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[青少年自杀未遂:法国急诊科收治的517名15岁及以下青少年的流行病学特征]

[Suicide attempts by young adolescents: epidemiological characteristics of 517 15-year-old or younger adolescents admitted in French emergency departments].

作者信息

Giraud P, Fortanier C, Fabre G, Ghariani J, Guillermain Y, Rouviere N, Chabrol B, Jouve J-L, Simeoni M-C

机构信息

Réseau de soins Association suicide mal-être chez l'adolescent (ASMA), 35, rue Estelle, 13001 Marseille, France.

出版信息

Arch Pediatr. 2013 Jun;20(6):608-15. doi: 10.1016/j.arcped.2013.03.024. Epub 2013 Apr 28.

Abstract

Adolescents who attempt suicide are a major concern. A growing body of literature seeks to explain this phenomenon and to identify its predictive factors, but relatively little information is available and children and adolescents under 15 years of age who present to general hospitals because of a suicide attempt. This study aimed to describe the demographic, social, medical, and psychological characteristics of a large sample of 517 French adolescents aged not more than 15 years 3 months. A second purpose was to measure observance of psychological care in a 1-year follow-up. Third, we aimed to document the reattempt rate during the follow-up in this population of young adolescents. Following the French official recommendations, a systematic 72-h hospitalization as well as a somatic, social, and psychological assessment was proposed to every suicide attempter after his or her admission to the emergency department. The adolescent was followed for 1 year after the suicide attempt, called the index episode. This follow-up was organized by two physicians, one of whom was not associated with the care of any of the patients. It consisted in seeking regular information as well as organization and/or optimization of the patient's psychological care, which was delivered in dedicated structures for adolescents, in outpatient care by a psychiatrist, or in an adolescent psychiatric inpatient care unit. In case of a repeated suicide attempt or persistence of alarming symptoms, this follow-up was prolonged for 1 more year. Patient data were compiled by experienced clinicians during initial assessment and alongside the 1-year follow-up through patient self-reports, but also through interviews with informants (family members, social professionals) and clinical sources (general practitioner, psychiatrist, etc.). The areas covered were the characteristics of the index episode, those of the population at the time of the index episode, as well as those of the 1-year follow-up including observance to the care and potential repetition of the suicide attempt. The mean age was 14 years with a minimum of 7 years 9 months. The vast majority of the population was female (86.1%), less than one-third lived with both parents, and 27% had academic problems. The most frequent means of suicide attempt was medication (83.9%), 92.6% of adolescents were hospitalized following the index episode, only 7.5% of them were admitted to adolescent psychiatric unit inpatient care following the initial care. Psychiatric evaluation was documented for 93.3% of the adolescents. Half (n=222) had at least one symptom of a psychiatric disorder. One-year follow-up data were available for 394 adolescents: 40 had not yet completed the year and 83 were lost to follow-up. Among the analyzable population of 391 adolescents, 35.3% were optimally observant of the care proposed and 21.4% did not observe treatment. Fifty-nine youths (15%) were referred to the hospital because of a repeated suicide attempt. Two of the patients who repeated the suicide attempt within the year had died. The findings from this study are informative with regard to prevention and intervention efforts with suicidal young and very young adolescents. First, repetition of the suicide attempt in young adolescents is not rare since nearly 15% of the cohort were repeaters within the year following the index episode. Nevertheless, intensive care and follow-up resulting in good attendance appeared to have a positive impact on the repetition of the suicide attempt.

摘要

企图自杀的青少年是一个主要的关注点。越来越多的文献试图解释这一现象并确定其预测因素,但相关信息相对较少,尤其是针对因企图自杀而前往综合医院就诊的15岁及以下儿童和青少年。本研究旨在描述517名年龄不超过15岁3个月的法国青少年大样本的人口统计学、社会、医学和心理特征。第二个目的是在1年的随访中衡量心理护理的依从性。第三,我们旨在记录这群青少年在随访期间的再次自杀企图率。按照法国官方建议,每一位自杀未遂者在进入急诊科后都会被安排72小时的系统住院治疗以及进行躯体、社会和心理评估。青少年在自杀未遂(称为索引事件)后会被随访1年。这次随访由两名医生组织,其中一名医生与任何患者的护理均无关联。随访包括定期获取信息以及组织和/或优化患者的心理护理,心理护理在专门为青少年设立的机构、由精神科医生进行的门诊护理或青少年精神科住院护理单元中提供。如果再次发生自杀企图或持续出现警示症状,随访将延长1年。患者数据由经验丰富的临床医生在初始评估期间以及1年随访期间通过患者自我报告收集,同时也通过与信息提供者(家庭成员、社会专业人员)和临床来源(全科医生、精神科医生等)的访谈收集。涵盖的领域包括索引事件的特征、索引事件发生时人群的特征,以及1年随访的特征,包括对护理的依从性和自杀企图的潜在复发情况。平均年龄为14岁,最小年龄为7岁9个月。绝大多数人群为女性(86.1%),不到三分之一的人与父母双方同住,27%有学业问题。最常见的自杀企图方式是服药(83.9%),92.6%的青少年在索引事件后住院,初次护理后只有7.5%的人被收治到青少年精神科住院护理单元。93.3%的青少年有精神科评估记录。一半(n = 222)至少有一项精神障碍症状。394名青少年有1年的随访数据:40人尚未满1年,83人失访。在可分析的391名青少年人群中,35.3%对所提议的护理完全依从,21.4%未遵守治疗。59名青少年(15%)因再次自杀企图被转诊至医院。在这一年中再次自杀企图的两名患者死亡。这项研究的结果对于预防和干预自杀的青少年及非常年幼的青少年具有参考价值。首先,青少年再次自杀企图并不罕见,因为在索引事件后的一年中,近15%的队列是再次自杀者。然而,强化护理和随访且依从性良好似乎对自杀企图的复发有积极影响。

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