Pfaff J J, Acres J G, McKelvey R S
National General Practice Youth Suicide Prevention Project, Perth, WA.
Med J Aust. 2001 Mar 5;174(5):222-6. doi: 10.5694/j.1326-5377.2001.tb143241.x.
To determine the effectiveness of a training program for general practitioners in recognising and responding to psychological distress and suicidal ideation in young people.
The study, conducted in general practice surgeries in Tasmania, Victoria and Western Australia in 1996 and 1997, used a pre-/posttest design to audit consecutive young patients presenting in the six weeks before and the six weeks after the GPs' participation in the training program.
Consisted of 23 GPs who attended a youth suicide prevention workshop and 423 patients aged 15-24 years who presented to the GPs' surgeries (203 pre-workshop and 220 post-workshop).
GPs attended a one-day training workshop designed to enhance their ability to recognise, assess and manage young patients at risk of suicide.
Scores on three patient self-report inventories (General Health Questionnaire-12 [GHQ-12], Center for Epidemiological Studies Depression Scale [CES-D] and Depressive Symptom Inventory--Suicidality Subscale [DSI-SS]); a GP-completed form for each patient summarising presenting complaint(s), psychological assessment and proposed management plan.
After training, GPs demonstrated increased recognition rates of psychologically distressed patients scoring above the cut-offs of the GHQ-12 (48% increase; odds ratio [OR], 1.748; 95% CI, 0.904-03.381) and CES-D (39.5% increase; OR, 2.067; 95% CI, 1.031-4.143); enquiry about suicidal ideation increased by 32.5% (OR, 1.483; 95% CI, 0.929-2.366); and identification of suicidal patients (determined by DSI-SS score) increased by 130% (OR, 3.949; 95% CI, 1.577-9.888). Training did not lead to any significant change in GPs' patient management strategies.
A one-day training course can significantly enhance GP detection rates of psychological distress and suicidal ideation in young patients, but higher recognition rates do not necessarily lead to changes in patient management.
确定一项针对全科医生的培训项目在识别和应对年轻人心理困扰及自杀意念方面的有效性。
该研究于1996年和1997年在塔斯马尼亚、维多利亚和西澳大利亚的全科医疗诊所进行，采用前后测试设计，对全科医生参加培训项目前六周和后六周内连续就诊的年轻患者进行审核。
包括23名参加青少年自杀预防研讨会的全科医生以及423名年龄在15至24岁之间到全科医生诊所就诊的患者（培训前203名，培训后220名）。
全科医生参加了为期一天的培训研讨会，旨在提高他们识别、评估和管理有自杀风险的年轻患者的能力。
三项患者自我报告量表（一般健康问卷-12[GHQ-12]、流行病学研究中心抑郁量表[CES-D]和抑郁症状量表-自杀倾向分量表[DSI-SS]）的得分；全科医生为每位患者填写的一份表格，总结就诊主诉、心理评估和拟议的管理计划。
培训后，全科医生对GHQ-12得分高于临界值的心理困扰患者的识别率提高了48%（优势比[OR]，1.748；95%置信区间，0.904 - 3.381），对CES-D得分高于临界值的患者的识别率提高了39.5%（OR，2.067；95%置信区间，1.031 - 4.143）；对自杀意念的询问增加了32.5%（OR，1.483；95%置信区间，0.929 - 2.366）；对自杀患者的识别（由DSI-SS得分确定）增加了130%（OR，3.949；95%置信区间，1.577 - 9.888）。培训并未导致全科医生的患者管理策略发生任何显著变化。
为期一天的培训课程可显著提高全科医生对年轻患者心理困扰和自杀意念的检出率，但更高的识别率不一定会导致患者管理方式的改变。
