van Aalst J A, Shotts S D, Vitsky J L, Bass S M, Miller R S, Meador K G, Morris J A
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212.
J Trauma. 1992 Sep;33(3):457-64.
Of 9046 consecutive trauma admissions, all suicide attempts (n = 156) were identified: 38 patients (24%) died in hospital; 118 (76%) were discharged and received long-term follow-up (mean = 2.8 years). Factors assessed included suicidal ideation and planning, reason for attempt; number of attempts, methods, dates of prior and subsequent attempts; psychiatric diagnoses, substance abuse history, treatment and medication compliance, hospitalizations, incidence of family depression and suicide; education level, job history, and living conditions.
104 (88%) patients were interviewed and 14 (12%) were lost to follow-up. Seventy-seven of the patients (74%) used guns in their attempt; their mean ISS was 14.2. Seven (6.7%) made repeat suicide attempts (all unsuccessful). Late mortality was 7% (one related to index suicide, five to chronic illness, one to motor vehicle crash). Most patients (96%) had psychiatric diagnoses at discharge, 77 of 93 (83%) had diagnosed depression. Sixty-six percent (69 of 104) had histories of alcohol abuse, 42% (42 of 101) histories of drug abuse. Thirty-five percent (34 of 96) were noncompliant with psychiatric follow-up and 70% (16 of 23) were noncompliant with alcohol abuse treatment.
(1) Repeat attempts were rare (7%) after failed suicide attempts. (2) No late deaths resulted from repeat suicide attempts. (3) Risk factors associated with repeat attempts were younger age (p = 0.002), prior attempts (p = 0.02), family history of suicide (p = 0.03), schizophrenia (p = 0.005), and not living at home (p = 0.04). (4) Identifying patients with these risk factors, ensuring that they receive inpatient alcohol abuse treatment, along with sustained psychiatric treatment and help in maintaining home environments, may prevent repeat suicide attempts.
在9046例连续的创伤入院患者中，识别出所有自杀未遂病例（n = 156）：38例患者（24%）在医院死亡；118例（76%）出院并接受长期随访（平均2.8年）。评估的因素包括自杀意念和计划、自杀未遂原因、自杀未遂次数、方法、之前和之后自杀未遂的日期、精神科诊断、药物滥用史、治疗及药物依从性、住院情况、家族抑郁和自杀发生率、教育水平、工作经历及生活条件。
104例（88%）患者接受了访谈，14例（12%）失访。77例患者（74%）自杀未遂时使用了枪支；他们的平均损伤严重度评分（ISS）为14.2。7例（6.7%）患者再次自杀未遂（均未成功）。晚期死亡率为7%（1例与首次自杀有关，5例与慢性病有关，1例与机动车碰撞有关）。大多数患者（96%）出院时被诊断有精神疾病，93例中的77例（83%）被诊断为抑郁症。66%（104例中的69例）有酒精滥用史，42%（101例中的42例）有药物滥用史。35%（96例中的34例）未接受精神科随访，70%（23例中的16例）未接受酒精滥用治疗。
（1）自杀未遂后再次自杀未遂的情况很少见（7%）。（2）再次自杀未遂未导致晚期死亡。（3）与再次自杀未遂相关的危险因素包括年龄较小（p = 0.002）、之前有过自杀未遂（p = 0.02）、家族自杀史（p = 0.03）、精神分裂症（p = 0.005）以及不住在家里（p = 0.04）。（4）识别出有这些危险因素的患者，确保他们接受住院酒精滥用治疗，同时持续接受精神科治疗并获得维持家庭环境方面的帮助，可能会预防再次自杀未遂。
