Tanimoto S, Yayama S, Suto S, Matoba K, Kajiwara T, Inoue M, Endo Y, Yamakawa M, Makimoto K
Department of Nursing, Ishikawa Prefectural Nursing University, Ishikawa, Japan.
Department of Nursing, Kyoto Gakuen University, Kyoto, Japan.
East Asian Arch Psychiatry. 2018 Mar;28(1):23-27.
Self-harm and attempted suicide are risk factors for suicide in psychiatric hospital in-patients. This study aimed to analyse the circumstances of self-harm and suicide attempts in a Japanese psychiatric hospital so as to improve management and care.
Incident reports of self-harm and suicide attempts during a 12.4-year period from November 2000 to March 2013 were reviewed. A descriptive analysis was conducted in terms of age, sex, and diagnosis of patients, as well as level, ward, situations, and causes of incidents.
During the study period, 90 cases of self-harm and attempted suicide involving 58 patients were reported. The rate of self-harm and suicide attempts was 0.05 per 1000 patient-days. The types of selfharm and suicide attempts included hanging (n = 25), wrist cutting (n = 19), ingestion of foreign objects (n = 17), and others (n = 29). The single case of completed suicide involved hanging, in a patient with schizophrenia. Among 55 patients with relevant data, the most common clinical diagnosis was mood disorder (41.8%), followed by schizophrenia (36.4%). Mood disorder was 3.5 times as prevalent in females as in males (14 vs. 4). Fourteen patients with mood disorder (n = 8) or schizophrenia (n = 6) were repeatedly involved in 46 of 89 cases of self-harm or attempted suicide; 11 were female. One woman with mood disorder attempted suicide 9 times within the same year. The top 3 management and care factors related to self-harm and suicide attempts were failure to adhere to preventive procedures (28%), insufficient therapeutic communication (28%), and difficulty in predicting suicide (20%).
Self-harm and suicide attempts at this psychiatric hospital occurred at a rate of 0.05 per 1000 patient-days between late 2000 and early 2013. Efforts are needed to increase compliance with suicide prevention procedures and therapeutic communication, so as to improve management and care of psychiatric in-patients and prevent them from committing suicide.
自残及自杀未遂是精神病院住院患者自杀的危险因素。本研究旨在分析一家日本精神病院自残及自杀未遂的情况，以改善管理和护理。
回顾了2000年11月至2013年3月这12.4年期间自残及自杀未遂的事件报告。从患者的年龄、性别、诊断以及事件的程度、病房、情况和原因等方面进行了描述性分析。
在研究期间，报告了涉及58名患者的90起自残及自杀未遂事件。自残及自杀未遂率为每1000患者日0.05起。自残及自杀未遂的类型包括上吊（n = 25）、割腕（n = 19）、吞食异物（n = 17）以及其他（n = 29）。唯一一例自杀死亡事件为一名精神分裂症患者上吊自杀。在55名有相关数据的患者中，最常见的临床诊断是心境障碍（41.8%），其次是精神分裂症（36.4%）。心境障碍在女性中的患病率是男性的3.5倍（14例对4例）。14名患有心境障碍（n = 8）或精神分裂症（n = 6）的患者反复参与了89起自残或自杀未遂事件中的46起；其中11名是女性。一名患有心境障碍的女性在同一年内自杀未遂9次。与自残及自杀未遂相关的前三大管理和护理因素是未遵守预防程序（28%）、治疗性沟通不足（28%）以及难以预测自杀（20%）。
2000年末至2013年初，这家精神病院的自残及自杀未遂发生率为每1000患者日0.05起。需要努力提高对自杀预防程序和治疗性沟通的依从性，以改善精神病住院患者的管理和护理，防止他们自杀。
