Hunt I M, Kapur N, Webb R, Robinson J, Burns J, Shaw J, Appleby L
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University Place, University of Manchester, Manchester, UK.
Psychol Med. 2009 Mar;39(3):443-9. doi: 10.1017/S0033291708003644. Epub 2008 May 28.
Few controlled studies have specifically investigated aspects of mental health care in relation to suicide risk among recently discharged psychiatric patients. We aimed to identify risk factors, including variation in healthcare received, for suicide within 3 months of discharge.
We conducted a national population-based case-control study of 238 psychiatric patients dying by suicide within 3 months of hospital discharge, matched on date of discharge to 238 living controls.
Forty-three per cent of suicides occurred within a month of discharge, 47% of whom died before their first follow-up appointment. The first week and the first day after discharge were particular high-risk periods. Risk factors for suicide included a history of self-harm, a primary diagnosis of affective disorder, recent last contact with services and expressing clinical symptoms at last contact with staff. Suicide cases were more likely to have initiated their own discharge and to have missed their last appointment with services. Patients who were detained for compulsory treatment at last admission, or who were subject to enhanced levels of aftercare, were less likely to die by suicide.
The weeks after discharge from psychiatric care represent a critical period for suicide risk. Measures that could reduce risk include intensive and early community follow-up. Assessment of risk should include established risk factors as well as current mental state and there should be clear follow-up procedures for those who have self-discharged. Recent detention under the Mental Health Act and current use of enhanced levels of aftercare may be protective.
很少有对照研究专门调查近期出院的精神病患者心理健康护理与自杀风险相关的方面。我们旨在确定出院后3个月内自杀的风险因素，包括所接受医疗护理的差异。
我们进行了一项基于全国人口的病例对照研究，研究对象为238例在出院后3个月内自杀死亡的精神病患者，并按出院日期与238名存活对照进行匹配。
43%的自杀发生在出院后一个月内，其中47%在首次随访预约前死亡。出院后的第一周和第一天是特别高风险期。自杀的风险因素包括自残史、情感障碍的初步诊断、最近与服务机构的最后一次接触以及在与工作人员最后一次接触时表现出临床症状。自杀病例更有可能自行出院并错过最后一次与服务机构的预约。上次入院时被强制治疗或接受强化后续护理的患者自杀死亡的可能性较小。
从精神病护理机构出院后的几周是自杀风险的关键时期。可以降低风险的措施包括强化和早期社区随访。风险评估应包括既定风险因素以及当前精神状态，对于自行出院的患者应有明确的随访程序。近期根据《精神健康法》被拘留以及目前使用强化后续护理可能具有保护作用。
