The authors are with the National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Oslo, Norway.
Psychiatr Serv. 2018 Jul 1;69(7):751-759. doi: 10.1176/appi.ps.201700475. Epub 2018 Apr 16.
Access to mental health care is regarded as a central suicide prevention strategy. This is the first systematic review and meta-analysis of the prevalence of contact with mental health services preceding suicide.
A systematic search for articles reporting prevalence of contact with mental health services before suicide was conducted in MEDLINE and PsycINFO, restricted to studies published from January 1, 2000, to January 12, 2017. A random-effects meta-analysis with double arcsine transformations was conducted, with meta-regression used to explore heterogeneity.
Thirty-five studies were included in the systematic review, and 20 were included in the meta-analysis. Among suicide decedents in the population, 3.7% (95% confidence interval [CI]=2.6%-4.8%) were inpatients at the time of death. In the year before death, 18.3% (CI=14.6%-22.4%) of suicide decedents had contact with inpatient mental health services, 26.1% (CI=16.5%-37.0%) had contact with outpatient mental health services, and 25.7% (CI=22.7%-28.9%) had contact with inpatient or outpatient mental health services. Meta-regression showed that women had significantly higher levels of contact compared with men and that the prevalence of contact with inpatient or outpatient services increased according to the sample year.
Contact with services prior to suicide was found to be common and contact with inpatient or outpatient mental health services before suicide seems to be increasing. However, the reviewed studies were mainly conducted in Western European and North American countries, and most studies focused on psychiatric hospitalization, which resulted in limited data on contact with outpatient services. Better monitoring and data on suicides that occur during and after treatment seem warranted.
获得精神卫生保健被视为预防自杀的一项核心策略。这是第一项关于自杀前接触精神卫生服务的流行率的系统综述和荟萃分析。
对 MEDLINE 和 PsycINFO 中关于自杀前接触精神卫生服务的流行率的文章进行了系统检索，检索时间限制为 2000 年 1 月 1 日至 2017 年 1 月 12 日。采用双反正弦变换的随机效应荟萃分析，采用荟萃回归探索异质性。
系统综述纳入了 35 项研究，荟萃分析纳入了 20 项研究。在人群中的自杀死者中，3.7%（95%置信区间[CI]=2.6%-4.8%）在死亡时为住院患者。在死亡前一年，18.3%（CI=14.6%-22.4%）的自杀死者曾接触过住院精神卫生服务，26.1%（CI=16.5%-37.0%）曾接触过门诊精神卫生服务，25.7%（CI=22.7%-28.9%）曾接触过住院或门诊精神卫生服务。荟萃回归显示，女性接触的比例明显高于男性，且接触住院或门诊精神卫生服务的比例随着样本年份的增加而增加。
自杀前接触服务的情况较为常见，自杀前接触住院或门诊精神卫生服务的情况似乎在增加。然而，所审查的研究主要在西欧和北美国家进行，并且大多数研究都集中在精神科住院治疗上，这导致有关门诊服务接触的数据有限。似乎有必要更好地监测和报告治疗期间和之后发生的自杀事件。
