山口県立総合医療センター救命救急センターにおける自殺企図患者の現状

A Report about the Suicidal People in Emergency Medical Service Center of Yamaguchi Grand Medical Center

抄録

　自殺予防対策は今や社会的な急務であり，自殺未遂者への危機介入において総合病院精神科が果たすべき役割は大きい。今回我々は，2005年4月～2007年3月の2年間に山口県立総合医療センター救命救急センターを受診した自殺企図者181名(男性56名，女性125名)を対象とし，その背景について検討した。自殺既遂者は男性が多く，縊首という手段を選ぶ傾向にあり，中高年が過半数を占め，自殺未遂者に比べて有意に平均年齢が高かった。自殺未遂者は女性が多く，過量服薬による手段が大半であり，20～30代では自殺企図を繰り返す傾向があった。自殺未遂者の中でも高齢者は精神科通院歴を認めず，気分障害を多く認めるなど自殺既遂者に共通した背景を認めた。年代に応じた自殺予防対策が重要と思われた。

　The number of sucidal people is increasing in recent years in Japan(over 30,000, per year). Prevention of suicide is a task of pressing urgency in Japan. We discussed suicidal patients who visited the Emergency Medical Service Center of Yamaguchi Grand Medical Center from April, 2005 to March, 2007. The total number of these patients was 181(56 male, 125 female, 17 completed, 164 attempted).

　In the Completed suicide group, the majority was male, middle-age and elderly. They tended to choose hanging as the suicidal method. Some of them with no history of psychiatry had symptoms such as loss of appetite, general fatigue and depressive mood, which indicated that they were suffering from depression. Significant difference was identified in terms of average age between the completed suicide group and the attempted suicide group.

　In the attempted suicide group, the majority were female, and chose overdose as the suicidal method. The number of repeated suicide attempts was 78. Especially, Those in the 20s and 30s in the attempted suicide group tended to repeat suicidal attempts and most of them had a history of psychiatry.

　The elderly patients in the attempted suicide group shared some features with the completed suicide group in that most patients had no history of psychiatry, but were diagnosed with depression. These results suggest that age-appropriate prevention of suicide and early detection of depression are very important. In addition, two cases who attempted suicide for the first time accomplished it after discharge. Attempted suicide is thougth to be a predictor of completed suicide.

　Most of the suicidal patients lived with their family, but the family failed to noticed the signs of suicide. This indicates that psychoeducation for patients and their families is the key to prevention of suicide.

　We need to work together closely with emergency physicians and strive to enhance the psychiatric emergency system in conjunction with psychiatric hospitals for rapid recovery and rehabilitation for suicidal people.