参与基于网络的自杀意念治疗试验的个体的服务使用史：基线数据分析

Service Use History of Individuals Enrolling in a Web-Based Suicidal Ideation Treatment Trial: Analysis of Baseline Data.

作者信息

Wong Quincy Jj, Werner-Seidler Aliza, Torok Michelle, van Spijker Bregje, Calear Alison L, Christensen Helen

机构信息

Black Dog Institute, University of New South Wales, Sydney, Australia.

School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia.

出版信息

JMIR Ment Health. 2019 Apr 2;6(4):e11521. doi: 10.2196/11521.

DOI:10.2196/11521

PMID:30938686

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6465979/

Abstract

BACKGROUND

A significant recent innovation is the development of internet-based psychological treatments for suicidal thinking. However, we know very little about individuals experiencing suicidal ideation who seek help through Web-based services and, in particular, their previous health service use patterns.

OBJECTIVE

We aimed to examine service use history and its correlates among adults experiencing suicidal ideation who enrolled in a Web-based suicidal ideation treatment trial.

METHODS

We used baseline data of 418 individuals seeking Web-based treatment for their suicidal ideation recruited into a randomized controlled trial of a 6-week Web-based self-help program. Participants at preintervention reported demographic information, clinical characteristics, and health service use over the previous 6 months.

RESULTS

Participants had a high rate of service use in the 6 months before enrolling in the treatment trial (404/418, 96.7% of participants had contact with services). The two most common contact points were general practitioners (385/418, 92.1% of participants) and mental health professionals (295/418, 70.6% of participants). Notably, those with a previous single suicide attempt had lower odds of contact with any service than those with no attempt (odds ratio [OR] 0.21, 95% CI 0.05-0.86; P=.03). Those living in rural or remote areas had lower odds of contacting general practitioners (OR 0.35, 95% CI 0.13-0.91; P=.03) or mental health professionals (OR 0.44, 95% CI 0.23-0.83; P=.01) than those living in metropolitan areas.

CONCLUSIONS

Individuals enrolling in an electronic health intervention trial have often received treatment from general practitioners or mental health professionals. These services can therefore play an important role in preventing the escalation of suicidal thinking. Enrollment in our Web-based treatment trial suggested, though, that face-to-face health services may not be enough. Our study also highlighted the need to improve the provision of coordinated and assertive care after a suicide attempt, as well as health service availability and utilization for those living in rural and remote areas.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12613000410752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364016 (Archived by WebCite at http://www.webcitation.org/6vK5FvQXy); Universal Trial Number U1111-1141-6595.

摘要

背景

近期一项重大创新是针对自杀念头开发基于互联网的心理治疗方法。然而，对于通过网络服务寻求帮助的有自杀意念的个体，尤其是他们之前的医疗服务使用模式，我们了解甚少。

目的

我们旨在研究参与一项基于网络的自杀意念治疗试验的有自杀意念的成年人的服务使用历史及其相关因素。

方法

我们使用了418名因自杀意念寻求网络治疗的个体的基线数据，这些个体被纳入一项为期6周的基于网络的自助项目的随机对照试验。干预前的参与者报告了人口统计学信息、临床特征以及过去6个月的医疗服务使用情况。

结果

在参与治疗试验前的6个月里，参与者的服务使用率很高（404/418，96.7%的参与者与服务机构有接触）。两个最常见的接触点是全科医生（385/418，92.1%的参与者）和心理健康专业人员（295/418，70.6%的参与者）。值得注意的是，之前有过单次自杀未遂的人比没有自杀未遂的人接触任何服务的几率更低（优势比[OR]0.21，95%置信区间0.05 - 0.86；P = 0.03）。与居住在大城市地区的人相比，居住在农村或偏远地区的人接触全科医生（OR 0.35，95%置信区间0.13 - 0.91；P = 0.03）或心理健康专业人员（OR 0.44，95%置信区间0.23 - 0.83；P = 0.01）的几率更低。

结论

参与电子健康干预试验的个体通常接受过全科医生或心理健康专业人员的治疗。因此，这些服务在预防自杀念头升级方面可以发挥重要作用。不过，参与我们基于网络的治疗试验表明，面对面的医疗服务可能还不够。我们的研究还强调了在自杀未遂后改善提供协调和积极护理的必要性，以及提高农村和偏远地区居民的医疗服务可及性和利用率。