Brovelli Sebastien, Dorogi Yves, Feiner Adam-Scott, Golay Philippe, Stiefel Friedrich, Bonsack Charles, Michaud Laurent
Service of Liaison Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Front Psychiatry. 2017 Sep 27;8:188. doi: 10.3389/fpsyt.2017.00188. eCollection 2017.
Suicide is a major cause of premature deaths worldwide and belongs to the top priority public health issues. While suicide attempt is the most important risk factor for completed suicide, intervention for suicide attempters (SA) have produced mixed results. Since an important proportion of SA request medical care, emergency units (EU) are an opportune setting to implement such interventions. This exploratory study evaluated the feasibility and acceptability of a multicomponent intervention for SA admitted to an EU. The intervention consisted of coordination by a case manager of a joint crisis plan (JCP), an early meeting with relatives and the existing care network, as well as phone contacts during 3 months after suicide attempt. Among 107 SA admitted to the emergency unit during the study period, 51 could not be included for logistical reason, 22 were excluded, and intervention was offered to 34. Of these, 15 refused the intervention, which was thus piloted with 19 SA. First-time attempters most frequently declined the intervention. Feasibility and acceptability of phone contacts and case manager were good, while JCPs and meetings were difficult to implement and perceived as less acceptable. Refusal pattern questions the global acceptability and is discussed: JCPs and meetings will have to be modified in order to improve their feasibility and acceptability, especially among first-time attempters.
自杀是全球过早死亡的主要原因之一,属于公共卫生领域的首要问题。虽然自杀未遂是导致自杀身亡的最重要风险因素,但对自杀未遂者的干预效果参差不齐。由于很大一部分自杀未遂者会寻求医疗救治,急诊科是实施此类干预的合适场所。这项探索性研究评估了对入住急诊科的自杀未遂者进行多组分干预的可行性和可接受性。干预措施包括由个案管理员协调联合危机计划(JCP)、与亲属及现有护理网络尽早会面,以及在自杀未遂后的3个月内进行电话联系。在研究期间入住急诊科的107名自杀未遂者中,51人因后勤原因无法纳入,22人被排除,34人接受了干预。其中,15人拒绝了干预,因此该干预措施在19名自杀未遂者中进行了试点。首次自杀未遂者最常拒绝干预。电话联系和个案管理员的可行性和可接受性良好,而联合危机计划和会面难以实施且被认为可接受性较低。拒绝模式对整体可接受性提出了质疑,并对此进行了讨论:联合危机计划和会面必须进行修改,以提高其可行性和可接受性,尤其是在首次自杀未遂者中。