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目的了解大一、大二医学生既往首发自杀意念后不同时间(年)向自杀未遂发展风险,探索促使这一发展过程的危险因素。方法安徽省3所医学院校(安徽医科大学、皖南医学院和蚌埠医学院)1~2年级共10 297名学生接受自填式问卷调查。其中自制问卷包括既往自杀行为史、儿童期不良经历史、家庭自杀史以及一般人口学资料;专用量表包括抑郁、贝克焦虑、Barratt冲动、攻击以及社会支持量表。有自杀意念向自杀未遂发展速度和风险采用寿命表法进行描述,促使这一发展过程的危险因素则采用Cox回归模型分析。结果 10 297名大学生中,16.52%学生称有过自杀意念,1.47%有自杀未遂。自杀意念向自杀未遂发展的累积发生率为8.88%。有自杀意念后的第一年自杀未遂的条件风险最高(7.02%),76.16%(n=115)的自杀未遂者发生在有自杀意念后的第一年。Cox回归模型的多因素分析结果显示父母离婚(OR=2.32,95%CI 1.28~4.21)、躯体虐待(OR=1.69,95%CI 1.20~2.37)和一级亲属自杀行为(OR=2.02,95%CI 1.25~3.25)等家庭不良事件,青少年行为冲动性(中/低:OR=1.88,95%CI 1.15~3.06;高/低:OR=2.09,95%CI1.30~3.36)以及较高的焦虑评分(高/低:OR=1.60,95%CI 1.10~2.33)是自杀意念向自杀未遂进一步发展的危险因素。结论青少年有自杀意念是近期自杀未遂的高危信号。家庭不良事件、青少年行为冲动性以及严重焦虑状态是有自杀意念者自杀未遂主要危险因素。
Objective To understand the risk of attempting suicide at different times (years) after attempting suicide ideation of freshmen and sophomore medical students in the past, and to explore the risk factors that contribute to this process of development. Methods A total of 10 297 students from Grade 1 to Grade 2 in 3 medical schools in Anhui Province (Anhui Medical University, Wannan Medical College and Bengbu Medical College) were surveyed by self-administered questionnaires. The self-made questionnaire includes the history of previous suicidal behavior, the history of childhood unhealthy experiences, the history of family suicide, and general demographic information; the specific scales include depression, Baker’s anxiety, Barratt impulse, aggression and social support scales. The idea of suicidal ideation sums up the speed and risk of attempted suicide by the life table method, and the risk factors of this development process are analyzed by Cox regression model. Results Of 10 297 college students, 16.52% of students said they had suicidal thoughts and 1.47% attempted suicide. The cumulative incidence of suicidal ideation toward attempted suicide was 8.88%. In the first year of suicidal ideation, the highest conditional risk of attempted suicide (7.02%) and 76.16% (n = 115) of attempted suicide occurred in the first year after suicidal ideation. The multivariate analysis of the Cox regression model showed that divorce (OR = 2.32, 95% CI 1.28-4.21), physical abuse (OR = 1.69, 95% CI 1.20-2.37) and first-degree relatives suicidal behavior (OR = 2.02,95 % CI 1.25-3.25) and other family adverse events such as adolescent behavioral impulsivity (medium / low: OR = 1.88, 95% CI 1.15 to 3.06; high / low: OR = 2.09, 95% CI 1.30 to 3.36) (High / low: OR = 1.60, 95% CI 1.10-2.33) were risk factors for the further development of attempted suicide from suicidal ideation. Conclusion Adolescents have suicide ideation is the recent high-risk signal of attempted suicide. Family adverse events, impulsive behavior of adolescents and severe anxiety status are the main risk factors of attempted suicide with suicidal ideation.