Achse-I-Störungen als Risikofaktoren für Suizid in Abhängigkeit von Alter und Geschlecht

Zusammenfassung

Anliegen und Methode: Die Bedeutung einzelner psychiatrischer Achse-I-Störungen als Risikofaktoren für Suizid wurde in verschiedenen Altersgruppen mit einer kontrollierten psychologischen Autopsiestudie untersucht. Ergebnisse: In einer logistischen Regression erzielten signifikant erhöhte Odds Ratios bei 61 - 75-Jährigen Einzelepisode einer Major Depression, bei Männern im Alter von über 30 Jahren (Altersgruppen: 31 - 45, 46 - 60 und 61 - 75 Jahre) Störungen durch Konsum von Alkohol und bei 61 - 75-jährigen Frauen organische psychische Störungen. Schlussfolgerungen: Störungen durch Konsum von Alkohol und Major Depression (Einzelepisode) tragen bei Männern und Frauen einzelner Altersgruppen zu einem erhöhten Suizidrisiko bei.

Abstract

Objectives and methods: Aim of the study was to identify and estimate psychiatric axis I disorders as risk factors for suicide in different age groups using a psychological autopsy study with case-control design. 163 suicides and 396 population-based control persons were assessed with a standardized semi-structured interview including SCID-I (for DSM-IV). Results: Logistic regression analyses revealed significantly elevated odds ratios for alcohol-related disorders in men aged 31 to 45, 46 to 60, and 61 to 75 years (OR = 9.0, OR = 7.5, and OR = 10.7, respectively) and for Major Depression, single episode, in men and women aged 61 to 75 years (OR = 42.7 and OR = 15.9). In males aged 31 to 45 years polysubstance-related disorders (OR = 9.5) and in females aged 61 to 75 years cognitive and mental disorders due to a general medical condition (OR = 12.2) were significantly and independently associated with suicide. Conclusions: Alcohol-related disorders and Major Depression differently contribute to male and female suicide risk in special age groups. These findings imply differentiated prevention strategies.

