Objective: To investigate the status of medication adherence and various types of risky behaviors of schizophrenia patients in a certain area of western China and to explore accordingly the correlation between the two.
Methods: A total of 292 667 patients with schizophrenia were enrolled in a follow-up survey between 2006 and 2018. In addition, based on the outcome-wide analysis strategy, a multivariate Cox proportional risk regression model was used to estimate and compare the impact of medication adherence on different types of risky behaviors in schizophrenia patients.
Results: In this 13-year prospective cohort, 65 175 patients (31.4%) showed good medication adherence, while 142 394 patients (68.6%) showed poor medication adherence. The incidence rates of various risky behaviors during the follow-up period were as follows, minor nuisances, 12.25%, violation of the Law of the People's Republic of China on Penalties for Administration of Public Security (APS law), 3.82%, violation of criminal law, 0.94%, suicide completed, 0.28%, self-harm, 1.42%, and attempted suicide, 0.82%. Schizophrenia patients who had poor medication adherence had higher risks of committing violence against others and self-inflicted injury compared to patients with good medication adherence did, with the associated effects being minor nuisances (hazard ratio [HR]=1.31, 95% confidence interval [CI]: 1.27-1.35), violation of APS law (HR=1.47, 95% CI: 1.38-1.56), violation of criminal law (HR=1.17, 95% CI: 1.05-1.31), and self-harm (HR=1.43, 95% CI: 1.32-1.56), respectively, while the risk of suicide completed is lower in schizophrenia patients with poor medication adherence than that in patients with good medication adherence (HR=0.56, 95% CI: 0.47-0.66). There was no statistically significant association between attempted suicide and medication adherence.
Conclusion: There are variations in the direction and strength of the association between medication adherence and different types of risky behaviors and further research is needed to elucidate the mechanisms of the association.
目的: 调查中国西部某地精神分裂症患者的服药依从性与不同类型危险行为发生情况，并进一步探索二者之间的关联。
方法: 此项研究在2006–2018年间对292 667名精神分裂症患者进行了随访调查，并基于Outcome-Wide分析策略，采用多变量Cox比例风险回归模型估计并比较服药依从性对精神分裂症患者不同类型的危险行为的影响。
结果: 在这项长达13年的前瞻性队列中，服药依从性良好的患者有65 175例（31.4%），服药依从性不佳的患者142 394例（68.6%）；各类危险行为在随访期间的发生率分别为：轻度滋事12.25%，肇事3.82%，肇祸0.94%，自杀0.28%，自伤1.42%，自杀未遂0.82%。服药依从性较差的精神分裂症患者对他人暴力和自伤的发生风险均高于服药依从性较好的患者，其关联效应分别为轻度滋事〔风险比（hazard ratio, HR）=1.31，95%置信区间（confidence interval, CI）：1.27~1.35〕、肇事（HR=1.47，95%CI：1.38~1.56）、肇祸（HR=1.17，95%CI：1.05~1.31）、自伤（HR=1.43，95%CI：1.32~1.56），而自杀的发生风险低于服药依从性较好的患者（HR=0.56，95%CI：0.47~0.66）；自杀未遂与服药依从性的关联无统计学意义。
结论: 精神分裂症患者服药依从性与不同类型的危险行为间的关联方向和强度不同，需要进一步的研究来阐明关联机制。
Keywords: Medication compliance; Outcome-wide analysis; Risky behavior; Schizophrenia.
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