Achse-I-Störungen als Risikofaktoren für Suizid in Abhängigkeit von Alter und Geschlecht

Barbara Schneider; Bernadette Bartusch; Axel Schnabel; Jürgen Fritze

doi:10.1055/s-2004-828388

Psychiatrische Praxis, Table of Contents

Psychiatr Prax 2005; 32(4): 185-194
DOI: 10.1055/s-2004-828388

Originalarbeit

Achse-I-Störungen als Risikofaktoren für Suizid in Abhängigkeit von Alter und Geschlecht

Age and Gender: Confounders for Axis I Disorders as Risk Factors for SuicideBarbara Schneider¹ , Bernadette Bartusch¹ ^, ² , Axel Schnabel² , Jürgen Fritze¹

¹Zentrum der Psychiatrie, Klinik für Psychiatrie und Psychotherapie, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
²Zentrum der Rechtsmedizin, Institut für Forensische Medizin, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main

Wir danken Herrn Dr. Hanns Ackermann, Zentrum der Biomathematik, für die Beratung bezüglich der Anwendung und Interpretation der statistischen Verfahren. Außerdem möchten wir uns bei allen Informanten für ihre Mitarbeit bedanken.

Abstract

Zusammenfassung

Anliegen und Methode: Die Bedeutung einzelner psychiatrischer Achse-I-Störungen als Risikofaktoren für Suizid wurde in verschiedenen Altersgruppen mit einer kontrollierten psychologischen Autopsiestudie untersucht. Ergebnisse: In einer logistischen Regression erzielten signifikant erhöhte Odds Ratios bei 61 - 75-Jährigen Einzelepisode einer Major Depression, bei Männern im Alter von über 30 Jahren (Altersgruppen: 31 - 45, 46 - 60 und 61 - 75 Jahre) Störungen durch Konsum von Alkohol und bei 61 - 75-jährigen Frauen organische psychische Störungen. Schlussfolgerungen: Störungen durch Konsum von Alkohol und Major Depression (Einzelepisode) tragen bei Männern und Frauen einzelner Altersgruppen zu einem erhöhten Suizidrisiko bei.

Abstract

Objectives and methods: Aim of the study was to identify and estimate psychiatric axis I disorders as risk factors for suicide in different age groups using a psychological autopsy study with case-control design. 163 suicides and 396 population-based control persons were assessed with a standardized semi-structured interview including SCID-I (for DSM-IV). Results: Logistic regression analyses revealed significantly elevated odds ratios for alcohol-related disorders in men aged 31 to 45, 46 to 60, and 61 to 75 years (OR = 9.0, OR = 7.5, and OR = 10.7, respectively) and for Major Depression, single episode, in men and women aged 61 to 75 years (OR = 42.7 and OR = 15.9). In males aged 31 to 45 years polysubstance-related disorders (OR = 9.5) and in females aged 61 to 75 years cognitive and mental disorders due to a general medical condition (OR = 12.2) were significantly and independently associated with suicide. Conclusions: Alcohol-related disorders and Major Depression differently contribute to male and female suicide risk in special age groups. These findings imply differentiated prevention strategies.

