瑞典研究:隆乳與之後的自殺風險有關


  August 16, 2007 — 瑞典接受隆乳手術的女性,其自殺率是其他女性的3倍;此風險在手術後10年出現,隆乳婦女因為藥物和酒精濫用而死亡的比率也增加3倍。
  
  這些發現是基於1965 到1993年對瑞典隆乳女性的世代研究資料,平均追蹤19年,該研究的追蹤期比之前對此一世代的研究之追蹤期長8年,研究結果發表於八月號的整形手術期刊(Annals of Plastic Surgery)。
  
  主要作者Vanderbilt大學的Loren Lipworth博士向Medscape表示,婦女和醫師必須對尋求隆乳的女性可能遭受嚴重精神疾患有所警覺,這會導致她們在之後面臨自殺風險及藥物與酒精濫用致死的風險。
  
  該研究團隊結論表示,對尋求隆乳的婦女於隆乳前篩檢精神疾病發病率,以及隆乳之後進行監控是必須的。
  
  【5個研究顯示自殺風險】
  研究者解釋,之前有5個著眼於瑞典、丹麥、芬蘭、加拿大和美國5個世代接受隆乳婦女發病率的流行病學研究,這些研究都報告接受隆乳手術的女性,其自殺率是其他女性的2到3倍。
  
  目前的研究目標是獲得對隆乳與自殺之間關聯的更進一步瞭解,研究已經被追蹤達平均11.3年的3,527位的瑞典婦女,繼續追蹤到平均18.7年(範圍從0.1 – 37.8年)。
  
  根據醫院出院的全國登記確認從1965年到1993年首度接受隆乳手術(大多數是矽膠植入物)的婦女,婦女手術時的平均年紀是32 歲。
  
  整體而言,175位婦女在追蹤期間死亡 ,而依據年紀相仿瑞典婦女死亡率推估,預期應該只有133.4件死亡,隆乳婦女有24位自殺死亡 ,未隆乳者有8 件(標準死亡率比= 3; 95% CI, 1.9 – 4.5),提高的自殺率在10年後出現,隆乳時年紀在45歲以上的婦女,其自殺案件更多。
  
  其他14位在追蹤期間死亡的婦女,死於心智異常或者與酒精(和/或藥物)依賴(和/或濫用)有關的意外和傷害。
  
  相較於一般婦女,隆乳婦女死於肺癌和慢性呼吸道疾病的比率也較高,大部分是因為抽菸,但是她們的乳癌比率並沒有比較高。
  
  研究團隊指出,過多的自殺,以及酒精和藥物依賴相關死亡,認為這些接受隆乳手術的婦女,可能帶來或後來發展嚴重的長期精神疾病,而最終死亡,因此需要對尋求此手術的婦女增加篩檢、諮商、以及儘可能進行術後追蹤。
  
  Lipworth醫師解釋,美國在2006年有超過300,000件隆乳手術,而數目是否持續增加則有待觀察;美國食品藥物管理局(FDA)已經核准於1992年到2006年間下市的矽膠隆乳物。
  
  本研究接受國際流行病研究中心贊助,而資金來自Dow Corning Corporation;Dow Corning Corporation並未參與本研究之設計、資料收集、資料分析、資料解讀或本手稿;共同研究作者,來自國際流行病研究中心的Joseph K. McLaughlin博士,對研究過程中全部數據及對數據的完整和數據分析的準確性負責。

Cosmetic Breast Implants Linke

By Marlene Busko
Medscape Medical News

August 16, 2007 — Swedish women who received cosmetic breast implants had suicide rates that were 3 times higher than other women; the risk appeared 10 years after surgery. Deaths due to drug and alcohol abuse also increased 3-fold in the women who received breast augmentation.

These findings are based on data from a cohort of Swedish women who received breast implants from 1965 to 1993 and were followed for an average of almost 19 years. This study, which has an 8-year longer follow-up than an earlier study of this cohort, is published in the August issue of the Annals of Plastic Surgery.

"Women and doctors should be aware that there is a group of women [seeking cosmetic breast implants] who may be suffering from severe psychiatric illness, which may put them at risk later on for suicide or death from drug and alcohol abuse," lead author, Loren Lipworth, ScD, from Vanderbilt University, in Nashville, Tennessee, told Medscape.

The group concludes that "screening for preimplant psychiatric morbidity and postimplant monitoring among women seeking cosmetic breast implants may be warranted."

Five Studies Showed Suicide Risk

The researchers explain that 5 previous epidemiologic studies looked at mortality patterns among 5 cohorts of women in Sweden, Denmark, Finland, Canada, and the United States who received cosmetic breast implants. These studies all reported an approximately 2- to 3-fold higher rate of suicide in the women who received implants compared with other women.

The current study aimed to gain further insight into the relationship between implants and suicide by looking at a cohort of 3527 Swedish women who had previously been followed for a mean of 11.3 years, extending this follow-up to a mean of 18.7 years (range, 0.1 – 37.8 years).

The women, identified by a national registry of hospital discharges, had undergone cosmetic breast augmentation (mostly silicone gel implants) for the first time from 1965 to 1993. The women had a mean age of 32 at the time of surgery.

Overall, 175 women with implants died during follow-up, vs 133.4 expected deaths based on mortality rates of age-matched Swedish women. A total of 24 women with implants committed suicide, vs 8 expected deaths from suicide (standardized mortality ratio = 3; 95% CI, 1.9 – 4.5). The elevated rate of suicide was seen after 10 years. Suicides were higher in women who were aged 45 years and older at the time of breast augmentation.

An additional 14 women with implants died during follow-up from mental disorders or injuries and accidents related to alcohol and or drug dependence or abuse.

Compared with women in the general population, the women with implants had higher rates of death from lung cancer and chronic respiratory disease, largely related to smoking, but they did not have higher rates of breast cancer.

"The large excesses of suicide, as well as alcohol- and drug-dependence-related deaths, suggest that a nontrivial proportion of women undergoing cosmetic breast augmentation may bring with them — or develop later — serious long-term psychiatric morbidity and eventually mortality," the group writes, adding that this might warrant increased screening, counseling, and possibly postimplant monitoring of women seeking this procedure.

Dr. Lipworth explained there were more than 300,000 cosmetic breast implants in the United States in 2006, and it remains to be seen whether that number will increase now that the Food and Drug Administration has approved the sale of silicone breast implants after their removal from the market from 1992 to 2006.

The study was funded by the International Epidemiology Institute, in Rockville, Maryland, which in turn received funds from the Dow Corning Corporation. The Dow Corning Corporation was not involved in any aspect of the study design, data collection, data analysis, data interpretation, or writing of this manuscript. Corresponding study author Joseph K. McLaughlin, PhD, from the International Epidemiology Institute, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Annals of Plastic Surgery. 2007;59:119-123. Abstract

    
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