Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Severity of Comorbidities among Suicidal Attempters Classified by the Forms of Psychiatric Follow-up

자살시도자의 정신건강의학과 치료 연계 형태에 따른 동반질병 심각도의 차이

  • Lee, Hyeok (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Oh, Seung-Taek (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Kim, Min-Kyeong (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Lee, Seon-Koo (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Seok, Jeong-Ho (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Choi, Won-Jung (Department of Psychiatry, National Health Insurance Service Ilsan Hospital) ;
  • Lee, Byung Ook (Department of Psychiatry, National Health Insurance Service Ilsan Hospital)
  • 이혁 (국민건강보험 일산병원 정신건강의학과) ;
  • 오승택 (국민건강보험 일산병원 정신건강의학과) ;
  • 김민경 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 이선구 (국민건강보험 일산병원 정신건강의학과) ;
  • 석정호 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 최원정 (국민건강보험 일산병원 정신건강의학과) ;
  • 이병욱 (국민건강보험 일산병원 정신건강의학과)
  • Received : 2016.02.01
  • Accepted : 2016.05.20
  • Published : 2016.06.30
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Abstract

Objectives : Suicide attempters have impaired decision making and are at high risk of reattempt. Therefore it is important to refer them to psychiatric treatment. Especially, People with medical comorbidity are at higher risk of suicidal attempt and mortality. The aim of this study was to investigate the characteristics of suicidal attempters and to analyze the influence of the medical comorbidity on decision to receive psychiatric treatment after visit to an emergency department. Methods : One hundred and thirty two patients, who visited the emergency room of a general hospital in Gyeonggi-do between January, 2012 and December, 2012 were enrolled as the subjects of this study. After reviewing each subject's medical records retrospectively, demographic and clinical factors were analyzed. Results : Regardless of the engagement type, either via admission or outpatient clinic, the determinant factors of psychiatric treatment engagement were psychiatric diagnosis, employment status, previous psychiatric treatment history, and previous attempt history. Comparison of severity of medical comorbidity(Charlson Comorbidity Index) showed that suicide attempters who received psychiatric treatment via admission or refused the treatment tended to have higher level of medical comorbidity than who received psychiatric treatment via outpatient department. Conclusions : Our findings showed that medical comorbidity of suicide attempters affected the decision to accept psychiatric treatment. All psychiatrists should evaluate the presence and the severity of medical comorbidity of the suicide attempters and consider implementing more intervention for the medically ill attempters who are willing to discharge against advice.

연구목적 자살시도자는 일반적인 경우에 비해 의사결정 능력이 떨어지며, 다시 자살을 시도할 위험성이 높기 때문에 재시도 전에 정신건강의학과 치료로 연계하는 것이 중요하다. 특히 신체적 질병이 있는 사람은 자살시도를 할 확률이 높고, 사망률 역시 높아진다. 이 연구는 자살시도자의 특성을 조사하고, 자살시도 후 응급실에 방문하여 정신건강의학과 치료를 받기로 결정하는 데 신체적 질병이 어떤 영향을 주는지 분석하였다. 방 법 2012년 1월부터 12월까지 경기도의 일 종합병원 응급실에 내원한 132명의 자살시도자를 대상으로 하였다. 환자의 의무 기록을 후향적으로 검토해 인구통계학적, 임상적 요인을 조사하였고 정신건강의학과 치료 연계여부에 따라 분석하였다. 결 과 입원과 외래 상관 없이 정신건강의학과 치료를 받는 것에 영향을 주는 요인은 정신건강의학과 진단 유무, 직업 유무, 정신건강의학과 치료 과거력, 자살시도 과거력이었다. 정신건강의학과 치료 형태를 입원과 외래로 나누어 동반된 의학적 질병의 심각도(Charlson comorbidity index)를 비교했을 때, 입원을 통해 정신건강의학과 치료를 받은 자살시도자와 치료 자체를 거부한 자살시도자는 외래에서 치료를 받은 자살시도자보다 동반된 의학적 질병의 심각도가 높게 나타났다. 결 론 이 연구 결과 응급실에 내원한 자살시도자에게 동반된 의학적 질병의 심각도(Charlson comorbidity index)가 정신건강의학과 치료 형태에 영향을 미친다는 점을 알 수 있었다. 따라서 정신건강의학과 의사는 응급실에 내원한 자살시도자에 대해 의학적 동반질병의 여부 및 심각도를 평가하여 동반된 의학적 질병이 상대적으로 심각함에도 불구하고 자의퇴원을 진행하려고 하는 자살시도자에게 좀 더 합리적인 의사결정을 할 수 있도록 도움을 줄 수 있어야 한다.

