating scales in suicide risk assessment.Gen Hosp Psychiatry,22,445-451.
4. Fawcett, J,Scheftner, WA,Fogg, L(1990).Time-related predictors of suicide in major affective disorder.Am J Psychiatry,147,1189-1194.
5. Gau, SS,Chen, CH,Lee, CT,Chang, JC,Cheng, AT(2009).Development of a Chinese version of the Suicide Intent Scale.Suicide Life-Threat Beh,39,332-342.
6. Goldberg, JF,Ernst, CL,Bird, S(2007).Predicting hospitalization versus discharge of suicidal patients presenting to a psychiatric emergency service.Psychiatr Serv,58,561-565.
7. Hall, RC,Platt, DE,Hall, RC(1999).Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts: evaluation of suicide risk in a time of managed care.Psychosomatics,40,18-27.
8. Hirokawa, S,Matsumoto, T,Katsumata, Y(2012).Psychosocial and psychiatric characteristics of suicide completers with psychiatric treatment before death: a psychological autopsy study of 76 cases.Psychiatry Clin Neurosci,66,292-302.
9. Hirschfeld, RM,Russell, JM(1997).Assessment and treatment of suicidal patients.New Engl J Med,337,910-915.
10. Hockberger, RS,Rothstein, RJ(1988).Assessment of suicide potential by nonpsychiatrists using the SAD PERSONS score.J Emerg Med,6,99-107.
11. Mendez-Bustos, P,de Leon-Martinez, V,Miret, M(2013).Suicide reattempters: a systematic review.Harvard Rev Psychiatry,21,281-295.
12. Patterson, WM,Dohn, HH,Bird, J,Patterson, GA(1983).Evaluation of suicidal patients: the SAD PERSONS scale.Psychosomatics,24,343–5-348-9.
13. Paykel, ES,Myers, JK,Lindenthal, JJ,Tanner, J(1974).Suicidal feelings in the general population: a prevalence study.Brit J Psychiatry,124,460-469.
14. Petronis, KR,Samuels, JF,Moscicki, EK,Anthony, JC(1990).An epidemiologic investigation of potential risk factors for suicide attempts.Soc Psychiatry Psychiatr Epidemiol,25,193-199.
15. Rich, CL,Young, D,Fowler, RC(1986).San Diego suicide study. I. Young vs old subjects.Arch Gen Psychiatry,43,577-582.
16. Sani, G,Tondo, L,Koukopoulos, A(2011).Suicide in a large population of former psychiatric inpatients.Psychiatry Clin Neurosci,65,286-295.
17. Schnyder, U,Valach, L,Bichsel, K,Michel, K(1999).Attempted suicide: do we understand the patients’ reasons?.Gen Hosp Psychiatry,21,62-69.
18. Suominen, K,Lonnqvist, J(2006).Determinants of psychiatric hospitalization after attempted suicide.Gen Hosp Psychiatry,28,424-430.
19. Weissman, MM(1974).The epidemiology of suicide attempts, 1960 to 1971.Arch Gen Psychiatry,30,737-746.
20. Weissman, MM,Klerman, GL,Markowitz, JS,Ouellette, R(1989).Suicidal ideation and suicide attempts in panic disorder and attacks.New Engl J Med,321,1209-1214.