Department of Pediatrics, Ohio State University, Center for Innovation in Pediatric Practice, Research Institute at Nationwide Children's Hospital, Columbus, OH 43023, USA.
Pediatrics. 2010 May;125(5):945-52. doi: 10.1542/peds.2009-1964. Epub 2010 Apr 12.
Suicidal youths are rarely identified in primary care settings. We describe here a care process that includes a computerized screen, colocated social workers, and a coordinated suicide-prevention team at a specialty mental health unit.
Patients were 1547 youths aged 11 to 20 years seen in an urban primary care system during 2005 and 2006. We performed an observational study of services provided to youths who screened positive for suicidal ideation on a computerized behavioral health screen during visits to pediatric primary care clinics. Data included clinical records, provider notes, and patients' responses to the screen.
A total of 209 (14%) youths reported suicidal thought in the previous month. Suicidal thought was more common among girls, younger youths, substance users, depressed youths, youths who carried weapons, and those who had been in fights; 87% reported at least 1 other serious behavioral health problem. Social workers were able to triage 205 (98%) youths. Triage occurred on the visit day for 193 youths (94%). Mental health evaluations were recommended for 152 (74%) of the triaged youths. Of the 109 subjects referred to a clinic with records accessible for review, 71 (65%) received a mental health service within 6 months.
Pediatric primary care is a feasible setting in which to screen for suicidal youths and link them with mental health services. Youths who visit primary care clinics are willing to disclose suicidal ideation on a computerized screen. Youths who screen positive for suicide have many associated behavioral health needs. The use of information technology, colocated physician extenders, and a coordinated team on the mental health side can facilitate rapid, personal contact between the family and mental health service providers, and has the potential to overcome barriers to care for youths with suicidal ideation in the primary care setting.
在初级保健环境中很少能识别出有自杀倾向的年轻人。我们在此描述一种包含计算机筛查、同地设置的社会工作者和精神卫生专科单位协调的自杀预防小组的护理流程。
我们对 2005 年至 2006 年在城市初级保健系统中就诊的 1547 名 11 至 20 岁的年轻人进行了一项观察性研究。我们对在儿科初级保健诊所就诊期间通过计算机化行为健康筛查对有自杀意念的年轻人提供的服务进行了研究。数据包括临床记录、医生记录和患者对屏幕的反应。
共有 209 名（14%）年轻人报告在过去一个月内有自杀想法。女性、年龄较小、使用药物、抑郁、携带武器和打架的年轻人更常见自杀想法；87%的年轻人报告至少有 1 种其他严重的行为健康问题。社会工作者能够对 205 名（98%）年轻人进行分诊。193 名（94%）年轻人在就诊当天进行了分诊。对分诊出的 152 名（74%）年轻人建议进行心理健康评估。在可查阅记录的 109 名转诊到诊所的患者中，71 名（65%）在 6 个月内接受了心理健康服务。
儿科初级保健是筛查有自杀倾向的年轻人并将其与心理健康服务联系起来的可行场所。在计算机屏幕上，年轻人愿意透露自杀意念。对自杀进行筛查呈阳性的年轻人有许多相关的行为健康需求。信息技术的使用、同地设置的医生助手和精神卫生方面的协调小组可以促进家庭与心理健康服务提供者之间的快速、个人联系，并有可能克服初级保健环境中对有自杀意念的年轻人的护理障碍。