Keywords

References

  1. Organization WH. WHO report. Geneva 27, Switzerland; 2004.
  2. Bohanna I. Suicide "contagion": what we know and what we need to find out. CMAJ: Canadian Medical Association journal 2013;185:861-862. https://doi.org/10.1503/cmaj.130678
  3. Development Of Economic Cooperation and Development. OECD Health Statistics 2014. Paris;2014.
  4. 통계청. 2014년 사망원인통계. 통계청;2014. p.5-16.
  5. Sakinofsky I. Repetition of suicidal behaviour. The international handbook of suicide and attempted suicid;2000. p.385-404.
  6. Beautrais AL. Subsequent mortality in medically serious suicide attempts: a 5 year follow-up. Australian and New Zealand Journal of Psychiatry 2003;37:595-599. https://doi.org/10.1046/j.1440-1614.2003.01236.x
  7. Kuo C, Gunnell D, Chen C, Yip PS, Chen Y. Suicide and non-suicide mortality after self-harm in Taipei City, Taiwan. The British Journal of Psychiatry 2012;200:405-411. https://doi.org/10.1192/bjp.bp.111.099366
  8. 서울시정신건강증진센터. 자살위기개입핸드북;2011. p.1-55.
  9. Finkelstein Y, Macdonald EM, Hollands S, Sivilotti ML, Hutson JR, Mamdani MM, Koren G, Juurlink DN. Risk of suicide following deliberate self-poisoning. JAMA Psychiatry 2015;72:570. https://doi.org/10.1001/jamapsychiatry.2014.3188
  10. Beghi M, Rosenbaum JF, Cerri C, Cornaggia CM. Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review. Neuropsychiatric Disease and Treatment 2013; 9:1725.
  11. Jin W, Choi WJ, Yoon JH, Cho HS, Kim SJ, Lee E, Kang JI, Kim KR, Seok JH. Associated factors of psychiatric follow-up after emergency care in suicide attempters. J of KorSoc for Dep and Bip Disorders 2013;11:143-150.
  12. Brown GK, Beck AT, Steer RA, Grisham JR. Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. Journal of Consulting and Clinical Psychology 2000;68: 371. https://doi.org/10.1037/0022-006X.68.3.371
  13. Appleby L, Dennehy JA, Thomas CS, Faragher EB, Lewis G. Aftercare and clinical characteristics of people with mental illness who commit suicide: a case-control study. The Lancet 1999;353:1397-1400. https://doi.org/10.1016/S0140-6736(98)10014-4
  14. Kapur N, Cooper J, Hiroeh U, May C, Appleby L, House A. Emergency department management and outcome for self-poisoning: a cohort study. General Hospital Psychiatry 2004; 26:36-41. https://doi.org/10.1016/j.genhosppsych.2003.06.002
  15. Kim WJ, Song YJ, Namkoong K, Kim JM, Yoon HJ, Lee E. Does a copycat effect exist in the emergency department? The International Journal of Psychiatry in Medicine 2013;45: 59-72. https://doi.org/10.2190/PM.45.1.e
  16. Barr W, Leitner M, Thomas J. Psychosocial assessment of patients who attend an accident and emergency department with self-harm. Journal of Psychiatric and Mental Health Nursing 2005;12:130-138. https://doi.org/10.1111/j.1365-2850.2004.00804.x
  17. Houry D. Suicidal patients in the emergency department. Annals of emergency Medicine 2004;43:731-732. https://doi.org/10.1016/j.annemergmed.2004.02.034
  18. Bergen H, Hawton K, Waters K, Ness J, Cooper J, Steeg S, Kapur N. Premature death after self-harm: a multicentre cohort study. The Lancet 2012;380:1568-1574. https://doi.org/10.1016/S0140-6736(12)61141-6
  19. Karasouli E, Owens D, Abbott RL, Hurst KM, Dennis M. All-cause mortality after non-fatal self-poisoning: a cohort study. Social Psychiatry and Psychiatric Epidemiology 2011;46:455-462. https://doi.org/10.1007/s00127-010-0213-3
