Miller Ivan W, Camargo Carlos A, Arias Sarah A, Sullivan Ashley F, Allen Michael H, Goldstein Amy B, Manton Anne P, Espinola Janice A, Jones Richard, Hasegawa Kohei, Boudreaux Edwin D
Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, Rhode Island.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
JAMA Psychiatry. 2017 Jun 1;74(6):563-570. doi: 10.1001/jamapsychiatry.2017.0678.
Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped.
To determine whether an ED-initiated intervention reduces subsequent suicidal behavior.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013.
Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk.
The primary outcome was suicide attempts (nonfatal and fatal) over the 52-week follow-up period. The proportion and total number of attempts were analyzed.
A total of 1376 participants were recruited, including 769 females (55.9%) with a median (interquartile range) age of 37 (26-47) years. A total of 288 participants (20.9%) made at least 1 suicide attempt, and there were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and screening phases (23% vs 22%, respectively). However, compared with the TAU phase, patients in the intervention phase showed a 5% absolute reduction in suicide attempt risk (23% vs 18%), with a relative risk reduction of 20%. Participants in the intervention phase had 30% fewer total suicide attempts than participants in the TAU phase. Negative binomial regression analysis indicated that the participants in the intervention phase had significantly fewer total suicide attempts than participants in the TAU phase (incidence rate ratio, 0.72; 95% CI, 0.52-1.00; P = .05) but no differences between the TAU and screening phases (incidence rate ratio, 1.00; 95% CI, 0.71-1.41; P = .99).
Among at-risk patients in the ED, a combination of brief interventions administered both during and after the ED visit decreased post-ED suicidal behavior.
自杀是美国主要的死亡原因之一。尽管急诊科是开展自杀预防工作的合适场所，但急诊科发起的自杀预防干预措施仍不完善。
确定急诊科发起的干预措施是否能减少后续的自杀行为。
设计、地点和参与者：这项在美国8家急诊科开展的多中心研究纳入了近期有自杀未遂或自杀意念的成年人，研究由3个连续阶段组成：（1）2010年8月至2011年12月的常规治疗（TAU）阶段；（2）2011年9月至2012年12月的普遍筛查（筛查）阶段；（3）2012年7月至2013年11月的普遍筛查加干预（干预）阶段。
筛查包括普遍的自杀风险筛查。干预阶段包括普遍筛查加一项干预措施，其中包括急诊科医生进行的二次自杀风险筛查、出院资源以及旨在降低自杀风险的急诊科后电话随访。
主要结局是在52周随访期内的自杀未遂（非致命和致命）情况。分析了自杀未遂的比例和总数。
共招募了1376名参与者，其中769名女性（55.9%），年龄中位数（四分位间距）为37（26 - 47）岁。共有288名参与者（20.9%）至少有1次自杀未遂，参与者中自杀未遂总数为548次。TAU阶段和筛查阶段在风险降低方面无显著差异（分别为23%和22%）。然而，与TAU阶段相比，干预阶段的患者自杀未遂风险绝对降低了5%（23%对18%），相对风险降低了20%。干预阶段的参与者自杀未遂总数比TAU阶段的参与者少30%。负二项回归分析表明，干预阶段的参与者自杀未遂总数显著少于TAU阶段的参与者（发病率比，0.72；95%置信区间，0.52 - 1.00；P = 0.05），但TAU阶段和筛查阶段之间无差异（发病率比，1.00；95%置信区间，0.71 - 1.41；P = 0.99）。
在急诊科的高危患者中，在急诊科就诊期间及之后实施的简短干预措施相结合可减少急诊科后的自杀行为。
