Rice Simon M, Simmons Magenta B, Bailey Alan P, Parker Alexandra G, Hetrick Sarah E, Davey Christopher G, Phelan Mark, Blaikie Simon, Edwards Jane
Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Centre of Excellence in Youth Mental Health, headspace - National Youth Mental Health Foundation, Melbourne, VIC, Australia.
Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Orygen Youth Health Clinical Program, Melbourne, VIC, Australia.
SAGE Open Med. 2014 Nov 19;2:2050312114559574. doi: 10.1177/2050312114559574. eCollection 2014.
There is a lack of clear guidance regarding the management of ongoing suicidality in young people experiencing major depressive disorder. This study utilised an expert consensus approach in identifying practice principles to complement relevant clinical guidelines for the treatment of major depressive disorder in young people. The study also sought to outline a broad treatment framework for clinical intervention with young people experiencing ongoing suicidal ideation.
In-depth focus groups were undertaken with a specialist multidisciplinary clinical team (the Youth Mood Clinic at Orygen Youth Health Clinical Program, Melbourne) working with young people aged 15-25 years experiencing ongoing suicidal ideation. Each focus group was audio recorded and transcribed verbatim using orthographic conventions. Principles of grounded theory and thematic analysis were used to analyse and code the resultant data.
The identified codes were subsequently synthesised into eight practice principles reflecting engagement and consistency of care, ongoing risk assessment and documentation, individualised crisis planning, engaging systems of support, engendering hopefulness, development of adaptive coping, management of acute risk, and consultation and supervision.
The identified practice principles provide a broad management framework, and may assist to improve treatment consistency and clinical management of young people experiencing ongoing suicidal ideation. The practice principles may be of use to health professionals working within a team-based setting involved in the provision of care, even if peripherally, to young people with ongoing suicidal ideation. Findings address the lack of treatment consistency and shared terminology and may provide containment and guidance to multidisciplinary clinicians working with this at-risk group.
对于患有重度抑郁症的年轻人持续存在的自杀倾向的管理，缺乏明确的指导。本研究采用专家共识方法来确定实践原则，以补充针对年轻人重度抑郁症治疗的相关临床指南。该研究还试图勾勒出一个针对有持续自杀意念的年轻人进行临床干预的广泛治疗框架。
与一个多学科专家临床团队（墨尔本Orygen青年健康临床项目的青年情绪诊所）进行了深入的焦点小组讨论，该团队与年龄在15至25岁、有持续自杀意念的年轻人合作。每个焦点小组都进行了录音，并按照正字法惯例逐字转录。采用扎根理论和主题分析的原则对所得数据进行分析和编码。
随后将确定的编码综合为八项实践原则，反映了护理的参与度和连贯性、持续的风险评估和记录、个性化的危机规划、引入支持系统、培养希望感、发展适应性应对、急性风险的管理以及咨询和监督。
确定的实践原则提供了一个广泛的管理框架，可能有助于提高对有持续自杀意念的年轻人的治疗一致性和临床管理水平。这些实践原则可能对在基于团队的环境中工作、参与为有持续自杀意念的年轻人提供护理（即使是间接护理）的卫生专业人员有用。研究结果解决了治疗一致性和术语不一致的问题，可能为与这个高危群体合作的多学科临床医生提供控制措施和指导。