Literatur

• 1 Statistisches Bundesamt Deutschland .Gesundheitswesen - Todesursachen in Deutschland. Wiesbaden; CD-ROM 2002
• 2 Wolfersdorf M, Martinez C. Suizid bei Depression, verlorene Lebensjahre und Bruttosozialprodukt. Was bringt Suizidprävention?.  Psychiat Prax. 1998;  25 139-141
• 3 Schneider B. Risikofaktoren für Suizid. Regensburg; Roderer Verlag 2003
• 4 Shneidman E S, Farberow N L. Sample investigations of equivocal deaths. In: Farberow NL, Shneidman ES (eds) The cry for help. New York; McGraw-Hill 1961: 118-129
• 5 Stillion J M, McDowell E E, May J H. Suicide across the life-span - Premature exits. New York; Hemisphere 1989
• 6 Cheng A TA. Mental illness and suicide. A case-control study in East Taiwan.  Arch Gen Psychiatry. 1995;  52 594-603
• 7 Vijayakumar L, Rajkumar S. Are risk factors for suicide universal? A case-control study in India.  Acta Psychiatr Scand. 1999;  99 407-411
• 8 Foster T, Gillespie K, McClelland R, Patterson C. Risk factors for suicide independent of DSM-III-R Axis I disorder. Case-control psychological autopsy study in Northern Ireland.  Br J Psychiatry. 1999;  175 175-179
• 9 Lesage A D, Boyer R, Grunberg F, Vanier C, Morissette R, Menard-Buteau C, Loyer M. Suicide and mental disorders: a case-control study of young men.  Am J Psychiatry. 1994;  151 1063-1068
• 10 Appleby L, Cooper J, Amos T, Faragher B. Psychological autopsy of suicides by people under 35.  Br J Psychiatry. 1999;  175 168-174
• 11 Waern M, Runeson B S, Allebeck P, Beskow J, Rubenowitz E, Skoog I, Wilhelmson K. Mental disorder in elderly suicides: a case-control study.  Am J Psychiatry. 2002;  159 450-455
• 12 Harris E C, Barraclough B. Suicide as an outcome for mental disorders: a meta-analysis.  Br J Psychiatry. 1997;  170 205-228
• 13 Hert M De, Peuskens J. First-episode schizophrenia, a naturalistic 10 year follow-up study.  Schizophr Res. 1998;  29 7-8
• 14 Baxter D, Appleby L. Case register study of suicide risk in mental disorders.  Br J Psychiatry. 1999;  175 322-326
• 15 Hiroeh U, Appleby L, Mortensen P B, Dunn G. Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study.  Lancet. 2001;  358 (9299) 2110-2112
• 16 Hert M De, McKenzie K, Peuskens J. Risk factors for suicide in young patients suffering from schizophrenia.  Schizophr Res. 2001;  47 127-134
• 17 Angst F, Stassen H H, Clayton P J, Angst J. Mortality of patients with mood disorders: follow-up over 34 - 38 years.  J Affect Disord. 2002;  68 167-181
• 18 Rich C L, Rickets J E, Fowler R C, Young D. Some differences between men and women who commit suicide.  Am J Psychiatry. 1988;  145 718-722
• 19 Henriksson M M, Aro H M, Marttunen M J, Heikkinen M E, Isometsä E T, Kuoppasalmi K I, Lönnqvist J K. Mental disorders and comorbidity in suicide.  Am J Psychiatry. 1993;  150 935-940
• 20 Carney S S, Rich C L, Burke P A, Fowler R C. Suicide over 60: The San Diego study.  J Am Geriatr Soc. 1994;  42 174-180
• 21 Conwell Y, Duberstein P R, Cox C, Herrmann J H, Forbes N T, Caine E D. Relationship of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study.  Am J Psychiatry. 1996;  153 1001-1008
• 22 Foster T, Gillespie K, McClelland R. Mental disorders and suicide in Northern Ireland.  Br J Psychiatry. 1997;  170 447-452
• 23 Waern M. Alcohol dependence and misuse in elderly suicides.  Alcohol alcohol. 2003;  38 249-254
• 24 Duberstein P R, Conwell Y, Caine E D. Age differences in the personality characteristics of suicide completers: preliminary findings from a psychological autopsy study.  Psychiatry. 1994;  57 213-224
• 25 Harwood D, Hawton K, Hope T, Jacoby R. Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case-control study.  Int J Geriatr Psychiatry. 2001;  16 155-165
• 26 Barraclough B M, Bunch J, Nelson B, Sainsbury P. A hundred cases of suicide: clinical aspects.  Br J Psychiatry. 1974;  125 355-373
• 27 Rich C L, Young D, Fowler R C. San Diego Suicide Study. I. Young vs old subjects.  Arch Gen Psychiatry. 1986;  43 577-582
• 28 Conwell Y, Brent D. Suicide and aging. I. Patterns of psychiatric diagnosis.  Int Psychogeriatr. 1995;  7 149-164
• 29 Robins E, Murphy G E, Wilkinson R H, Gessner F, Kayes J. Some clinical considerations in the preventions of suicide based on a study of 134 successful suicides.  Am J Public Health. 1959;  49 888-899
• 30 Beskow J. Suicide and mental disorder in Swedish men.  Acta Psychiatr Scand. 1979;  277, Suppl 1-138
• 31 Arato M, Demeter E, Rihmer Z, Somogyi E. Retrospective psychiatric assessment of 200 suicides in Budapest.  Acta Psychiatr Scand. 1988;  77 454-456
• 32 Asgard U. A psychiatric study of suicide among urban Swedish females.  Acta Psychiatr Scand. 1990;  82 115-124
• 33 Wolfersdorf M, Faust V, Brehm M, Moser K, Hölzer R, Hole G. Suicide in the Ravensburg area. A study of 508 cases on the basis of criminal investigation data. In: Böhme K, Freytag R, Wächtler C, Sedler H (eds) Suicidal Behavior, the State of the Art. Regensburg; Roderer Verlag 1993: 890-895