  20. MacKenzie TB, Popkin MK. Suicide in the medical patient. The International Journal of Psychiatry in Medicine 1988;17: 3-22. https://doi.org/10.2190/EF4F-9KV7-1MLM-MYXQ
  21. Druss RG. The psychology of illness: in sickness and in health: American Psychiatric Pub;1995. p.390.
  22. Yoo S, Kim Y, Noh J, Oh K, Kim C, Namkoong K, Chae J, Lee G, Jeon S, Min K. Validity of Korean version of the mini-international neuropsychiatric interview. Anxiety Mood 2006; 2:50-55.
  23. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 1987;40:373-383. https://doi.org/10.1016/0021-9681(87)90171-8
  24. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. Journal of Clinical Epidemiology 2004;57:1288-1294. https://doi.org/10.1016/j.jclinepi.2004.03.012
  25. Druss B, Pincus H. Suicidal ideation and suicide attempts in general medical illnesses. Archives of Internal Medicine 2000; 160:1522-1526. https://doi.org/10.1001/archinte.160.10.1522
  26. Needham DM, Scales DC, Laupacis A, Pronovost PJ. A systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research. Journal of Critical Care 2005; 20:12-19. https://doi.org/10.1016/j.jcrc.2004.09.007
  27. Jollant F, Bellivier F, Leboyer M, Astruc B, Torres S, Verdier R, Castelnau D, Malafosse A, Courtet P. Impaired decision making in suicide attempters. American Journal of Psychiatry 2014;162:304-310.
  28. Suominen K, Lonnqvist J. Determinants of psychiatric hospitalization after attempted suicide. General Hospital Psychiatry 2006;28:424-430. https://doi.org/10.1016/j.genhosppsych.2006.03.009
  29. Jung WY, Park JM, Kang CJ, Lee BD, Lee YM. Clinical characteristics of completed versus non-completed suicide and re-attempt rates in 2-4 years. Journal of Korean Neuropsychiatric Association 2009;48:488-495.
  30. Mortensen PB, Agerbo E, Erikson T, Qin P, Westergaard-Nielsen N. Psychiatric illness and risk factors for suicide in Denmark. The Lancet 2000;355:9-12. https://doi.org/10.1016/S0140-6736(99)06376-X
  31. Park HN. Relationship characteristic in attempted suicide of the psychiatric care(dissertation). Pusan: Pusan National University; 2011.
  32. Suominen KH, Isometsa ET, Lonnqvist JK. Attempted suicide and psychiatric consultation. European Psychiatry 2004; 19:140-145. https://doi.org/10.1016/j.eurpsy.2003.12.004
  33. Hanson GD, Babigian HM. Reasons for hospitalization from a psychiatric emergency service. Psychiatric Quarterly 1974; 48:336-351. https://doi.org/10.1007/BF01562157
  34. Schmidtke A, Bille-Brahe U, DeLeo D, Kerkhof A, Bjerke T, Crepef P, Haring C, Hawton K, Lonnqvist J, Michel K. Attempted suicide in Europe: rates, trend. S and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatrica Scandinavica 1996;93:327-338. https://doi.org/10.1111/j.1600-0447.1996.tb10656.x
  35. Bennewith O, Gunnell D, Peters T, Hawton K, House A. Variations in the hospital management of self harm in adults in England: observational study. BMJ 2004;328:1108-1109. https://doi.org/10.1136/bmj.328.7448.1108
  36. Batki SL, Meszaros ZS, Strutynski K, Dimmock JA, Leontieva L, Ploutz-Snyder R, Canfield K, Drayer RA. Medical comorbidity in patients with schizophrenia and alcohol dependence. Schizophrenia Research 2009;107:139-146. https://doi.org/10.1016/j.schres.2008.10.016