Large Matthew Michael, Chung Daniel Thomas, Davidson Michael, Weiser Mark, Ryan Christopher James
, DMedSci FRANZCP, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
, MD (candidate), Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
BJPsych Open. 2017 May 1;3(3):102-105. doi: 10.1192/bjpo.bp.116.004309. eCollection 2017 May.
Being a current psychiatric in-patient is one of the strongest statistical risk factors for suicide. It is usually assumed that this strong association is not causal but is a result of the combination of the selection of high-risk patients for admission and the imperfect protection from suicide afforded by psychiatric wards. Logically, a third factor, which is causal, might play a role in the association. It has recently been suggested that adverse experiences in psychiatric units such as trauma, stigma and loss of social role might precipitate some in-patient suicides.
To consider whether there is a causal association between psychiatric hospitalisation and suicide.
We used the framework of Austin Bradford Hill's criteria for assessing causality in epidemiology to consider the possibility that psychiatric hospitalisation might causally contribute to the extent and variation in in-patient suicide rates.
The association between psychiatric hospitalisation and suicide clearly meets five of the nine Hill's criteria (strength of association, consistency, plausibility, coherence and analogy) and partially meets three of the remaining four criteria (gradient of exposure, temporality and experimental evidence).
Admission to hospital itself might play a causal role in a proportion of in-patient suicides. The safety of being in hospital with respect to suicide could be examined with a large-scale randomised controlled trial (RCT). In the absence of an RCT, the possibility of a causal role provides further impetus to calls to make care in the community more available and psychiatric hospitals more acceptable to patients.
M.M.L. and C.J.R. have provided expert testimony in legal proceedings following in-patient suicide.
© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
目前作为一名精神科住院患者是自杀最强的统计学风险因素之一。通常认为这种强关联并非因果关系，而是高风险患者被选入住院以及精神科病房对自杀防护不完善这两者结合的结果。从逻辑上讲，一个具有因果关系的第三个因素可能在这种关联中起作用。最近有人提出，精神科病房中的不良经历，如创伤、耻辱感和社会角色丧失，可能会促使一些住院患者自杀。
探讨精神科住院与自杀之间是否存在因果关联。
我们使用奥斯汀·布拉德福德·希尔的流行病学因果关系评估标准框架，来考量精神科住院是否可能在住院患者自杀率的程度和差异方面具有因果作用。
精神科住院与自杀之间的关联显然符合希尔九条标准中的五条（关联强度、一致性、合理性、连贯性和类推性），部分符合其余四条标准中的三条（暴露梯度、时间顺序和实验证据）。
住院本身可能在一部分住院患者自杀中起到因果作用。关于自杀方面住院安全性可通过大规模随机对照试验（RCT）进行检验。在没有随机对照试验的情况下，因果作用的可能性为呼吁增加社区护理可及性以及使精神科医院更能为患者所接受提供了进一步动力。
M.M.L.和C.J.R.在住院患者自杀后的法律程序中提供了专家证词。
©皇家精神科医学院2017年。本文是一篇开放获取文章，根据知识共享非商业性、无衍生作品（CC BY-NC-ND）许可条款发布。
