Barr Wally, Leitner Maria, Thomas Joan
University of Liverpool Health and Community Care Research Unit, Thompson Yates Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK.
Accid Emerg Nurs. 2007 Jul;15(3):122-7. doi: 10.1016/j.aaen.2007.04.005. Epub 2007 Jul 2.
A suicide note can be a very powerful communication to the family and friends of the deceased. However, in a number of cases a note is written by an individual who survives an apparent act of attempted suicide. These cases will frequently present at a hospital accident and emergency department (A&E) and will be classified as incidents of self-harm. Despite the importance of suicide notes in determining the motivation of people who die by their own hand, research findings have been patchy and ambiguous. This is also true when someone writes a suicide note but survives an act of apparent attempted suicide. In such cases the question is raised whether the person truly intended to complete suicide or whether their actions had some other motivation. This paper seeks to throw some light on this matter by examining the meaning that should be attributed to a suicide note when it has been written by someone who presents at a hospital accident and emergency department after intentionally harming or injuring themselves. More specifically, the study addresses the question whether the presence of a suicide note in such cases is more likely to reflect a serious act of attempted suicide than it is to reflect an act of self-harm with low suicidal intent. Using a large dataset collected over a 5-year period the authors compare note-leavers with self-harm patients who have not written a suicide note, focussing on the presence or absence of other known risk indicators for completed suicide in each of the two patient groups. The aim is to test the hypothesis that patients presenting at A&E with self-harm who have left a suicide note, are at higher risk of future completed suicide than are self-harm presenters who have not left a note. The conclusion reached is that clinical staff in the emergency department should err on the side of caution and regard the presence of a suicide note as an indication of a failed but serious attempt at suicide.
遗书对于逝者的家人和朋友而言可能是一种极具影响力的交流方式。然而，在一些案例中，遗书是由明显自杀未遂的幸存者所写。这些案例常常会出现在医院的急诊科（A&E），并会被归类为自残事件。尽管遗书在判定自杀者的动机方面很重要，但研究结果却参差不齐且含混不清。当某人写下遗书但自杀未遂时情况也是如此。在这类案例中，会出现这样的问题：此人是否真的打算自杀，或者他们的行为是否有其他动机。本文旨在通过研究当一个人在故意伤害自己后出现在医院急诊科时所写遗书的意义，来阐明这一问题。更具体地说，该研究探讨了在这类案例中，遗书的存在更有可能反映的是严重的自杀未遂行为，还是低自杀意图的自残行为这一问题。作者使用在5年时间里收集的一个大型数据集，将留遗书者与未写遗书的自残患者进行比较，重点关注两组患者中各自是否存在其他已知的自杀完成风险指标。目的是检验这样一个假设：在急诊科因自残而留遗书的患者，比起未留遗书的自残患者，未来自杀完成的风险更高。得出的结论是，急诊科的临床工作人员应谨慎行事，将遗书的存在视为一次失败但严重的自杀未遂尝试的迹象。
