VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, USA.
Psychiatry Res. 2012 Dec 30;200(2-3):395-9. doi: 10.1016/j.psychres.2012.06.036. Epub 2012 Jul 15.
This study examined warning signs for suicide observed in the final day(s) of life in Veteran decedents who received healthcare from Veterans Health Administration (VHA) (N=381), using data obtained from detailed chart reviews.
Veterans who died within a week (7 days) of healthcare contact (18%) were compared to those who died later (82%). Multivariate logistic regression was used to examine differences in suicidal thoughts, psychiatric symptoms, and somatic symptoms as documented at the last visit, after controlling for demographic variables. A second multivariate regression examined whether the identified warning signs were also risk factors for suicide within a month (30 days) of contact.
Documented suicidal ideation, OR (95% CI)=3.46 (1.15-10.38), and psychotic symptoms, OR (95% CI)=2.67 (1.11-6.42), at the last visit increased the likelihood of suicide within a week of healthcare contact. Both variables also increased the odds of suicide within a month of contact.
The assessment of suicidal ideation is critical to identify Veterans at immediate risk. However, recognition of psychotic symptoms may also improve identification. In addition to indicating immediate risk, some warning signs may also suggest on-going risk.
本研究通过详细的病历回顾，调查了在退伍军人健康管理局（VHA）接受医疗服务的死者在生命的最后几天（s）中观察到的自杀警告信号（N=381）。
将在医疗接触后一周（7 天）内死亡的退伍军人（18%）与之后死亡的退伍军人（82%）进行比较。使用多变量逻辑回归，在控制人口统计学变量的情况下，比较了最后一次就诊时记录的自杀想法、精神症状和躯体症状的差异。第二项多变量回归检验了在接触后一个月（30 天）内，确定的警告信号是否也是自杀的风险因素。
最后一次就诊时记录的自杀意念（OR（95%CI）=3.46（1.15-10.38））和精神病症状（OR（95%CI）=2.67（1.11-6.42））增加了在医疗接触后一周内自杀的可能性。这两个变量也增加了在接触后一个月内自杀的几率。
评估自杀意念对于识别有即时风险的退伍军人至关重要。然而，识别精神病症状也可能有助于识别。除了表明立即存在风险外，一些警告信号还可能表明存在持续风险。