• 34 Heikkinen M E, Isometsä E T, Marttunen M J, Aro H M, Lönnqvist J. Social factors in suicide.  Br J Psychiatry. 1995;  167 747-753
• 35 Tondo L, Isacsson G, Baldessarini R. Suicidal behaviour in bipolar disorder: risk and prevention.  CNS Drugs. 2003;  17 491-511
• 36 Waern M, Rubenowitz E, Wilhelmson K. Predictors of suicide in the old elderly.  Gerontology. 2003;  49 328-334
• 37 Henriksson M M, Marttunen M J, Isometsä E T, Heikkinen M E, Aro H M, Kuoppasalmi K I, Lönnqvist J K. Mental disorders in elderly suicide.  Int Psychogeriatr. 1995;  7 275-286
• 38 Schneider B, Maurer K, Sargk D, Heiskel H, Weber B, Frölich L, Georgi K, Fritze J, Seidler A. Concordance of DSM-IV Axis I and II diagnoses by personal and informant's interview.  Psychiatry Res. 2004;  127 121-136
• 39 Wittchen H U, Wunderlich U, Gruschwitz S, Zaudig M. Strukturiertes Klinisches Interview für DSM-IV, Achse I. Eine deutschsprachige erweiterte Bearbeitung der amerikanischen Originalversion des SCID-I. Göttingen; Hogrefe 1997
• 40 Cavanagh J TO, Carson A J, Sharpe M, Lawrie S M. Psychologcial autopsy studies of suicide: a systematic review.  Psychol Med. 2003;  33 395-405
• 41 Brent D A, Perper J A, Kolko D J, Zelenak J P. The psychological autopsy: methodological considerations for the study of adolescent suicide.  J Am Acad Child Adolesc Psychiatry. 1988;  27 362-366
• 42 Beskow J, Runeson B, Asgard U. Psychological autopsies: methods and ethics.  Suicide Life Threat Behav. 1990;  20 307-323
• 43 Kelly T M, Mann J J. Validity of DSM-III-R diagnosis by psychological autopsy: a comparison with clinician ante-mortem diagnosis.  Acta Psychiatr Scand. 1996;  94 337-343
• 44 Conner K R, Duberstein P R, Conwell Y. The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. I. Psychiatric diagnoses.  Acta Psychiatr Scand. 2001;  104 204-209
• 45 Cavanagh J TO, Owens D GC, Johnstone E C. Life events in suicide and undetermined death in south-east Scotland: a case-control study using the method of psychological autopsy.  Soc Psychiatry Psychiatr Epidemiol. 1999;  34 645-650
• 46 Hawton K, Simkin S, Rue J, Haw C, Barbour F, Clements A, Sakarovitch C, Deeks J. Suicide in female nurses in England and Wales.  Psychol Med. 2002;  32 239-250
• 47 Wittchen H U, Müller N, Pfister H, Winter S, Schmidtkunz B. Affektive, somatoforme und Angststörungen in Deutschland. Erste Ergebnisse des bundesweiten Zusatzsurveys „psychische Störungen”.  Gesundheitswesen. 1999;  61 (Sonderheft 2) 216-222
• 48 Strobl M, Klapper J, Pelzel K H, Bader G, Zahn H, Lange S. Suchthilfestatistik 2001 für Deutschland. Tabellenband für die ambulante Suchtkrankenhilfe. München; IFT Institut für Therapieforschung 2002
• 49 Schneider B, Maurer K, Frölich L. Demenz und Suizid.  Fortschritt Neuro Psychiat. 2001;  4 164-169
• 50 Pirkola S P, Isometsä E T, Heikkinen M E, Henriksson M M, Lönnqvist J K. Female psychoactive substance-dependent suicide victims differ from male - results from a nationwide psychological autopsy study.  Compr Psychiatry. 1999;  40 101-107
• 51 Rossow I, Amundsen A. Alcohol abuse and suicide: a 40-year prospective study of Norwegian conscripts.  Addiction. 1995;  90 685-691
• 52 Runeson B. Mental disorder in youth suicide. DSM-III-R Axes I and II.  Acta Psychiatr Scand. 1989;  79 490-497
• 53 Fowler R C, Rich C L, Young D. San Diego suicide study: Substance abuse in young cases.  Arch Gen Psychiatry. 1986;  43 962-965
• 54 Heilä H, Isometsä E, Henriksson M, Heikkinen M, Marttunen M, Lönnqvist J. Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sex-specific clinical characteristics of 92 suicide victims with schizophrenia.  Am J Psychiatry. 1997;  154 1235-1242
• 55 Althaus D, Hegerl U. Evaluation suizidpräventiver Maßnahmen. Aktueller Forschungsstand und resultierende Implikationen.  Nervenarzt. 2001;  72 677-684
• 56 Wolfersdorf M, Klinkisch M, Franke C, Keller F, Wurst F M, Dobmeier M. Patientensuizid - Ein Kontrollgruppenvergleich: Suizidenten versus nach Behandlungszeitraum parallelisierte Patienten eines psychiatrischen Fachkrankenhauses.  Psychiat Prax. 2003;  30 14-20
• 57 Wurst F M, Vogel R, Wolfersdorf M. Substanzabhängigkeit und Suizid im stationären Rahmen. Eine Deskription.  Psychiat Prax. 2000;  27 11-13
• 58 Bierut L J, Heath A C, Bucholz K K, Dinwiddie S H, Madden P AF, Statham D J, Dunne M P, Martin N G. Major Depressive Disorder in a community-based twin sample: Are there different genetic and environmental contributions for men and women?.  Arch Gen Psychiatry. 1999;  56 557-563
• 59 Kendler K S, Gardner C O, Neale M C, Prescott C A. Genetic risk factors for major depression in men and women: similar or different heritabilities and same or partly distinct genes?.  Psychol Med. 2001;  31 605-616
• 60 Tyndale R F. Genetics of alcohol and tobacco use in humans.  Ann Med. 2003;  35 94-121