越南難治性憂鬱症患者的自殺傾向、心理因素和社區融入：一項短期追蹤研究

Abstract

簡介：與其他診斷為抑鬱症相關的患者相比，難治性抑鬱症 (TRD) 患者的自殺意念和自殺企圖發生率更高。 然而，與 TRD 人口和自殺相關的研究在越南很可怕。 因此，本研究旨在調查一家領先的國家醫院 TRD 患者自殺傾向的短期波動以及心理因素和社區融合與近期自殺意念和從住院到出院後 3 個月的嘗試之間的縱向關聯 在河內。 方法：前瞻性研究設計，從醫院到參與者社區進行為期 3 個月的隨訪。 2021 年 10 月至 2022 年 9 月，所有 53 名 TRD 患者在入院後一周 (T0) 以及出院後 1 週 (T1)、1 個月 (T2) 和三個月 (T3) 接受了結構化問卷訪談。 進行了描述性分析以表徵社會人口統計學和趨勢分析。 應用方差分析的重複測量來發現時間因素和重複測量對主要結果的因素內效應之間的顯著性。 此外，廣義估計方程 (GEE) 用於確定在整個研究期間與近期自殺意念/企圖相關的因素。 在廣義估計方程 (GEE) 分析中，在整個研究期間，高水平的心理困擾和絕望分別與自殺意念（1.35 分和 1.28 分）和自殺企圖（2.59 分和 2.41 分）顯著相關。 此外，社區融入得分降低 1 分會使隨訪期間產生自殺意念的風險增加 12%。 在人口統計變量中，性別差異、年齡較小和宗教信仰與自殺意念和企圖顯著相關。 在我們的觀察中，與女性相比，男性參與者自殺意念的風險高 4.10 倍，但自殺未遂的風險低 5.26 倍。 報告有宗教信仰的患者自殺意念的比值比降低了 4.55 倍。 值得注意的是，在研究期間，年輕一歲的 TRD 患者自殺未遂的風險增加了 9%。 結論：本研究中一組 TRD 患者的自殺傾向在住院治療階段和出院後的前三個月之間波動，心理壓力大、絕望、社區融合度低、性別、年齡小、無宗教信仰 導致自殺風險的首要因素。 研究結果強調需要在出院後對患者進行定期監測和評估，以確定那些患有高自殺風險的 TRD 患者。 精神科住院後短期內改善心理困擾、絕望和社區融合以預防自殺的干預措施值得更多關注。 精神科專業人員應幫助患有 TRD 的人改善和保持他們的壓力管理技能、希望感和社區生活融入，特別關注針對特定性別的政策（例如女性自殺未遂和男性自殺意念後續護理） 和那些更年輕的人。 在社區或醫院環境的非精神病學領域工作的護理專業人員也在早期參與和轉診患有抑鬱症和合併慢性身體疾病的高危患者方面發揮著看門人的關鍵作用。

Introduction: Patients with treatment-resistant depression (TRD) have higher rates of suicidal ideation and a higher prevalence of suicide attempts than patients with other diagnoses related to depressive disorders. However, studies related to the TRD population and suicide are scared in Vietnam. Therefore, this study sought to examine the short-term fluctuation of suicidality and the longitudinal association of psychological factors and community integration with recent suicide ideation and attempts from hospitalization to a 3-month post-discharge period among patients with TRD in a leading national hospital in Hanoi. Methods: A prospective study design with 3-month followed-up from hospital to the participants’ community. All 53 patients with TRD were interviewed one week after admission (T0) plus 1-week (T1), 1-month (T2), and three months (T3) post-discharge interviews with a structured questionnaire from October 2021 to September 2022. Descriptive analyses were performed to characterize sociodemographic and trend analysis. Repeated measures with ANOVA were applied to find the significance between the time factor and within–factor effects of repeated measures over the major outcome. Further, the Generalized estimation equations (GEE) were used to identify factors associated with recent suicide ideation/attempt during throughout the study period. Results: The trend of suicidality varied across the four-time points. The downward trend of suicidality at T0 and T1 reflected the initial effects of inpatient treatment; however, an upward trend was observed during the 3-month follow-up period. Nearly half of the participants (46%) reported recent suicide ideation, and 13.46% attempted suicide at T3. Antidepressant overdose was the most common suicide method among the participants. While the suicide attempt rate was found to be a significant difference only with T0>T1, suicide ideation and suicide intention were also found to be significantly different (T0>T1, T2, and T3). However, there was no significant difference between T1-3 interviews during the follow-up. Overall, the community integration performance increased after discharge compared to the time of admission (T0<T2, T3, p<0.05) and post-discharge one week (T1<T2, T3, p<0.05). The total score of psychological distress (BSRS-5) showed a reduction after treatment from hospitalization with a significant change from T0 compared to one-week (T1) and one-month (T2) after discharge, but the effect did not show significance compared to 3-month post-discharge period (T0>T1, T2, p<0.05). In addition, the hopelessness score reduced significantly after discharge compared to three follow-up periods (T0>T1, T2, T3, p<0.05). In our observations, most of the participants exhibited a low level of resilient coping, quality of life, self-rate self-efficacy, and recovery but with signs of improvement (T0<T1, T2, T3, p<0.05). An overall decrease in self-reported adherence was observed after discharge, with a significant difference between T1 and T2 compared to T0 (T0<T1, T2, p<0.05). In the Generalized estimation equations (GEE) analysis, high level of psychological distress and hopelessness significantly associated with suicide ideation (1.35-point and 1.28-point) and suicide attempt (2.59-point and 2.41-point) respectively throughout the study period. Moreover, one score lower in community integration increased the risk of suicide ideation during follow-up by 12%. Among demographic variables, gender difference, younger age, and religious belief significantly correlated with suicide ideation and attempt. In our observation, male participants revealed a higher risk for suicide ideation by 4.10-fold but lower risk for attempted suicide by 5.26-fold compared to females. Patients who reported a religious belief had a lower odds ratio for suicide ideation by 4.55-fold. Notably, with one-year younger, the risk for suicide attempt among the TRD patients increased by 9% during the study period. Conclusion: Suicidality fluctuated between the in-hospital treatment phase and the first three months following discharge in a group of patients with TRD in this study, with high psychological distress, hopelessness, low community integration, gender, younger age, and no religious belief being the top factors contributing to suicide risks. The findings highlighted the need for regular patient monitoring and assessment after discharge to identify those with TRD at high risk of suicide. The interventions improving psychological distress, hopelessness, and community integration for suicide prevention in the short-term after psychiatric hospitalization deserve more attention. Psychiatric professionals should help those with TRD to improve and maintain their stress management skills, feelings of hope, and life integration in the community, with a particular focus on gender-specific policy (e.g. female suicide attempt and male suicide ideation follow-up care) and those who are younger. Nursing professionals working in non-psychiatric fields of community or hospital settings also play the key role of gatekeepers for early engagement and referral of high-risk patients with depression and comorbid chronic physical conditions.