Lachal J, Grandclerc S, Spodenkiewicz M, Moro M R
Maison de Solenn, Cochin Hospital, AP-HP, 97, boulevard de Port-Royal, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 100-104, avenue de France, 75013 Paris, France; CESP, faculté de médecine, université Paris-Sud, faculté de médecine, UVSQ, Inserm, université Paris-Saclay, 94805 Villejuif, France.
Maison de Solenn, Cochin Hospital, AP-HP, 97, boulevard de Port-Royal, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 100-104, avenue de France, 75013 Paris, France; CESP, faculté de médecine, université Paris-Sud, faculté de médecine, UVSQ, Inserm, université Paris-Saclay, 94805 Villejuif, France.
Encephale. 2018 Nov;44(5):465-470. doi: 10.1016/j.encep.2018.01.004. Epub 2018 Mar 24.
Suicidal adolescents admitted in an Emergency Department (ED) present a high risk of suicidal reattempts. Poor observance of follow-up in this particular group imped the efficacity of the treatment. We propose to summarize the international literature on ED interventions promoting suicidal adolescents' adherence to care.
We carried out a comprehensive review of papers listed in PubMed, PsycInfo, and CINHAL databases using keywords about adolescence, suicide, and ED. We also manually consulted the main journals specialized in suicidology (Crisis and Suicide and Life-Threatening Behavior) and adolescence (Journal of the American Academy of Child and Adolescent Psychiatry, Journal of Adolescent Health, Neuropsychiatrie de l'Enfance et de l'Adolescence). We selected the relevant articles describing or evaluating one or more interventions initiated in the ED and designed to promote adolescent adherence to post-emergency care. The results are presented in a narrative review form.
Interventions are organized in three groups: interventions that take place solely at the ED (problem-solving interventions and educational interventions directed to families) and interventions that take place during and after emergency care (we included in this group the ED-Care program, the FISP program, and the SAFETY program), to which should be added interventions that take place prior to care, in particular specific trainings for medical and paramedical teams. Small samples and barriers in measuring adherence to care make statistical comparisons difficult, yet the interventions that seem most effective are those that target the time both during and after ED discharge, those which are implemented most rapidly after discharge, those which actively include parents, and those which involve an implication of the families about barriers to follow-up.
Our results show an effectiveness of complete programs on short-term compliance but no conclusion can be drawn on long-term effects. Most comprehensive care programs are based on the principle of adolescent compliance, which remains problematic. Until today, no ideal protocol exists to improve short-term as well as long-term compliance to care among adolescents after a suicide attempt. We have to improve our understanding of facilitators and barriers to follow-up using quantitative as well as qualitative research studies. Although it is well established that parents' involvement in the early stages of care is essential, little is known about the underlying processes. In these situations, qualitative studies could help to better target interventions that lead more particularly to follow up compliance in adolescence.
在急诊科（ED）就诊的自杀未遂青少年再次自杀的风险很高。该特定群体对后续治疗的依从性较差，这会影响治疗效果。我们建议总结国际上有关急诊科干预措施促进自杀未遂青少年坚持治疗的文献。
我们使用有关青少年、自杀和急诊科的关键词，对PubMed、PsycInfo和CINHAL数据库中列出的论文进行了全面综述。我们还手动查阅了专门研究自杀学（《危机与自杀及危及生命行为》）和青少年（《美国儿童与青少年精神病学会杂志》《青少年健康杂志》《儿童与青少年神经精神病学》）的主要期刊。我们选择了相关文章，这些文章描述或评估了在急诊科发起的一项或多项旨在促进青少年坚持急诊后护理的干预措施。结果以叙述性综述的形式呈现。
干预措施分为三组：仅在急诊科进行的干预措施（解决问题的干预措施和针对家庭的教育干预措施）以及在急诊护理期间和之后进行的干预措施（我们将ED-Care项目、FISP项目和SAFETY项目归入该组），此外还应加上在护理前进行的干预措施，特别是针对医疗和辅助医疗团队的特定培训。样本量小以及衡量护理依从性存在障碍，使得统计比较困难，但似乎最有效的干预措施是那些针对急诊科出院期间和之后的时间、出院后实施最快、积极纳入父母以及涉及家庭对后续治疗障碍的干预措施。
我们的结果表明完整的项目在短期依从性方面是有效的，但无法得出关于长期效果的结论。大多数综合护理项目基于青少年依从性的原则，这仍然存在问题。到目前为止，还没有理想的方案来提高自杀未遂青少年在短期和长期对护理的依从性。我们必须通过定量和定性研究来加深对促进后续治疗和阻碍因素的理解。虽然父母在护理早期的参与至关重要这一点已得到充分证实，但对其潜在过程了解甚少。在这些情况下，定性研究有助于更好地确定能更特别地提高青少年后续治疗依从性的干预措施。
