因農藥自殺的住院病人之精神科診斷及性別差異：在台灣一家綜合醫院 11 年的回溯性研究

Psychiatric Diagnoses and Gender Differences in Patients Admitted for Pesticide Suicide：An 11-year Retrospective Study in a General Hospital in Taiwan

目的：雖然在台灣，農藥中毒是一種常見的自殺方法，然而相關的精神科診斷及性別差異仍待研究。方法：我們執行一項針對以農藥中毒之自殺方法而住院的病人的病歷回溯性研究，時間為2000至2011年。針對有接受精神科照會的病病人，收集DSM-IV診斷、人口學資料、臨床資料、自殺當時的生活壓力等變數，進而分析。結果：在177位病人中，大多數(77%)以有機磷中毒方式自殺；憂鬱症佔58%，物質使用疾患佔35%，適應障礙佔28%。男女性別比為2。相較於女性，男性有較多的物質使用疾患，特別是酒精使用疾患(p<0.01)。主要的生活壓力事件為疾病、伴侶衝突、失業、親子衝突、及經濟壓力。在生活壓力事件當中，男性有較多的失業，女性有較多的伴侶衝突(p<0.05)。結論：以農藥中毒之自殺方法而住院的病人當中，在人口學資料及精神科診斷方面有性別的差異。因此，自殺風險的評估及防治應考慮性別因素。

Objectives: Pesticide poisoning is a common method of suicide in Taiwan. In this study, we intended to study patients’ underlying psychiatric diagnoses and gender differences. Methods: We conducted a retrospective observational study on inpatients who had suicide attempts with pesticide-poisoning from 2000 to 2011. The patients were referred to the psychiatric consultation staff, and their diagnoses were made according to DSM-IV. Patients’ demographic and clinical variables, psychiatric diagnoses, and concurrent life stress were obtained and analyzed. Results: Among 177 patients, the majority (77%) of the patients with attempted suicide used organophosphate poisoning. The most frequent diagnoses were depressive disorders (58%), substance use disorders (35%), and adjustment disorder (28%). The male-to-female gender ratio was 2. The male patients had signifi cantly more substance use disorder, particularly alcohol use disorder, than female counterparts (p < 0.01). Patients’ major life stressors were illness, couple confl icts, layoff from jobs, parent-child conflict, and economic stress. Among concurrent life stressors, male patients had signifi cantly more layoff reasons than female patients (p < 0.05). Female patients had signifi cantly more often couple conflicts than male patients (p < 0.05). Conclusion: Patients’ gender differences existed in attempted suicide with pesticide poisoning, in demographic profi les and psychiatric diagnoses. Suicide risk assessment and prevention should therefore be considered the patients’ factor of gender.