Wang Yunqiao, Bhaskaran Joanna, Sareen Jitender, Wang JianLi, Spiwak Rae, Bolton James M
Departments of *Psychology, †Psychiatry, and ‡Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; and Departments of §Psychiatry and ∥Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
J Nerv Ment Dis. 2015 Jul;203(7):507-13. doi: 10.1097/NMD.0000000000000320.
This study examined which factors predict future suicide attempts (SAs) among people referred to psychiatric services in the emergency department (ED). It included consecutive adult (age >18 years) presentations (N = 6919) over a 3-year period to the two tertiary care hospitals in Manitoba, Canada. Medical professionals assessed each individual on 19 candidate risk factors. Stepwise logistic regression and receiver operating characteristic curves examined the association between the baseline variables and future SAs within the next 6 months. A total of 104 individuals re-presented to the ED with future SAs. Of the 19 baseline variables, only two independently accounted for the variance in future attempts. High-risk scores using this two-item model were associated with elevated odds of future SA (odds ratio, 3.22; 95% confidence interval, 1.62-6.42; p < 0.01), but this was tempered by a low positive predictive value. Further evaluation is required to determine if this two-item tool could help identify people requiring more comprehensive risk assessment referred to psychiatry in the ED.
本研究调查了在急诊科（ED）接受精神科服务的人群中，哪些因素可预测未来的自杀未遂（SA）情况。该研究纳入了加拿大曼尼托巴省两家三级护理医院在3年期间连续就诊的成年患者（年龄>18岁）（N = 6919）。医学专业人员对每个个体的19个候选风险因素进行了评估。逐步逻辑回归和受试者工作特征曲线分析了基线变量与未来6个月内自杀未遂之间的关联。共有104人因未来自杀未遂再次到急诊科就诊。在19个基线变量中，只有两个独立解释了未来自杀未遂情况的差异。使用这个两项模型得出的高风险评分与未来自杀未遂的较高几率相关（优势比为3.22；95%置信区间为1.62 - 6.42；p < 0.01），但阳性预测值较低，这限制了其作用。需要进一步评估这个两项工具是否有助于识别在急诊科需要转介到精神科进行更全面风险评估的人群。
