National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Jean McFarlane Building, University of Manchester, Manchester, M13 9PL, UK.
BMC Psychiatry. 2010 Feb 3;10:14. doi: 10.1186/1471-244X-10-14.
Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received.
We carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death.
There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward.
Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.
精神卫生服务机构的自杀预防需要了解高危群体（如精神科住院患者）自杀的前因。本研究的目的是描述在自杀前从住院精神病病房擅自离开的人在社会和临床方面的特征，包括他们所接受的临床护理的各个方面。
我们进行了一项基于英格兰和威尔士在死亡前一年与精神卫生服务机构有过接触的人群的十年（1997-2006 年）样本的全国性临床调查。详细收集了那些与精神卫生服务机构有过接触的人的数据。
共有 1851 例当前住院精神病患者自杀，占所有患者自杀的 14%。其中 1292 例（70%）发生在病房外。这些患者中有 469 人在擅自离开病房后死亡，占住院患者自杀人数的 25%，占病房外自杀人数的 38%。擅自离开病房的自杀者与获得工作人员同意后离开病房的患者相比，更年轻、失业和无家可归。最常见的诊断是精神分裂症，且既往暴力和药物滥用的发生率较高。擅自离开病房的患者与经同意请假的住院患者相比，更有可能因治疗而被合法拘留、不遵医嘱和在入院第一周死亡。虽然擅自离开病房的患者被观察的可能性明显更高，但临床医生报告说，由于病房设计或病房内的其他患者，观察方面存在更多问题。
可能预防住院患者擅自离开病房和随后自杀的措施可能包括更严格控制病房出口，以及对患者进行更密集的观察，尤其是在入院的早期。改善病房环境，提供支持性和减少威胁性的体验，可能有助于降低风险。
