影响接受物质使用治疗的患者自杀意念、自杀企图和自杀死亡的诱发因素和保护因素：系统评价和荟萃分析方案。
Predisposing and protective factors influencing suicide ideation, attempt, and death in patients accessing substance use treatment: a systematic review and meta-analysis protocol.
机构信息
Addiction Program, Centre for Addiction and Mental Health, Nicotine Dependence Clinic, (CAMH), 175 College street, Toronto, ON, M5T 1P7, Canada.
Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Canada.
出版信息
Syst Rev. 2019 May 15;8(1):115. doi: 10.1186/s13643-019-1028-2.
BACKGROUND
The lifetime risk of suicide in patients with substance use disorder is five to ten times the risk in the general population. Critically, up to 19% of patients continue to think about and attempt suicide even after accessing treatment. Therefore, suicidality represents a significant clinical concern in patients struggling with substance use that warrants careful investigation of the factors involved. While most previous research has relied on limited cross-sectional designs, a growing number of prospective studies are improving our understanding of the factors involved. However, a systematic study of these factors has not yet been conducted.
METHODS
The primary objective of this review and possible meta-analysis will be to identify key risk and protective factors for suicide ideation, attempt, and death in patients accessing substance use treatment, guided by current models of suicide. Secondary and tertiary objectives will be to obtain pooled effect sizes for the factors identified and to disaggregate factors for suicidality before and after treatment, and for suicidal thought versus action. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we will conduct an electronic search of the literature using the databases Embase, Medline, PsycINFO, and Web of Science. Two authors will independently screen studies based on pre-specified inclusion and exclusion criteria, extract relevant data, and assess study quality. Observational and randomized-controlled studies will be included, whereas case-studies and reviews will be excluded. We will extract data on risk and protective factors associated with suicide ideation, attempt (odds or risk ratios), and death (hazard ratio). Given sufficient data (> 5 studies), we will calculate pooled effects using comprehensive meta-analysis.
DISCUSSION
This systematic review will contribute to our knowledge of risk and protective factors for suicidality in patients before and after treatment. Understanding these factors will help define areas of research for further investigation to ultimately inform risk assessment and prevention strategies.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (reference number: CRD42018076260).
背景
物质使用障碍患者的终生自杀风险是普通人群的五到十倍。至关重要的是，即使在接受治疗后，多达 19%的患者仍在思考和尝试自杀。因此，自杀意念是物质使用障碍患者的一个重大临床关注点，需要仔细调查相关因素。尽管大多数先前的研究依赖于有限的横断面设计，但越来越多的前瞻性研究正在提高我们对相关因素的理解。然而，这些因素还没有进行系统的研究。
方法
本综述和可能的荟萃分析的主要目的将是根据当前的自杀模型，确定接受物质使用治疗的患者自杀意念、尝试和死亡的关键风险和保护因素。次要和三级目标将是确定已识别因素的汇总效应大小，并在治疗前后以及自杀意念与自杀行为之间对自杀因素进行细分。根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，我们将使用 Embase、Medline、PsycINFO 和 Web of Science 数据库进行文献电子检索。两名作者将根据预先规定的纳入和排除标准独立筛选研究，提取相关数据，并评估研究质量。将纳入观察性和随机对照研究，而排除病例研究和综述。我们将提取与自杀意念、尝试（比值比或风险比）和死亡（风险比）相关的风险和保护因素的数据。如果有足够的数据 (> 5 项研究)，我们将使用综合荟萃分析计算汇总效应。
讨论
本系统综述将有助于我们了解治疗前后患者自杀意念的风险和保护因素。了解这些因素将有助于确定进一步研究的领域，最终为风险评估和预防策略提供信息。
系统综述注册
PROSPERO（参考编号：CRD42018076260）。
Zotero 插件