Hiles Sarah, Bergen Helen, Hawton Keith, Lewin Terry, Whyte Ian, Carter Gregory
Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia.
Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, UK.
J Psychosom Res. 2015 Apr;78(4):356-62. doi: 10.1016/j.jpsychores.2015.01.006. Epub 2015 Jan 17.
Hospital-treated deliberate self-poisoning (DSP) is common and the existing national monitoring systems are often deficient. Clinical Practice Guidelines (UK and Australia) recommend universal psychosocial assessment within the general hospital as standard care. We compared presentation rates, patient characteristics, psychosocial assessment and aftercare in UK and Australia.
We used a cross sectional design, for a ten year study of all DSP presentations identified through sentinel units in Oxford, UK (n=3042) and Newcastle, Australia (n=3492).
Oxford had higher presentation rates for females (standardised rate ratio 2.4: CI 99% 1.9, 3.2) and males (SRR 2.5: CI 99% 1.7, 3.5). Female to male ratio was 1.6:1, 70% presented after-hours, 95% were admitted to a general hospital and co-ingestion of alcohol occurred in a substantial minority (Oxford 24%, Newcastle 32%). Paracetamol, minor tranquilisers and antidepressants were the commonest drug groups ingested, although the overall pattern differed. Psychosocial assessment rates were high (Oxford 80%, Newcastle 93%). Discharge referral for psychiatric inpatient admission (Oxford 8%, Newcastle 28%), discharge to home (Oxford 80%, Newcastle 70%) and absconding (Oxford 11%, Newcastle 2%) differed between the two units.
Oxford has higher age-standardised rates of DSP than Newcastle, although many other characteristics of patients are similar. Services can provide a high level of assessment as recommended in clinical guidelines. There is some variation in after-care. Sentinel service monitoring routine care of DSP patients can provide valuable comparisons between countries.
医院收治的蓄意自我中毒（DSP）情况常见，而现有的国家监测系统往往存在缺陷。临床实践指南（英国和澳大利亚）建议，在综合医院进行普遍的社会心理评估作为标准护理。我们比较了英国和澳大利亚的就诊率、患者特征、社会心理评估及后续护理情况。
我们采用横断面设计，对通过英国牛津（n = 3042）和澳大利亚纽卡斯尔（n = 3492）的哨点单位识别出的所有DSP就诊病例进行了为期十年的研究。
牛津的女性就诊率更高（标准化率比2.4：99%置信区间1.9，3.2），男性就诊率也更高（标准化率比2.5：99%置信区间1.7，3.5）。男女比例为1.6：1，70%在非工作时间就诊，95%入住综合医院，相当一部分患者同时摄入了酒精（牛津为24%，纽卡斯尔为32%）。对乙酰氨基酚、小剂量镇静剂和抗抑郁药是最常摄入的药物类别，不过总体模式有所不同。社会心理评估率较高（牛津为80%，纽卡斯尔为93%）。两个单位在转介至精神病院住院（牛津为8%，纽卡斯尔为28%）、出院回家（牛津为80%，纽卡斯尔为70%）以及擅自离院（牛津为11%，纽卡斯尔为2%）方面存在差异。
牛津的DSP年龄标准化率高于纽卡斯尔，尽管患者的许多其他特征相似。服务机构可按照临床指南的建议提供高水平评估。后续护理存在一些差异。哨点服务对DSP患者常规护理的监测可为不同国家之间提供有价值的比较。
