Renaud Johanne, Chagnon François, Balan Bogdan, Turecki Gustavo, McGirr Alexander, Marquette Claude
Department of Child and Adolescent Psychiatry, CHU Mère-Enfant Sainte-Justine, 3175 Côte Sainte-Catherine, Université de Montréal, Montreal, Canada.
BMC Psychiatry. 2006 Aug 23;6:36. doi: 10.1186/1471-244X-6-36.
From a retrospective study of youth centres (YCs) and coroner's files, we investigated youths' history of medical service utilization who died by suicide. This is the second of two papers on YCs population, the first paper having shown that the rate of psychopathology was higher in the YCs population compared to the general adolescent population.
From 1995 to 2000, 422 youths, aged 18 years and younger, died as a result of suicide in Quebec. More than one-third received services from YCs at some point. Using the provincial physician payment and hospitalization database, we examined physical and psychiatric service utilization according to time intervals, as well as hospitalization for psychiatric reasons in the individuals' lifetime and in the year preceding suicide. Suicides were matched to living YCs youths for age, sex, and geographic area. YCs controls were then subdivided into two groups based on file information pertaining to the presence or absence of suicidal behavior or ideation.
Compared to living YCs youths, suicides had a higher rate of psychiatric service utilization in the week, month, 90 days, and year preceding suicide, as well as higher levels of lifetime hospitalization for psychiatric reasons than controls with or without a history of suicidal behavior or ideation. We found that 28.3% YCs suicides made use of psychiatric services in the year preceding suicide.
The rate of psychiatric service utilization by YCs youth suicides is substantially inferior to the needs of this population. Our study underscores the need for appropriate recognition of psychiatric and suicidal problems among YCs population by social and psycho-educational professionals. At the same time, it highlights the issues of general practitioners' risk identification, psychiatric referral and treatment. Our findings suggest the need for improved organization and coordination of psychiatric services to ameliorate treatment delivery.
通过对青少年中心（YC）和验尸官档案的回顾性研究，我们调查了自杀死亡青少年的医疗服务利用史。这是关于YC人群的两篇论文中的第二篇，第一篇论文表明，与普通青少年人群相比，YC人群的精神病理学发生率更高。
1995年至2000年期间，魁北克有422名18岁及以下的青少年自杀身亡。超过三分之一的人在某个时间点接受过YC的服务。利用省级医生薪酬和住院数据库，我们根据时间间隔检查了身体和精神科服务的利用情况，以及个体一生中及自杀前一年因精神原因住院的情况。将自杀者与在世的YC青少年按年龄、性别和地理区域进行匹配。然后根据与自杀行为或想法的存在与否相关的档案信息，将YC对照组分为两组。
与在世的YC青少年相比，自杀者在自杀前一周、一个月、90天和一年中的精神科服务利用率更高，且因精神原因导致的终身住院水平高于有或没有自杀行为或想法史的对照组。我们发现，28.3%的YC自杀者在自杀前一年使用过精神科服务。
YC青少年自杀者的精神科服务利用率远低于该人群的需求。我们的研究强调，社会和心理教育专业人员需要对YC人群中的精神和自杀问题进行适当识别。同时，它突出了全科医生的风险识别、精神科转诊和治疗问题。我们的研究结果表明，需要改善精神科服务的组织和协调，以改善治疗的提供。
