School of Psychology, University of New South Wales, NSW, 2052, Australia
J Clin Psychiatry. 2016 May;77(5):648-53. doi: 10.4088/JCP.14m09661.
Although traumatic injuries affect millions of patients each year and increase risk for psychiatric disorder, no evidence currently exists regarding associated suicidal risk. This study reports a longitudinal investigation of suicidal risk in the 2 years after traumatic injury.
A prospective design cohort study was conducted in 4 major trauma hospitals across Australia. A total of 1,129 traumatically injured patients were assessed during hospital admission between April 2004 and February 2006 and were followed up at 3 months (88%), 12 months (77%), and 24 months (72%). Lifetime psychiatric disorder was assessed in hospital using the Mini-International Neuropsychiatric Interview, version 5.5, which was also used to assess the prevalence of suicidality, psychiatric disorder, and exposure to adverse life events at 3, 12, and 24 months after traumatic injury.
Approximately 6% of patients reported moderate/high suicidal risk at each assessment. At each assessment, half of suicidal patients reported no suicidal risk at the previous assessment. Suicidality at 24 months was predicted by current pain levels (odds ratio [OR] = 1.16; 95% CI, 1.09-1.23), recent life events (OR = 1.30; 95% CI,1.17-1.44), and current psychiatric disorder (OR = 17.07; 95% CI, 7.03-41.42), whereas only 36.6% of suicidal patients had consulted a mental health professional in the previous month, and 66.2% had consulted a primary care physician.
Suicidal risk affects a significant proportion of patients who experience a traumatic injury, and the risk for suicide fluctuates markedly in the initial years following the injury. Primary care physicians need to be trained to assess for suicidal risk in the initial years after a traumatic injury.
尽管创伤性损伤每年影响数百万患者，并增加精神障碍的风险，但目前尚无关于相关自杀风险的证据。本研究报告了创伤后 2 年内自杀风险的纵向研究。
在澳大利亚的 4 家主要创伤医院进行了前瞻性设计队列研究。共有 1129 名创伤性损伤患者在 2004 年 4 月至 2006 年 2 月期间住院期间接受评估，并在 3 个月（88%）、12 个月（77%）和 24 个月（72%）进行了随访。使用 Mini-International Neuropsychiatric Interview，version 5.5 在医院评估终生精神障碍，该测试还用于评估创伤后 3、12 和 24 个月时的自杀意念、精神障碍和暴露于不良生活事件的患病率。
大约 6%的患者在每次评估时报告中度/高度自杀风险。在每次评估中，一半有自杀意念的患者在前一次评估时报告没有自杀风险。24 个月时的自杀意念由当前的疼痛水平（优势比[OR] = 1.16；95%置信区间，1.09-1.23）、近期生活事件（OR = 1.30；95%置信区间，1.17-1.44）和当前精神障碍（OR = 17.07；95%置信区间，7.03-41.42）预测，而只有 36.6%的自杀患者在过去一个月咨询过心理健康专业人员，66.2%咨询过初级保健医生。
自杀风险影响到相当一部分经历创伤性损伤的患者，并且在损伤后最初几年内自杀风险波动很大。初级保健医生需要接受培训，以评估创伤后最初几年的自杀风险。