Full Text

References

Literatur

1 Statistisches Bundesamt Deutschland .Gesundheitswesen - Todesursachen in Deutschland. Wiesbaden; CD-ROM 2002
2 Wolfersdorf M, Martinez C. Suizid bei Depression, verlorene Lebensjahre und Bruttosozialprodukt. Was bringt Suizidprävention?. Psychiat Prax. 1998; 25 139-141
3 Schneider B. Risikofaktoren für Suizid. Regensburg; Roderer Verlag 2003
4 Shneidman E S, Farberow N L. Sample investigations of equivocal deaths. In: Farberow NL, Shneidman ES (eds) The cry for help. New York; McGraw-Hill 1961: 118-129
5 Stillion J M, McDowell E E, May J H. Suicide across the life-span - Premature exits. New York; Hemisphere 1989
6 Cheng A TA. Mental illness and suicide. A case-control study in East Taiwan. Arch Gen Psychiatry. 1995; 52 594-603
7 Vijayakumar L, Rajkumar S. Are risk factors for suicide universal? A case-control study in India. Acta Psychiatr Scand. 1999; 99 407-411
8 Foster T, Gillespie K, McClelland R, Patterson C. Risk factors for suicide independent of DSM-III-R Axis I disorder. Case-control psychological autopsy study in Northern Ireland. Br J Psychiatry. 1999; 175 175-179
9 Lesage A D, Boyer R, Grunberg F, Vanier C, Morissette R, Menard-Buteau C, Loyer M. Suicide and mental disorders: a case-control study of young men. Am J Psychiatry. 1994; 151 1063-1068
10 Appleby L, Cooper J, Amos T, Faragher B. Psychological autopsy of suicides by people under 35. Br J Psychiatry. 1999; 175 168-174
11 Waern M, Runeson B S, Allebeck P, Beskow J, Rubenowitz E, Skoog I, Wilhelmson K. Mental disorder in elderly suicides: a case-control study. Am J Psychiatry. 2002; 159 450-455
12 Harris E C, Barraclough B. Suicide as an outcome for mental disorders: a meta-analysis. Br J Psychiatry. 1997; 170 205-228
13 Hert M De, Peuskens J. First-episode schizophrenia, a naturalistic 10 year follow-up study. Schizophr Res. 1998; 29 7-8
14 Baxter D, Appleby L. Case register study of suicide risk in mental disorders. Br J Psychiatry. 1999; 175 322-326
15 Hiroeh U, Appleby L, Mortensen P B, Dunn G. Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. Lancet. 2001; 358 (9299) 2110-2112
16 Hert M De, McKenzie K, Peuskens J. Risk factors for suicide in young patients suffering from schizophrenia. Schizophr Res. 2001; 47 127-134
17 Angst F, Stassen H H, Clayton P J, Angst J. Mortality of patients with mood disorders: follow-up over 34 - 38 years. J Affect Disord. 2002; 68 167-181
18 Rich C L, Rickets J E, Fowler R C, Young D. Some differences between men and women who commit suicide. Am J Psychiatry. 1988; 145 718-722
19 Henriksson M M, Aro H M, Marttunen M J, Heikkinen M E, Isometsä E T, Kuoppasalmi K I, Lönnqvist J K. Mental disorders and comorbidity in suicide. Am J Psychiatry. 1993; 150 935-940
20 Carney S S, Rich C L, Burke P A, Fowler R C. Suicide over 60: The San Diego study. J Am Geriatr Soc. 1994; 42 174-180
21 Conwell Y, Duberstein P R, Cox C, Herrmann J H, Forbes N T, Caine E D. Relationship of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. Am J Psychiatry. 1996; 153 1001-1008
22 Foster T, Gillespie K, McClelland R. Mental disorders and suicide in Northern Ireland. Br J Psychiatry. 1997; 170 447-452
23 Waern M. Alcohol dependence and misuse in elderly suicides. Alcohol alcohol. 2003; 38 249-254
24 Duberstein P R, Conwell Y, Caine E D. Age differences in the personality characteristics of suicide completers: preliminary findings from a psychological autopsy study. Psychiatry. 1994; 57 213-224
25 Harwood D, Hawton K, Hope T, Jacoby R. Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case-control study. Int J Geriatr Psychiatry. 2001; 16 155-165
26 Barraclough B M, Bunch J, Nelson B, Sainsbury P. A hundred cases of suicide: clinical aspects. Br J Psychiatry. 1974; 125 355-373
27 Rich C L, Young D, Fowler R C. San Diego Suicide Study. I. Young vs old subjects. Arch Gen Psychiatry. 1986; 43 577-582
28 Conwell Y, Brent D. Suicide and aging. I. Patterns of psychiatric diagnosis. Int Psychogeriatr. 1995; 7 149-164
29 Robins E, Murphy G E, Wilkinson R H, Gessner F, Kayes J. Some clinical considerations in the preventions of suicide based on a study of 134 successful suicides. Am J Public Health. 1959; 49 888-899
30 Beskow J. Suicide and mental disorder in Swedish men. Acta Psychiatr Scand. 1979; 277, Suppl 1-138
31 Arato M, Demeter E, Rihmer Z, Somogyi E. Retrospective psychiatric assessment of 200 suicides in Budapest. Acta Psychiatr Scand. 1988; 77 454-456
32 Asgard U. A psychiatric study of suicide among urban Swedish females. Acta Psychiatr Scand. 1990; 82 115-124
33 Wolfersdorf M, Faust V, Brehm M, Moser K, Hölzer R, Hole G. Suicide in the Ravensburg area. A study of 508 cases on the basis of criminal investigation data. In: Böhme K, Freytag R, Wächtler C, Sedler H (eds) Suicidal Behavior, the State of the Art. Regensburg; Roderer Verlag 1993: 890-895
