Links Paul S, Eynan Rahel, Ball Jeffrey S, Barr Aiala, Rourke Sean
Suicide Studies Unit, Department of Psychiatry, University of Toronto, Canada.
Crisis. 2005;26(4):160-9. doi: 10.1027/0227-5910.26.4.160.
Assertive community treatment appears to have limited impact on the risk of suicide in persons with severe and persistent mental illness (SPMI). This exploratory prospective study attempts to understand this observation by studying the contribution of suicidality to the occurrence of crisis events in patients with SPMI. Specifically, an observer-rated measure of the need for hospitalization, the Crisis Triage Rating Scale, was completed at baseline, crisis occurrence, and resolution to determine how much the level of suicidality contributed to the deemed level of crisis. Second, observer-ratings of suicidal ideation, the Modified Scale for Suicide Ideation, and psychopathology and suicidality, Brief Psychiatric Rating Scale, were measured at baseline, crisis occurrence, and resolution. A self-report measure of distress, the Symptom Distress Scale, was completed at baseline, crisis occurrence, and resolution. Finally, the patients' crisis experiences were recorded qualitatively to compare with quantitative measures of suicidality. Almost 40% of the subjects experienced crisis events and more than a quarter of these events were judged to be severe enough to warrant the need for hospitalization. Our findings suggest that elevation of psychiatric symptoms is a major contributor to the crisis occurrences of individuals with SPMI; although the risk of suicide may have to be conceived as somewhat separate from crisis occurrence.
积极社区治疗对严重持续性精神疾病（SPMI）患者的自杀风险影响似乎有限。这项探索性前瞻性研究试图通过研究自杀倾向对SPMI患者危机事件发生的影响来理解这一观察结果。具体而言，在基线、危机发生时和危机解决时完成一项由观察者评定的住院需求测量，即危机分诊评定量表，以确定自杀倾向水平对认定的危机水平有多大影响。其次，在基线、危机发生时和危机解决时测量观察者对自杀观念的评定，即改良自杀观念量表，以及对精神病理学和自杀倾向的评定，即简明精神病评定量表。在基线、危机发生时和危机解决时完成一项痛苦的自我报告测量，即症状困扰量表。最后，对患者的危机经历进行定性记录，以便与自杀倾向的定量测量进行比较。近40%的受试者经历了危机事件，其中超过四分之一的事件被判定严重到需要住院治疗。我们的研究结果表明，精神症状的加重是SPMI患者危机发生的主要原因；尽管自杀风险可能在某种程度上与危机发生有所不同。
