McClure Janet R, Criqui Michael H, Macera Caroline A, Ji Ming, Nievergelt Caroline M, Zisook Sidney
Department of Research, VA San Diego Healthcare System, San Diego, CA, USA.
Department of Family and Preventive Medicine, University of California, San Diego, CA, USA; Department of Medicine, University of California, San Diego, CA, USA.
Compr Psychiatry. 2015 Jul;60:149-55. doi: 10.1016/j.comppsych.2014.09.010. Epub 2014 Sep 16.
Suicide prevention in the clinical setting is focused on evaluating risk in the coming hours to days, yet little is known about which factors increase acute risk.
To determine the prevalence of factors that may serve as warnings of heightened acute risk.
Veterans attending an urgent care psychiatric clinic (n=473) completed a survey on suicidal ideation and other acute risk warning signs.
More than half the sample (52%) reported suicidal ideation during the prior week. Of these, more than one-third (37%) had active ideation which included participants with a current suicide plan (27%) and those who had made preparations to carry out their plan (12%). Other warning signs were also highly prevalent, with the most common being: sleep disturbances (89%), intense anxiety (76%), intense agitation (75%), hopelessness (70%), and desperation (70%). Almost all participants (97%) endorsed at least one warning sign. Participants with depressive syndrome and/or who screened positive for post-traumatic stress disorder endorsed the largest number of warning signs. Those with both depressive syndrome and post-traumatic stress disorder were more likely to endorse intense affective states than those with either disorder alone. All p-values for group comparisons are <.008.
Our major findings are the strikingly high prevalence of past suicidal ideation, suicide attempts, current suicidal ideation and intense affective states in veterans attending an urgent care psychiatric clinic; and the strong associations between co-occurring post-traumatic stress disorder and depressive syndrome with intense affective states.
临床环境中的自杀预防重点在于评估未来数小时至数天内的风险，但对于哪些因素会增加急性风险却知之甚少。
确定可能作为急性风险升高预警信号的因素的患病率。
在一家紧急护理精神科诊所就诊的退伍军人（n = 473）完成了一项关于自杀意念及其他急性风险预警信号的调查。
超过一半的样本（52%）报告在前一周有自杀意念。其中，超过三分之一（37%）有活跃的意念，包括有当前自杀计划的参与者（27%）和已为实施计划做准备的人（12%）。其他预警信号也非常普遍，最常见的有：睡眠障碍（89%）、强烈焦虑（76%）、强烈激动（75%）、绝望（70%）和孤注一掷（70%）。几乎所有参与者（97%）都认可至少一种预警信号。患有抑郁综合征和/或创伤后应激障碍筛查呈阳性的参与者认可的预警信号数量最多。同时患有抑郁综合征和创伤后应激障碍的人比仅患其中一种疾病的人更有可能认可强烈的情感状态。所有组间比较的p值均<.008。
我们的主要发现是，在一家紧急护理精神科诊所就诊的退伍军人中，过去自杀意念、自杀未遂、当前自杀意念和强烈情感状态的患病率极高；以及创伤后应激障碍和抑郁综合征与强烈情感状态同时出现之间的紧密关联。
