Psychosocial Research Division, Douglas Mental Health University Institute, Perry Pavillion E-3311, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3, Canada.
Psychiatr Serv. 2012 Apr;63(4):364-9. doi: 10.1176/appi.ps.201000405.
The purpose of this study was to analyze patterns of mental health-related service utilization before and after hospitalization for attempting suicide.
This retrospective cohort study included all persons 15 years or older with a clinical diagnosis of schizophrenia (N=195) or depression (N=330) hospitalized in Montreal, Quebec, from April 2003 to December 2004 for attempting suicide. Data on the publicly managed health and social services system were retrieved from the linked administrative databases of Montreal's Health and Social Services Agency (April 2002 to March 2005). Twelve-month preattempt service utilization profile, health care contacts three months pre- and postattempt, and predictors of postattempt service utilization were analyzed for two diagnostic groups (schizophrenia and depression).
Specialized outpatient care and hospital emergency departments were the services most used by both groups before and after attempting suicide. Use of hospital emergency services as a primary care service did not adequately ensure aftercare, whereas prior contact with services and concurrent substance use disorder predicted greater service utilization postattempt among men but not women.
The publicly managed health and social services system in Montreal seems to respond rather well to severe suicide attempts, including those by men with a concurrent substance use disorder known to be at high suicide risk. However, better coordination among hospital emergency departments, primary care, specialized mental health services, and addiction services is needed in order to enhance continuity of care.
本研究旨在分析自杀未遂住院前后与心理健康相关的服务利用模式。
本回顾性队列研究纳入了 2003 年 4 月至 2004 年 12 月期间在魁北克省蒙特利尔因企图自杀而住院的所有 15 岁及以上的精神分裂症（N=195）或抑郁症（N=330）患者。从蒙特利尔健康和社会服务局的相关行政数据库中检索了（2002 年 4 月至 2005 年 3 月）公共管理的健康和社会服务系统的数据。分析了两个诊断组（精神分裂症和抑郁症）的自杀未遂前 12 个月的服务利用情况、自杀未遂前 3 个月和后 3 个月的医疗保健接触情况以及自杀未遂后服务利用的预测因素。
专门的门诊护理和医院急诊是两个组在自杀未遂前后使用最多的服务。将医院急诊服务作为初级保健服务并不能充分确保后续护理，而先前与服务的接触和同时存在的物质使用障碍预测了男性但不是女性在自杀未遂后的更多服务利用。
蒙特利尔的公共管理的健康和社会服务系统似乎对严重的自杀未遂反应良好，包括那些已知自杀风险高的同时存在物质使用障碍的男性。然而，需要更好地协调医院急诊部门、初级保健、专门的心理健康服务和成瘾服务，以加强护理的连续性。
