ImportanceAlthough incidence of suicide in depression varies remarkably temporally, risk factors have been modeled as constant and remain uncharted in the short term. How effectively factors measured at one point in time predict risk at different time points is unknown.ObjectiveTo examine the absolute risk and risk factors for suicide in hospitalized patients with depression starting from the first days after discharge up to 2 years and to evaluate whether the size of relative risk by factor displays temporal patterns over consecutive phases of follow-up.Design, Setting, and ParticipantsThis population-based study using Finnish registers (hospital discharge, population, and cause of death registers) included all hospitalizations for depression as the principal diagnosis in Finland from 1996 to 2017, with a maximum follow-up of 2 years. Data were analyzed from January 2022 to November 2023.Main Outcomes and MeasuresIncidence rate (IR), IR ratios, hazard functions, and hazard ratios for suicide by consecutive time periods (0 to 3 days, 4 to 7 days, 7 to 30 days, 31 to 90 days, 91 to 365 days, and 1 to 2 years) since discharge.ResultsThis study included 193 197 hospitalizations among 91 161 individuals, of whom 51 197 (56.2%) were female, and the mean (SD) age was 44.0 (17.3) years. Altogether, patients were followed up to 226 615 person-years. A total of 1219 men and 757 women died of suicide. Incidence of suicide was extremely high during the first days after discharge (IR of 6062 [95% CI, 4963-7404] per 100 000 on days 0 to 3; IR of 3884 [95% CI, 3119-4835] per 100 000 on days 4 to 7) and declined thereafter. Several factors were associated with risk of suicide over the first days after discharge. Current suicide attempt by hanging or firearms increased the risk of suicide most on days 0 to 3 (IR ratio, 18.9; 95% CI, 3.1-59.8) and on days 0 to 7 (IR ratio, 10.1; 95% CI, 1.7-31.5). Temporal patterns of the size of the relative risk diverged over time, being constant, declining, or increasing. Clinical factors had the strongest association immediately. Relative risk remained constant among men and even increased among those with alcohol or substance use disorder.Conclusions and RelevanceIn this study, patients hospitalized for depression had extremely high risk of suicide during the first days after discharge. Thereafter, incidence declined steeply but remained high. Within the periods of the highest risk of suicide, several factors increased overall risk manyfold. Risk factors’ observed potencies varied over time and had characteristic temporal patterns.

中文翻译：

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1996-2017 年芬兰因抑郁症住院后自杀风险和危险因素的变化

重要性尽管抑郁症自杀的发生率随时间变化很大，但危险因素已被建模为恒定的，并且在短期内仍然未知。一个时间点测量的因素如何有效预测不同时间点的风险尚不清楚。 目的检查住院抑郁症患者从出院后第一天到 2 年的自杀绝对风险和危险因素，并评估其大小是否有效。按因素划分的相对风险显示了连续随访阶段的时间模式。设计、设置和参与者这项基于人群的研究使用芬兰登记册（出院人数、人口和死亡原因登记册），包括所有因抑郁症住院的患者作为主要诊断1996年至2017年在芬兰进行，最长随访时间为2年。数据分析时间为 2022 年 1 月至 2023 年 11 月。主要结果和措施按连续时间段（0 至 3 天、4 至 7 天、7 至 30 天、出院后 31 至 90 天、91 至 365 天和 1 至 2 年）。 结果 本研究纳入了 91 161 名受试者中的 193 197 名住院患者，其中 51 197 名 (56.2%) 为女性，平均 (SD) 年龄为 44.0 岁（17.3）年。总共对 226 615 人年的患者进行了随访。共有 1219 名男性和 757 名女性死于自杀。出院后的头几天，自杀率极高（第 0 至 3 天，每 10 万人中自杀率为 6062 [95% CI，4963-7404]；第 3 天，每 10 万人中自杀率为 3884 [95% CI，3119-4835]。第 4 至 7 天），此后下降。有几个因素与出院后头几天的自杀风险有关。目前通过上吊或枪械自杀的尝试在第 0 至 3 天（IR 比率，18.9；95% CI，3.1-59.8）和第 0 至 7 天（IR 比率，10.1；95% CI，1.7- 31.5）。相对风险大小的时间模式随着时间的推移而变化，保持不变、下降或增加。临床因素立即具有最强的关联性。男性的相对风险保持不变，而患有酒精或药物滥用障碍的人的相对风险甚至有所增加。结论和相关性在这项研究中，因抑郁症住院的患者在出院后的头几天自杀风险极高。此后，发病率急剧下降，但仍然很高。在自杀风险最高的时​​期，有几个因素使总体风险成倍增加。观察到的风险因素的效力随时间而变化，并具有特征性的时间模式。