预测儿科急诊患者 3 个月内自杀未遂的风险。
Predicting 3-month risk for adolescent suicide attempts among pediatric emergency department patients.
机构信息
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.
出版信息
J Child Psychol Psychiatry. 2019 Oct;60(10):1055-1064. doi: 10.1111/jcpp.13087. Epub 2019 Jul 21.
BACKGROUND
The incidence of adolescent suicide is rising in the United States, yet we have limited information regarding short-term prediction of suicide attempts. Our aim was to identify predictors of suicide attempts within 3-months of an emergency department (ED) visit.
METHODS
Adolescents, ages 12-17, seeking health care at 13 pediatric EDs (Pediatric Emergency Care Applied Research Network) and one Indian Health Service Hospital in the United States were consecutively recruited. Among 10,664 approached patients, 6,448 (60%) were enrolled and completed a suicide risk survey. A subset of participants (n = 2,897) was assigned to a 3-month telephone follow-up, and 2,104 participants completed this follow-up (73% retention). Our primary outcome was a suicide attempt between the ED visit and 3-month follow-up.
RESULTS
One hundred four adolescents (4.9%) made a suicide attempt between enrollment and 3-month follow-up. A large number of baseline predictors of suicide attempt were identified in bivariate analyses. The final multivariable model for the full sample included the presence of suicidal ideation during the past week, lifetime severity of suicidal ideation, lifetime history of suicidal behavior, and school connectedness. For the subgroup of adolescents who did not report recent suicidal ideation at baseline, the final model included only lifetime severity of suicidal ideation and social connectedness. Among males, the final model included only lifetime severity of suicidal ideation and past week suicidal ideation. For females, the final model included past week suicidal ideation, lifetime severity of suicidal ideation, number of past-year nonsuicidal self-injury (NSSI) incidents, and social connectedness.
CONCLUSIONS
Results indicate that the key risk factors for adolescent suicide attempts differ for subgroups of adolescents defined by sex and whether or not they report recent suicidal thoughts. Results also point to the importance of school and social connectedness as protective factors against suicide attempts.
背景
美国青少年自杀的发生率正在上升，但我们对自杀企图的短期预测知之甚少。我们的目的是确定在急诊就诊后 3 个月内自杀企图的预测因素。
方法
在美国 13 家儿科急诊室（儿科急诊护理应用研究网络）和一家印度卫生服务医院，连续招募年龄在 12-17 岁、寻求医疗保健的青少年。在 10664 名被接触的患者中，有 6448 名（60%）被纳入并完成了自杀风险调查。参与者的一个子集（n=2897）被分配到 3 个月的电话随访，2104 名参与者完成了此随访（73%的保留率）。我们的主要结局是在急诊就诊和 3 个月随访之间发生自杀企图。
结果
在登记和 3 个月随访之间，有 104 名青少年（4.9%）自杀。在单变量分析中发现了大量自杀企图的基线预测因素。全样本的最终多变量模型包括过去一周内存在自杀意念、一生中自杀意念的严重程度、一生中自杀行为的历史以及与学校的联系。对于基线时未报告近期自杀意念的青少年亚组，最终模型仅包括一生中自杀意念的严重程度和社会联系。对于男性，最终模型仅包括一生中自杀意念的严重程度和过去一周的自杀意念。对于女性，最终模型包括过去一周的自杀意念、一生中自杀意念的严重程度、过去一年非自杀性自伤（NSSI）事件的次数以及社会联系。
结论
结果表明，青少年自杀企图的关键风险因素因性别和是否报告近期自杀念头的青少年亚组而异。结果还表明，学校和社会联系作为预防自杀企图的保护因素的重要性。
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