Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Clin Infect Dis. 2010 Apr 15;50(8):1165-73. doi: 10.1086/651420.
Human immunodeficiency virus (HIV) and AIDS continue to be associated with an underrecognized risk for suicidal ideation, attempted suicide, and completed suicide. Suicidal ideation represents an important predictor for subsequent attempted and completed suicide. We sought to implement routine screening of suicidal ideation and associated conditions using computerized patient-reported outcome (PRO) assessments.
Two geographically distinct academic HIV primary care clinics enrolled patients who attended scheduled visits from December 2005 through February 2009. Touch-screen, computer-based PRO assessments were implemented into routine clinical care. Substance abuse, alcohol consumption, depression, and anxiety were assessed. The 9-item Patient Health Questionnaire assesses the frequency of suicidal ideation in the preceding 2 weeks. A response of "nearly every day" triggered an automated page to predetermined clinic personnel, who completed more detailed self-harm assessments.
Overall, 1216 patients (740 from the University of Alabama at Birmingham and 476 from the University of Washington) completed the initial PRO assessment during the study period. Patients were predominantly white (646 [53%]) and male (959 [79%]), with a mean age (+/- standard deviation) of 44 +/- 10 years. Among surveyed patients, 170 (14%) endorsed some level of suicidal ideation, whereas 33 (3%) admitted suicidal ideation nearly every day. In multivariable analysis, suicidal ideation risk was lower with advancing age (odds ratio [OR], 0.74 per 10 years; 95% confidence interval [CI], 0.58-0.96) and was increased with current substance abuse (OR, 1.88; 95% CI, 1.03-3.44) and more-severe depression (OR, 3.91 for moderate depression [95% CI, 2.12-7.22] and 25.55 for severe depression [95% CI, 12.73-51.30]).
Suicidal ideation was associated with current substance abuse and depression. The use of novel technologies to incorporate routine self-reported screening for suicidal ideation and other health domains allows for timely detection and intervention for this life-threatening condition.
人类免疫缺陷病毒（HIV）和艾滋病仍然与自杀意念、自杀未遂和自杀死亡的风险被低估有关。自杀意念是随后自杀未遂和自杀死亡的重要预测因素。我们试图使用计算机化的患者报告结果（PRO）评估来实施自杀意念和相关情况的常规筛查。
两个地理位置不同的学术性 HIV 初级保健诊所招募了 2005 年 12 月至 2009 年 2 月期间定期就诊的患者。将基于触摸屏的计算机化 PRO 评估纳入常规临床护理。评估了物质滥用、饮酒、抑郁和焦虑。9 项患者健康问卷评估了过去 2 周内自杀意念的频率。回答“几乎每天”会触发自动向预先设定的诊所人员发送页面，他们会完成更详细的自残评估。
总体而言，1216 名患者（阿拉巴马大学伯明翰分校 740 名，华盛顿大学 476 名）在研究期间完成了初始 PRO 评估。患者主要为白人（646[53%]）和男性（959[79%]），平均年龄（+/-标准差）为 44 +/- 10 岁。在接受调查的患者中，有 170 名（14%）表示存在某种程度的自杀意念，而 33 名（3%）表示几乎每天都有自杀意念。在多变量分析中，自杀意念的风险随着年龄的增长而降低（优势比[OR]，每 10 岁降低 0.74；95%置信区间[CI]，0.58-0.96），随着当前物质滥用（OR，1.88；95% CI，1.03-3.44）和更严重的抑郁（OR，中度抑郁[95% CI，2.12-7.22]的 3.91 和重度抑郁[95% CI，12.73-51.30]的 25.55）而增加。
自杀意念与当前的物质滥用和抑郁有关。使用新的技术来纳入常规的自我报告自杀意念和其他健康领域的筛查，可以及时发现和干预这种危及生命的情况。
