零自杀模式:将基于证据的自杀预防实践应用于临床护理。
The Zero Suicide Model: Applying Evidence-Based Suicide Prevention Practices to Clinical Care.
作者信息
Brodsky Beth S, Spruch-Feiner Aliza, Stanley Barbara
机构信息
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, United States.
New York State Psychiatric Institute, New York, NY, United States.
出版信息
Front Psychiatry. 2018 Feb 23;9:33. doi: 10.3389/fpsyt.2018.00033. eCollection 2018.
Suicide is reaching epidemic proportions, with over 44,000 deaths by suicide in the US, and 800,000 worldwide in 2015. This, despite research and development of evidence-based interventions that target suicidal behavior directly. Suicide prevention efforts need a comprehensive approach, and research must lead to effective implementation across public and mental health systems. A 10-year systematic review of evidence-based findings in suicide prevention summarized the areas necessary for translating research into practice. These include risk assessment, means restriction, evidence-based treatments, population screening combined with chain of care, monitoring, and follow-up. In this article, we review how suicide prevention research informs implementation in clinical settings where those most at risk present for care. Evidence-based and best practices address the fluctuating nature of suicide risk, which requires ongoing risk assessment, direct intervention and monitoring. In the US, the National Action Alliance for Suicide Prevention has put forth the Zero Suicide (ZS) Model, a framework to coordinate a multilevel approach to implementing evidence-based practices. We present the Assess, Intervene and Monitor for Suicide Prevention model (AIM-SP) as a guide for implementation of ZS evidence-based and best practices in clinical settings. Ten basic steps for clinical management model will be described and illustrated through case vignette. These steps are designed to be easily incorporated into standard clinical practice to enhance suicide risk assessment, brief interventions to increase safety and teach coping strategies and to improve ongoing contact and monitoring of high-risk individuals during transitions in care and high risk periods.
自杀正呈流行态势,2015年美国有超过44000人自杀身亡,全球范围内这一数字为80万。尽管针对自杀行为直接开展了基于证据的干预措施的研发工作,但情况依然如此。自杀预防工作需要采取综合方法,研究必须推动在公共卫生系统和心理健康系统中有效实施相关措施。一项对自杀预防方面基于证据的研究结果进行的为期10年的系统综述总结了将研究转化为实践所需的领域。这些领域包括风险评估、手段限制、基于证据的治疗、结合照护链的人群筛查、监测和随访。在本文中,我们回顾自杀预防研究如何为那些自杀风险最高的患者前来就诊的临床环境中的实施工作提供信息。基于证据的最佳实践应对自杀风险的波动特性,这需要持续的风险评估、直接干预和监测。在美国,国家自杀预防行动联盟提出了零自杀(ZS)模式,这是一个协调实施基于证据的实践的多层次方法的框架。我们提出自杀预防评估、干预和监测模式(AIM-SP),作为在临床环境中实施ZS基于证据的最佳实践的指南。将通过病例 vignette 描述和说明临床管理模式的十个基本步骤。这些步骤旨在易于纳入标准临床实践,以加强自杀风险评估、进行简短干预以提高安全性并教授应对策略,以及在护理过渡期间和高风险时期改善对高风险个体的持续联系和监测。