Şizofrenide İntihar Davranışı ile Depresyon, İçgörü ve Hastalık Özelliklerinin Değerlendirilmesi

Öz

Giriş: İntihar önemli morbidite ve mortalite oranlarına sahip ciddi bir halk sağlığı sorunudur. Şizofrenide de intihar oranları yüksek olup, morbidite ve mortaliteyi artıran en önemli sebeplerden biridir. Şizofrenide intihar risk faktörlerinin anlaşılması, intihar insidansını azaltmaya yönelik yaklaşımları geliştirmek için hayati önem taşımaktadır. Bu çalışmada şizofreni hastalarında intihar davranışı riski ile demografik değişkenler ve hastalık özellikleri, depresyon ve içgörü ilişkisinin literatür bilgileri eşliğinde değerlendirilerek, şizofrenide intiharın azaltılmasına katkı sağlamak ve ileriki çalışmalara örnek oluşturmak amaçlanmıştır. Yöntem: Araştırmaya toplum ruh sağlığı merkezinde (TRSM) şizofreni tanısı ile en az 4 yıldır takipli 103 hasta dahil edilmiştir. Çalışmaya akut psikotik atak döneminde olmayan, ölçekleri anlayabilecek ve doldurabilecek zihinsel kapasiteye sahip olan ve çalışmaya katılmayı onaylayan hastalar dahil edilmiştir. Hastalara sosyodemografik veri formu, Şizofrenide Pozitif Belirtileri Değerlendirme Ölçeği (SAPS), Şizofrenide Negatif Belirtileri Değerlendirme Ölçeği (SANS) Calgary Şizofrenide Depresyon Ölçeği (CŞDÖ), İçgörünün Üç Bileşenini Değerlendirme Ölçeği (İÜBDÖ) ve İntihar Davranış Ölçeği (İDÖ) uygulanmıştır. Bulgular: Hastaların % 69’ u erkek olup, %47’ sinde intihar düşüncesi saptanmış; intihar düşüncesi bulunan grubun ise %46’ sında ciddi düzeyde intihar düşüncesi (şiddetli ve çok şiddetli) tespit edilmiştir. Şizofrenide intihar düşüncesinin üzerine cinsiyet, İDÖ, CŞDÖ, SANS ve SAPS puanlarının anlamlı bir etkisi bulunmazken; yaş ve hastalık süresi intihar riski üzerine etkili faktörler olarak bulunmuştur (sırasıyla p=0.033, p=0.004). Yaşla intihar riski arasında ters bir ilişkinin olduğu ve yaştaki her 1 birimlik artışın, intihar riskini 0.929 kat bir azalttığı bulunmuştur. Hastalık süresi arttıkça da intihar riski artmaktadır. Hastalık süresindeki her 1 birimlik artış ile intihar riski 1.133 kat artmaktadır. Ayrıca intihar düşüncesi şiddetli-çok şiddetli olan grubun depresyon şiddeti, hafif-orta olan gruptan anlamlı olarak yüksek çıkmıştır (p=0.01). Tartışma: Şizofreni ile takipli hastaların yarıdan fazlasında intihar davranışı saptanmış olup intihar düşüncesi olan grubun yaklaşık yarısında ciddi intihar düşüncesi tesbit edilmiştir. İntihar düşüncesi ile sadece yaş ve hastalık süresi arasında ilişki bulunmuş olup, yaş arttıkça intihar düşüncesinin azaldığı ve hastalık süresi uzadıkça arttığı saptanmıştır. Bu örneklemde içgörü, depresyon, cinsiyet ve belirti şiddeti ile intihar düşüncesi arasında anlamlı ilişki olmadığı görülmüştür. Ayrıca intihar düşüncesi şiddetli-çok şiddetli olan grupta, depresyon puanları istatistiksel olarak anlamlı yüksek saptanmıştır. Literatürle uyumlu olarak şizofreni ile takipli hastalarda, depresyon şiddeti arttıkça intihar davranışı şiddeti de artmıştır. Sonuç: Sonuç olarak şizofrenide intihar ve intihar girişimi önemli bir morbidite ve mortalite faktörü olup, şizofreni hastalarında intihar risk faktörleri ve koruyucu faktörlerin tesbiti yapılarak, bunlara dönük müdahelelerin oluşturulması büyük önem arz etmektedir.

Anahtar Kelimeler

• şizofreni
• intihar
• intihar davranışı
• depresyon

Evaluation of Suicidal Behavior and Depression, Insight and Disease Characteristics in Schizophrenia

Abstract

Introduction: Suicide is a severe public health issue with high rates of morbidity and mortality. Schizophrenia also has a high suicide incidence, which is one of the main factors contributing to rising morbidity and mortality. For strategies to lower suicide rates, it is essential to understand the risk factors for suicide in people with schizophrenia. By evaluating the relationship between the risk of suicidal behavior and demographic factors, disease characteristics, depression, and insight in schizophrenia patients, in the light of literature information, this study aimed at preventing suicide in schizophrenia and set an example for future studies. Method: This study included 103 schizophrenia patients who underwent follow-up for at least 4 years in a community mental health center (CMHC). The study included patients who had the mental capacity to understand and complete the questionnaires, were not experiencing an acute psychotic attack, and gave their consent to participate. The patients were given the Three Components of Insight Scale (TCIS), Scale for Evaluation of Positive Symptoms in Schizophrenia (SAPS), Scale for Evaluation of Negative Symptoms in Schizophrenia (SANS), Calgary Depression Inventory in Schizophrenia (CDIS), and Suicide Behavior Scale (SBS). Results: 47% of patients demonstrated suicidal behavior, and 69% of patients were men. 46% of the group demonstrating suicidal behavior had severe or very severe suicidal ideation. Age and disease duration were revealed to be significant risk factors for suicidal behavior (p=0.033 and p=0.004, respectively), but gender, SBS, CDIS, SANS, SAPS, and TCIS scores had no significant effect. Age and suicidal behavior risk were found to be inversely correlated, with each unit of age increase reducing the risk of suicidal behavior by 0.929 times. The risk of suicidal behavior rises along with the duration of disease. With every one unit increase in the duration of disease, the risk of suicidal behavior increases by 1.133 times. Additionally, the group with severe-very severe suicidal ideation had significantly more severe depression scores than the group with mild-moderate (p=0.01). Discussion: More than half of the patients with schizophrenia who were followed up showed suicidal behavior, and approximately half of the group who had suicidal ideation showed severe suicidal ideation. Suicidal behavior was found to be correlated with age and duration of illness. While suicidal behavior increases age decreases and duration of illness increases.There was no significant correlation between insight, depression, gender, symptom severity and suicidal behavior in this population. In addition, depression scores were found to be statistically significantly higher in the group with severe-very severe suicidal ideation. According to the research, in individuals with schizophrenia who were being monitored, the frequency of suicidal behavior increased along with the severity of depression. Conclusion: It is crucial to identify the risk factors and protective factors for suicide in schizophrenia patients in order to develop interventions for them. Because suicidal behavior is a significant morbidity and mortality factor in schizophrenia.

Keywords

• schizophrenia
• suicide
• suicidal behavior
• depression

Kaynakça

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