Brown Gregory K, Currier Glenn W, Jager-Hyman Shari, Stanley Barbara
Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, 3535 Market St, Philadelphia, PA 19104
J Clin Psychiatry. 2015 Oct;76(10):1397-403. doi: 10.4088/JCP.14m09015.
The degree of concordance between clinical and standardized assessments in the detection and classification of suicidal behavior and nonsuicidal self-injury behavior in psychiatric emergency department settings was examined.
Two hundred fifty-four patients at 3 psychiatric emergency departments between 2007 and 2011 were evaluated by research staff using standardized assessments of suicidal behavior and nonsuicidal self-injury behavior. Of 254 patients, 128 (50%) made a recent suicide attempt, 30 (12%) engaged in recent nonsuicidal self-injury behavior, 20 (8%) made a recent suicide attempt interrupted by self or others, and 76 (30%) had other psychiatric symptoms in the absence of recent suicidal or nonsuicidal self-injury behavior. The classifications derived from the standardized assessments using the Centers for Disease Control and Prevention (CDC) nomenclature were compared to clinical assessments independently extracted from emergency department medical records.
Agreement between clinical and standardized assessments was substantial for both suicide attempts (κ = 0.76, P < .001) and nonsuicidal self-injury behavior (κ = 0.72, P < .001). Importantly, 18% of patients determined to have made a suicide attempt in the past week by standardized assessment were not identified as such by clinical assessment. In addition, as measured by the Columbia Suicide Severity Rating Scale, the potential lethality of attempts for patients classified as making a recent suicide attempt by both clinician and standardized assessments was significantly greater (t120 = 2.1, P = .04) than that for patients who were classified as having made an attempt by the standardized but not clinical assessment.
The use of standardized assessment measures may improve sensitivity and accuracy of identifying suicidal behavior and nonsuicidal self-injury behavior in psychiatric emergency departments.
研究在精神科急诊科环境中，临床评估与标准化评估在自杀行为和非自杀性自伤行为的检测及分类方面的一致性程度。
2007年至2011年间，研究人员对3个精神科急诊科的254名患者进行了自杀行为和非自杀性自伤行为的标准化评估。在这254名患者中，128名（50%）近期有自杀未遂行为，30名（12%）近期有非自杀性自伤行为，20名（8%）近期有自杀未遂行为但被自己或他人打断，76名（30%）在近期无自杀或非自杀性自伤行为的情况下有其他精神症状。将使用疾病控制与预防中心（CDC）命名法从标准化评估中得出的分类与从急诊科病历中独立提取的临床评估进行比较。
临床评估与标准化评估在自杀未遂行为（κ = 0.76，P <.001）和非自杀性自伤行为（κ = 0.72，P <.001）方面的一致性都很高。重要的是，通过标准化评估确定在过去一周有自杀未遂行为的患者中，有18%未被临床评估识别出来。此外，根据哥伦比亚自杀严重程度评定量表测量，临床评估和标准化评估均判定为近期有自杀未遂行为的患者，其自杀未遂的潜在致死性显著高于标准化评估判定有自杀未遂行为但临床评估未判定的患者（t120 = 2.1，P =.04）。
使用标准化评估措施可能会提高精神科急诊科识别自杀行为和非自杀性自伤行为的敏感性和准确性。
