Boyle A, Jones P, Lloyd S
Addenbrooke's Hospital, Hills Road, Cambridge, UK.
Emerg Med J. 2006 Aug;23(8):604-7. doi: 10.1136/emj.2005.031260.
This study compared rates of self harm among victims of domestic assault presenting to an emergency department (ED) with those rates among other ED patients. It also explored the temporal and numeric relation between domestic assaults and self harm.
A retrospective matched cohort study was conducted using the medical records of a single ED. The cases were patients who had presented to the ED as a consequence of domestic assault. Two control groups matched for age, sex, and Cambridge postcode were randomly generated from the ED patient list. The second control group cases were also matched for postcode sector as a surrogate approximate for socioeconomic status in addition to age and sex. Cases and controls were followed up between November 1996 and 1 October 2004 documenting the number and timing of episodes of self harm reported in the study period.
Altogether, 294 cases and 558 controls were followed up. Patients suffering domestic assault were more likely to present with self harm than controls (RR 3.6 95% CI 2.1-6.5). This effect appeared to be independent of deprivation. Patients suffering domestic assault had more ED contacts than controls. There was a moderate correlation between the number of episodes of self harm and number of assaults (Spearman's rho 0.3 p<0.001). Socioeconomic status was a poor predictor of self harm. Emergency physicians should consider asking about suicidal ideation in victims of domestic assault.
本研究比较了因家庭攻击而前往急诊科（ED）的受害者与其他急诊科患者的自我伤害发生率。同时探讨了家庭攻击与自我伤害之间的时间和数量关系。
采用单一急诊科的病历进行回顾性匹配队列研究。病例为因家庭攻击而前往急诊科的患者。从急诊科患者名单中随机生成两个在年龄、性别和剑桥邮政编码方面匹配的对照组。第二个对照组病例除年龄和性别外，还根据邮政编码区域进行匹配，作为社会经济地位的替代近似指标。在1996年11月至2004年10月1日期间对病例和对照进行随访，记录研究期间报告的自我伤害事件的数量和时间。
总共对294例病例和558例对照进行了随访。遭受家庭攻击的患者比对照组更有可能出现自我伤害（相对风险3.6，95%可信区间2.1 - 6.5）。这种效应似乎与贫困无关。遭受家庭攻击的患者比对照组有更多次前往急诊科就诊。自我伤害事件数量与攻击次数之间存在中等程度的相关性（斯皮尔曼等级相关系数0.3，p<0.001）。社会经济地位对自我伤害的预测能力较差。急诊医生应考虑询问家庭攻击受害者的自杀意念。
