Veterans Health Administration (VHA) Health Services Research and Development Center for Health Quality, Outcomes, and Economic Research, Bedford, Massachusetts, USA.
J Clin Psychiatry. 2011 May;72(5):622-9. doi: 10.4088/JCP.09m05608blu. Epub 2010 Sep 7.
To examine the recency and quality of the last Veterans Health Administration (VHA) visit for patients with depression who died by suicide.
We obtained services and pharmacy data for all 1,843 VHA patients with diagnosed depressive disorders (DSM-IV criteria) who died by suicide from April 1999 through September 2004. We ascertained the location and timing of their final VHA visit. For visits occurring within 30 days of suicide, we examined 3 quality indicators: (1) evidence that mental illness was a focus of the final visit, (2) adequacy of antidepressant dosage, and (3) recent receipt of mental health services.
Just over half of the patients (51%) with depression diagnoses had a VHA visit within 30 days of suicide. A minority of these patients (43%) died by suicide within 30 days of a final visit with mental health services, although 64% had received such services within 91 days of their suicide. Among the 57% of patients who died by suicide within 30 days and who were seen in non-mental health settings for their final visit, only 34% had a mental health condition coded at the final visit, and only 41% were receiving adequate dosages of antidepressant (versus 55% for those last seen by mental health services) (P < .0005).
Veterans Health Administration patients with depression who died by suicide within 30 days of their final visit received relatively high rates of mental health services, but most final visits still occurred in non-mental health settings. Increased referrals to mental health services, attention to mental health issues in non-mental health settings, and focus on antidepressant treatment adequacy by all providers might have reduced suicide risks for these patients.
调查患有抑郁症并自杀死亡患者最近一次接受退伍军人健康管理局（VHA）治疗的时间和治疗质量。
我们获取了 1999 年 4 月至 2004 年 9 月期间所有 1843 名被诊断为（DSM-IV 标准）抑郁症并自杀死亡的退伍军人健康管理局患者的服务和药物治疗数据。我们确定了他们最近一次 VHA 就诊的地点和时间。对于发生在自杀前 30 天内的就诊，我们检查了 3 个质量指标：（1）精神疾病是否是最后一次就诊的重点；（2）抗抑郁药剂量是否足够；（3）最近是否接受心理健康服务。
超过一半（51%）的抑郁症诊断患者在自杀前 30 天内有 VHA 就诊记录。这些患者中只有少数（43%）在最后一次接受心理健康服务后 30 天内自杀死亡，尽管 64%的患者在自杀前 91 天内接受过此类服务。在 57%的在自杀前 30 天内就诊且最后一次就诊是非心理健康治疗场所的患者中，只有 34%的患者在最后一次就诊时被诊断出有心理健康问题，只有 41%的患者接受了足够剂量的抗抑郁药（而非心理健康服务就诊患者为 55%）（P <.0005）。
在自杀前 30 天内接受 VHA 治疗的抑郁症患者接受了相对较高比例的心理健康服务，但大多数最后一次就诊仍发生在非心理健康治疗场所。增加向心理健康服务机构的转诊、在非心理健康治疗场所关注心理健康问题，以及所有医疗服务提供者关注抗抑郁药物治疗的充分性，可能会降低这些患者的自杀风险。
