思覺失調症病人自傷行為的發生率與危險因子

Incidence and Risk Factors of Self-harm among Patients with Schizophrenia in Taiwan: A 12-year Retrospective Cohort Study

背景：思覺失調症病人自傷及自殺的危險性較高。先前文獻回顧指出曾經自傷、憂鬱症狀、物質濫用可能增加自傷風險。然而臺灣的思覺失調症病人自傷發生率鮮為人所知。本研究試圖探討自傷發生率、自傷方法、共病、社會流行病學等因素。方法：我們採用全民健康保險研究資料庫。於2001 至2012 年間，曾因思覺失調類群疾患至少兩度緊急送醫或至少一次住院之病人，並至少使用一種抗精神病藥物者，方引入研究；診斷時年紀過輕或過長、2001 年以前診斷、資料不全等排除。我們亦引入年齡及性別符合的對照組。結果定義為因自傷首次住院、送急診或門診。結果：思覺失調症病人較可能曾自傷、有情緒疾患、焦慮疾患及物質使用障礙症。物質中毒是最常見的自傷方法。思覺失調症病人自傷發生率為每千人年5.6 人，校正後風險比為9.4 (95% CI = 8.3 - 10.7, p < 0.001)。曾經自傷為自傷之最顯著預測因子（校正風險比18.56; 95% CI = 16.92 - 20.36, p < 0.001），其後為共病之精神疾患。結論：本研究發現思覺失調症病人自傷風險較高及相關危險因子。應有後續公眾關注以避免自傷。

Objectives: Patients with schizophrenia have higher risk of self-harm and suicide. Previous reviews revealed that previous self-harm, depressive symptoms, and substance abuse increase self-harm risk, but the incidence of self-harm of patients with schizophrenia in Taiwan has rarely been reported. In this study, we intended to explore the incidence, the self-harm methods, associated comorbidities, and socio-demographic factors. Methods: We used National Health Insurance Research Database. We included subjects who had at least two ambulatory claims or one admission with diagnosis of schizophrenia-spectrum disorder and at least one antipsychotic agent prescription during 2001-2012. Excluded were those who were too young or too old at diagnosis, diagnosed before 2001, and having missing data. We also recruited age- and sex-matched comparison group. The outcome was defi ned as the fi rst hospitalization, emergency department visits, or outpatient visits due to self-harm. Results: Patients with schizophrenia were in higher risk of history of self-harm, mood disorders, anxiety disorder, and substance use disorder. Poisoning by substance was the most common self-harm method. The incidence of self-harm for patients with schizophrenia was 5.6 per 1,000 person-years, and the adjusted hazard ratio was 9.4 (95% confi dence interval = 8.3 - 10.7, p < 0.001). History of self-harm was the most signifi cant predictors of self-harm (adjusted HR = 18.56; 95% CI = 16.92 - 20.36, p < 0.001), followed by comorbid psychiatric disorders. Conclusion: Our study revealed that patients with schizophrenia had higher self-harm risk and more associated risk factors. We suggest that further public attention should be paid to self-harm prevention.