34 Heikkinen M E, Isometsä E T, Marttunen M J, Aro H M, Lönnqvist J. Social factors in suicide. Br J Psychiatry. 1995; 167 747-753
35 Tondo L, Isacsson G, Baldessarini R. Suicidal behaviour in bipolar disorder: risk and prevention. CNS Drugs. 2003; 17 491-511
36 Waern M, Rubenowitz E, Wilhelmson K. Predictors of suicide in the old elderly. Gerontology. 2003; 49 328-334
37 Henriksson M M, Marttunen M J, Isometsä E T, Heikkinen M E, Aro H M, Kuoppasalmi K I, Lönnqvist J K. Mental disorders in elderly suicide. Int Psychogeriatr. 1995; 7 275-286
38 Schneider B, Maurer K, Sargk D, Heiskel H, Weber B, Frölich L, Georgi K, Fritze J, Seidler A. Concordance of DSM-IV Axis I and II diagnoses by personal and informant's interview. Psychiatry Res. 2004; 127 121-136
39 Wittchen H U, Wunderlich U, Gruschwitz S, Zaudig M. Strukturiertes Klinisches Interview für DSM-IV, Achse I. Eine deutschsprachige erweiterte Bearbeitung der amerikanischen Originalversion des SCID-I. Göttingen; Hogrefe 1997
40 Cavanagh J TO, Carson A J, Sharpe M, Lawrie S M. Psychologcial autopsy studies of suicide: a systematic review. Psychol Med. 2003; 33 395-405
41 Brent D A, Perper J A, Kolko D J, Zelenak J P. The psychological autopsy: methodological considerations for the study of adolescent suicide. J Am Acad Child Adolesc Psychiatry. 1988; 27 362-366
42 Beskow J, Runeson B, Asgard U. Psychological autopsies: methods and ethics. Suicide Life Threat Behav. 1990; 20 307-323
43 Kelly T M, Mann J J. Validity of DSM-III-R diagnosis by psychological autopsy: a comparison with clinician ante-mortem diagnosis. Acta Psychiatr Scand. 1996; 94 337-343
44 Conner K R, Duberstein P R, Conwell Y. The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. I. Psychiatric diagnoses. Acta Psychiatr Scand. 2001; 104 204-209
45 Cavanagh J TO, Owens D GC, Johnstone E C. Life events in suicide and undetermined death in south-east Scotland: a case-control study using the method of psychological autopsy. Soc Psychiatry Psychiatr Epidemiol. 1999; 34 645-650
46 Hawton K, Simkin S, Rue J, Haw C, Barbour F, Clements A, Sakarovitch C, Deeks J. Suicide in female nurses in England and Wales. Psychol Med. 2002; 32 239-250
47 Wittchen H U, Müller N, Pfister H, Winter S, Schmidtkunz B. Affektive, somatoforme und Angststörungen in Deutschland. Erste Ergebnisse des bundesweiten Zusatzsurveys „psychische Störungen”. Gesundheitswesen. 1999; 61 (Sonderheft 2) 216-222
48 Strobl M, Klapper J, Pelzel K H, Bader G, Zahn H, Lange S. Suchthilfestatistik 2001 für Deutschland. Tabellenband für die ambulante Suchtkrankenhilfe. München; IFT Institut für Therapieforschung 2002
49 Schneider B, Maurer K, Frölich L. Demenz und Suizid. Fortschritt Neuro Psychiat. 2001; 4 164-169
50 Pirkola S P, Isometsä E T, Heikkinen M E, Henriksson M M, Lönnqvist J K. Female psychoactive substance-dependent suicide victims differ from male - results from a nationwide psychological autopsy study. Compr Psychiatry. 1999; 40 101-107
51 Rossow I, Amundsen A. Alcohol abuse and suicide: a 40-year prospective study of Norwegian conscripts. Addiction. 1995; 90 685-691
52 Runeson B. Mental disorder in youth suicide. DSM-III-R Axes I and II. Acta Psychiatr Scand. 1989; 79 490-497
53 Fowler R C, Rich C L, Young D. San Diego suicide study: Substance abuse in young cases. Arch Gen Psychiatry. 1986; 43 962-965
54 Heilä H, Isometsä E, Henriksson M, Heikkinen M, Marttunen M, Lönnqvist J. Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sex-specific clinical characteristics of 92 suicide victims with schizophrenia. Am J Psychiatry. 1997; 154 1235-1242
55 Althaus D, Hegerl U. Evaluation suizidpräventiver Maßnahmen. Aktueller Forschungsstand und resultierende Implikationen. Nervenarzt. 2001; 72 677-684
56 Wolfersdorf M, Klinkisch M, Franke C, Keller F, Wurst F M, Dobmeier M. Patientensuizid - Ein Kontrollgruppenvergleich: Suizidenten versus nach Behandlungszeitraum parallelisierte Patienten eines psychiatrischen Fachkrankenhauses. Psychiat Prax. 2003; 30 14-20
57 Wurst F M, Vogel R, Wolfersdorf M. Substanzabhängigkeit und Suizid im stationären Rahmen. Eine Deskription. Psychiat Prax. 2000; 27 11-13
58 Bierut L J, Heath A C, Bucholz K K, Dinwiddie S H, Madden P AF, Statham D J, Dunne M P, Martin N G. Major Depressive Disorder in a community-based twin sample: Are there different genetic and environmental contributions for men and women?. Arch Gen Psychiatry. 1999; 56 557-563
59 Kendler K S, Gardner C O, Neale M C, Prescott C A. Genetic risk factors for major depression in men and women: similar or different heritabilities and same or partly distinct genes?. Psychol Med. 2001; 31 605-616
60 Tyndale R F. Genetics of alcohol and tobacco use in humans. Ann Med. 2003; 35 94-121

Dr. Barbara Schneider

Zentrum der Psychiatrie · Klinik für Psychiatrie und Psychotherapie · Johann-Wolfgang-Goethe-Universität

Heinrich-Hoffmann-Straße 10

60528 Frankfurt/Main

Email: b.schneider@em.uni-frankfurt.de