Department of Psychiatry, La Paz University Hospital, Madrid, Spain.
Universidad Autónoma de Madrid School of Medicine, Madrid, Spain.
Suicide Life Threat Behav. 2019 Dec;49(6):1587-1599. doi: 10.1111/sltb.12542. Epub 2019 Feb 14.
According to randomized trials, contact after a suicide attempt lowers relapse risk. However, effectiveness studies based on real clinical data can provide additional external validity.
We conducted an observational study to determine if an emergency department (ED)-initiated intervention for suicide attempt risk reduction, consisting on scheduling a single added appointment within 7 days after discharge following a suicide attempt, can reduce the risk of relapse. The study included 1,775 patients who had been treated at a general hospital ED due to a suicide attempt. The principal outcome measure was ED return after a new attempt. We obtained Kaplan-Meier survival functions and used Cox proportional hazard regression models to estimate unadjusted and adjusted risks of relapse by treatment phase. Covariates included: age, gender, history of suicide attempts, history of psychiatric disorders, concurrent alcohol/drug abuse, number of attempts during follow-up, admission as an inpatient and family support.
A total of 497 (22.5%) attempts were followed by a relapse. Subjects exposed to the studied intervention had a lower risk of relapse after a suicide attempt, with a 24% adjusted risk reduction estimate.
Our real-world results suggest that an additional early appointment, scheduled before discharging suicide attempters, reduces suicide reattempt risk.
根据随机试验结果，自杀未遂后进行接触可以降低复发风险。然而，基于真实临床数据的有效性研究可以提供额外的外部有效性。
我们进行了一项观察性研究，以确定在自杀未遂后出院的 7 天内安排一次额外预约的急诊（ED）发起的自杀未遂风险降低干预措施是否可以降低复发风险。该研究纳入了在综合医院 ED 因自杀未遂而接受治疗的 1775 名患者。主要结局指标为新尝试后 ED 就诊的复发情况。我们获得了 Kaplan-Meier 生存函数，并使用 Cox 比例风险回归模型来估计治疗阶段未调整和调整后的复发风险。协变量包括：年龄、性别、自杀尝试史、精神障碍史、同期酒精/药物滥用、随访期间的尝试次数、住院和家庭支持。
共有 497（22.5%）次尝试导致复发。接受研究干预的患者自杀尝试后复发的风险较低，调整后的风险降低估计为 24%。
我们的真实世界研究结果表明，在出院前安排的额外早期预约可以降低自杀再次尝试的风险。
