Objective To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. Design Population based cohort study using linked and validated provincial databases. Setting Ontario, Canada between January 2009 and December 2017 (inclusive). Participants Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. Main outcome measures The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. Results 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors ( v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). Conclusions Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.

中文翻译：

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危重病成年幸存者的自杀和自残：基于人群的队列研究

目的分析危重病生存与出院后自杀或自残的关系。使用链接和验证的省级数据库设计基于人群的队列研究。设置于 2009 年 1 月至 2017 年 12 月（含）之间的加拿大安大略省。参与者 包括连续成年重症监护病房 (ICU) 幸存者（≥18 岁）。关联的管理数据库用于比较 ICU 医院幸存者与从未需要入住 ICU 的医院幸存者（非 ICU 医院幸存者）。在研究期间，根据患者入院指数（ICU 或非 ICU）对患者进行分类。主要结果测量主要结果是自杀死亡（如省级死亡记录中所述）和出院后故意自残事件的复合。每个结果也被独立评估。评估自杀发生率的同时考虑了其他原因导致的死亡风险。分析是通过使用重叠倾向评分加权的，导致特定的 Cox 比例风险模型进行的。结果 确定了 423 060 名连续的 ICU 幸存者（平均年龄 61.7 岁，女性占 39%）。研究期间，ICU幸存者的自杀、自残以及自杀或自残复合的粗发生率（每10万人年）分别为41.4、327.9和361.0，而16.8、177.3、在非 ICU 医院幸存者中为 191.6。使用加权模型的分析表明，ICU 幸存者（v 非 ICU 医院幸存者）有更高的自杀风险（调整后的风险比为 1.22，95% 置信区间为 1.11 至 1.33）和自我伤害（1.15、1.12 至 1.19）。在 ICU 幸存者中，有几个因素与自杀或自残有关：既往抑郁或焦虑（5.69、5.38 至 6.02）、既往创伤后应激障碍（1.87、1.64 至 2.13）、有创机械通气（1.45、1.38 至 1.54） ）和肾脏替代疗法（1.35、1.17 至 1.56）。结论 危重病幸存者自杀和自残的风险增加，这些结果与先前存在的精神疾病和接受侵入性生命支持有关。了解这些预后因素可能允许早期干预以潜在地减少这一重要的公共卫生问题。38 至 1.54）和肾脏替代疗法（1.35、1.17 至 1.56）。结论 危重病幸存者自杀和自残的风险增加，这些结果与先前存在的精神疾病和接受侵入性生命支持有关。了解这些预后因素可能允许早期干预以潜在地减少这一重要的公共卫生问题。38 至 1.54）和肾脏替代疗法（1.35、1.17 至 1.56）。结论 危重病幸存者自杀和自残的风险增加，这些结果与先前存在的精神疾病和接受侵入性生命支持有关。了解这些预后因素可能允许早期干预以潜在地减少这一重要的公共卫生问题。