Asarnow Joan Rosenbaum, Baraff Larry J, Berk Michele, Grob Charles, Devich-Navarro Mona, Suddath Robert, Piacentini John, Tang Lingqi
UCLA Department of Psychiatry, Los Angeles, CA 90024-1759, USA.
J Am Acad Child Adolesc Psychiatry. 2008 Aug;47(8):958-66. doi: 10.1097/CHI.0b013e3181799ee8.
Reducing youth suicide and suicide attempts are national priorities. Suicidal youth emergency department (ED) patients are at high risk for repeat and fatal attempts, yet information is lacking to guide service delivery. In one of the largest clinical studies of youth ED patients presenting with suicidality, we examine ideators, single attempters, and repeat attempters with the aim of clarifying optimal strategies for ED management and risk assessment.
Consecutively admitted suicidal youths (10-18 years) from two EDs (N = 210) completed a questionnaire assessing sociodemographic, clinical, service use, and environmental stress variables.
Despite differences in background characteristics, high levels of depression, externalizing behavior, posttraumatic stress symptoms, substance use, and thought problems were observed across sites. Suicide attempt risk, defined along a continuum ranging from ideation to single attempts to repeat attempts, was predicted by higher levels of clinical symptoms, service use, and environmental stress. Specific stresses associated with increased suicide attempt risk were romantic breakups, exposure to suicide/suicide attempts, and pregnancy in self or partner. Significant predictors of attempt risk in the male-only subgroup were depression, thought problems, previous ED visits, and romantic breakups.
Pediatric ED patients presenting with suicidal ideation, single attempts, and repeat attempts fall along a continuum of increasing risk. Suicide attempt risk in males is associated with high levels of depression, but not with increased treatment rates, suggesting undertreatment in males, a group with particularly high risk for death by suicide. Treatment barriers must be addressed to achieve our national goal of reducing suicide/suicide attempts in youths.
降低青少年自杀率及自杀未遂发生率是国家重点关注事项。有自杀倾向的青少年急诊患者再次尝试自杀及自杀致死风险很高，但目前缺乏指导服务提供的相关信息。在一项针对有自杀倾向的青少年急诊患者的最大规模临床研究中，我们对有自杀想法者、单次自杀未遂者及多次自杀未遂者进行了研究，旨在明确急诊管理及风险评估的最佳策略。
连续纳入来自两家急诊室的有自杀倾向的青少年（10至18岁，N = 210），他们完成了一份问卷，评估社会人口统计学、临床、服务使用及环境压力变量。
尽管背景特征存在差异，但各研究点均观察到高水平的抑郁、外化行为、创伤后应激症状、物质使用及思维问题。自杀未遂风险，沿着从自杀想法到单次自杀未遂再到多次自杀未遂的连续谱定义，可由更高水平的临床症状、服务使用及环境压力预测。与自杀未遂风险增加相关的特定压力因素包括浪漫关系破裂、接触自杀行为/自杀未遂事件以及自身或伴侣怀孕。仅男性亚组中自杀未遂风险的显著预测因素为抑郁、思维问题、既往急诊就诊经历及浪漫关系破裂。
出现自杀想法、单次自杀未遂及多次自杀未遂的儿科急诊患者处于风险不断增加的连续谱中。男性的自杀未遂风险与高水平抑郁相关，但与治疗率增加无关，这表明男性群体（自杀死亡风险特别高的群体）治疗不足。必须解决治疗障碍，以实现我们降低青少年自杀/自杀未遂发生率的国家目标。
