The Euroa Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW 2031, Australia.
Acta Psychiatr Scand. 2011 Jul;124(1):18-29. doi: 10.1111/j.1600-0447.2010.01672.x. Epub 2011 Jan 25.
To estimate the strength of the associations between the suicide of psychiatric in-patients and demographic, historical, symptomatic, diagnostic and treatment factors.
A systematic review and meta-analysis of controlled studies of the suicide of psychiatric in-patients including suicides while on approved or unapproved leave.
Factors that were significantly associated with in-patient suicide included a history of deliberate self-harm, hopelessness, feelings of guilt or inadequacy, depressed mood, suicidal ideas and a family history of suicide. Patients suffering from both schizophrenia and depressed mood appeared to be at particular risk. The association between suicidal ideas and in-patient suicide was weak and did not reach statistical significance after a quantitative correction for publication bias. A high-risk categorization as defined by a combination of retrospectively determined individual risk factors was strongly statistically associated with in-patient suicide (OR=10.9), with a sensitivity of 64% and a specificity of 85%.
Despite the apparently strong association between high-risk categorization and subsequent suicide, the low base rate of in-patient suicide means that predictive value of a high-risk categorization is below 2%. The development of safer hospital environments and improved systems of care are more likely to reduce the suicide of psychiatric in-patients than risk assessment.
评估精神科住院患者自杀与人口统计学、历史、症状、诊断和治疗因素之间关联的强度。
对包括经批准或未经批准请假期间自杀在内的精神科住院患者自杀的对照研究进行系统回顾和荟萃分析。
与住院患者自杀显著相关的因素包括蓄意自伤史、绝望感、内疚感或不足感、抑郁情绪、自杀意念和自杀家族史。同时患有精神分裂症和抑郁情绪的患者似乎风险特别高。自杀意念与住院患者自杀之间的关联较弱，并且在对发表偏倚进行定量校正后没有达到统计学意义。根据回顾性确定的个体危险因素进行高风险分类与住院患者自杀强烈相关（OR=10.9），敏感性为 64%，特异性为 85%。
尽管高风险分类与随后的自杀之间存在明显的强关联，但住院患者自杀的基础发生率较低，这意味着高风险分类的预测值低于 2%。改善医院环境安全和改进护理系统比风险评估更有可能降低精神科住院患者的自杀率。
