Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Ludman, Pabiniak, Kirlin, Simon); Department of Health Services, University of Washington, Seattle (Richards); Nowmattersnow.org , Seattle (Whiteside, Hidalgo); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Whiteside); School of Law, University of California, Berkeley (Hidalgo).
Psychiatr Serv. 2019 Jan 1;70(1):40-45. doi: 10.1176/appi.ps.201800342. Epub 2018 Nov 20.
The authors sought to understand why patients may not report suicidal ideation at a health care visit prior to a suicide attempt.
Electronic health record data from Kaiser Permanente Washington were used to identify patients who reported having no suicidal ideation on question 9 of the nine-item Patient Health Questionnaire and who subsequently made a suicide attempt (≤60 days). Semistructured interviews were audio-recorded, transcribed, and analyzed by using a combination of directed (deductive) and conventional (inductive) content analysis to validate and further explore reasons why patients may not report suicidal ideation prior to a suicide attempt.
Of 42 adults sampled, 26 agreed to be interviewed, of whom about half were women (N=15) and a majority was white (N=20), with ages ranging from 18 to 63. Key themes were that patients who attempted suicide after having reported no thoughts of self-harm were either not experiencing suicidal ideation at the time of screening or feared the outcome of disclosure, including stigma, overreaction, and loss of autonomy. An additional theme that emerged from the interviews included reports of heavy episodic drinking at the time of the suicide attempt, particularly when suicide was completely unplanned. Patients also identified important aspects of interactions with health care system providers that may facilitate disclosure about suicidal ideation.
Nonjudgmental listening and expressions of caring without overreaction among providers may help patients overcome fear of reporting suicidal ideation. Screening for heavy episodic drinking may help identify individuals who make unplanned suicide attempts.
作者试图了解为什么患者在自杀未遂前的就诊中未报告自杀意念。
使用 Kaiser Permanente Washington 的电子健康记录数据，识别在九项患者健康问卷的第 9 项中报告没有自杀意念，随后在 60 天内自杀的患者。对 42 名成年患者进行抽样，对其中 26 名同意接受采访的患者进行半结构化访谈，访谈内容进行录音、转录，并使用定向（演绎）和常规（归纳）内容分析相结合的方法进行分析，以验证和进一步探讨为什么患者在自杀未遂前可能没有报告自杀意念。
在抽样的 42 名成年人中，有 26 名同意接受采访，其中约一半是女性（N=15），大多数是白人（N=20），年龄在 18 至 63 岁之间。主要主题是，在报告没有自我伤害念头后试图自杀的患者，要么在筛查时没有自杀意念，要么担心披露的后果，包括耻辱感、过度反应和丧失自主权。从访谈中还出现了另一个主题，即在自杀时报告大量饮酒，尤其是当自杀完全没有计划时。患者还确定了与医疗保健系统提供者互动的重要方面，这些方面可能有助于披露自杀意念。
提供者保持非评判性倾听和表达关怀而不过度反应，可能有助于患者克服报告自杀意念的恐惧。筛查大量饮酒可能有助于识别那些做出无计划自杀尝试的个体。
