Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Suicide Life Threat Behav. 2018 Jun;48(3):340-352. doi: 10.1111/sltb.12351. Epub 2017 Apr 21.
Health care providers have significant opportunities to identify individuals at near-term risk for suicide, but lack empirical data on near-term risk factors. This study aimed to identify dynamic, state-related risk factors observed by clinical practitioners within the last 30 days of life of 157 patients who died by suicide and to compare these near-term risk factors among patients who denied versus responded positively to having suicide ideation (SI) when last asked by a clinical practitioner prior to their death. Risk factors charted for the majority of all decedents were a history of prior suicide ideation and/or suicide attempt, current anxiety/agitation and sleep problems, current interpersonal problems or job/financial strain, current comorbid diagnoses, current social isolation/withdrawal, and a family history of mental disorder. Two-thirds of patients denied having SI when last asked and one-half of these patients were dead by suicide within 2 days. Decedents who denied having SI were quite similar in charted diagnoses, symptoms, behaviors, and environmental circumstances to decedents who responded affirmatively to having SI. Reliance on verbalized or reported SI as a gateway to a suicide risk assessment is questioned and the need for better understanding near-term risk for suicide, particularly in the absence of stated SI, is highlighted.
医疗保健提供者有很大的机会识别近期有自杀风险的个体，但缺乏关于近期风险因素的经验数据。本研究旨在确定在 157 名自杀死亡患者生命的最后 30 天内，临床医生观察到的与状态相关的动态风险因素，并比较这些风险因素在最后一次被临床医生询问时否认或对自杀意念（SI）有积极反应的患者之间的差异。为大多数死者记录的风险因素是既往有自杀意念和/或自杀企图、当前焦虑/激动和睡眠问题、当前人际关系问题或工作/经济压力、当前合并诊断、当前社交孤立/退缩，以及精神障碍家族史。三分之二的患者在最后一次被询问时否认有 SI，其中一半在两天内自杀身亡。否认有 SI 的死者在记录的诊断、症状、行为和环境方面与对有 SI 有积极反应的死者非常相似。质疑将口头或报告的 SI 作为自杀风险评估的门户的做法，并强调需要更好地了解近期自杀风险，特别是在没有明确 SI 的情况下。
