National Center for Veterans Studies, 260 S. Central Campus Dr., Suite 3525, Salt Lake City, UT 84112, United States of America; The University of Utah, 380 S 1530 E, Room 502, Salt Lake City, UT 84112, United States of America.
University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 330, MS F550, Aurora, CO 80045, United States of America.
Contemp Clin Trials. 2019 Sep;84:105823. doi: 10.1016/j.cct.2019.105823. Epub 2019 Aug 7.
Primary care is the most frequently visited clinic type immediately prior to suicidal behavior, with nearly half of suicide decedents visiting a primary care provider within a month of their death. Data supporting the efficacy of suicide risk screening in this setting is lacking, however. Improved suicide risk screening in primary care could lead to earlier intervention and treatment.
The PRImary care Screening Methods (PRISM) study is designed to develop and evaluate the efficacy of an alert algorithm that can be used by military primary care providers to accurately identify high-risk patients, to improve the identification of high-risk patients who deny suicidal thoughts, and to quantify patient subgroups who are more likely to be missed by existing screening methods (i.e., false negatives).
The rationale of the PRISM study is discussed, along with ethical and design considerations related to the conduct of suicide prevention research. The PRISM study enrolled 2690 patients from six primary care clinics across the U.S. Patients were enrolled during routine visits to a primary care clinic, and completed a battery of self-report scales in clinic waiting rooms. Follow-up phone interviews are conducted 1, 6, and 12 months after enrollment. The primary outcome is suicide attempt.
PRISM is the first study to prospectively examine multiple suicide risk screening methods in "real-world" military primary care clinics. Ethical and design issues were considered to ensure that human participants, especially suicidal patients, were adequately protected while minimizing the potential confounding effect of risk management protocols.
初级保健是自杀行为发生前最常就诊的诊所类型，近一半的自杀死亡者在去世前一个月内曾就诊于初级保健提供者。然而，目前缺乏该环境下自杀风险筛查有效性的数据。改善初级保健中的自杀风险筛查可能会导致更早的干预和治疗。
PRImary care Screening Methods（PRISM）研究旨在开发和评估一种警报算法的功效，该算法可由军事初级保健提供者用于准确识别高风险患者，改善对否认自杀念头的高风险患者的识别，并量化可能被现有筛查方法（即假阴性）遗漏的患者亚组。
讨论了 PRISM 研究的基本原理，以及与开展预防自杀研究相关的伦理和设计考虑。PRISM 研究从美国六家初级保健诊所招募了 2690 名患者。患者在常规初级保健诊所就诊期间入组，并在诊所等候室完成一系列自我报告量表。入组后 1、6 和 12 个月进行随访电话访谈。主要结局是自杀未遂。
PRISM 是第一项前瞻性研究“真实世界”中军事初级保健诊所中多种自杀风险筛查方法的研究。考虑了伦理和设计问题，以确保在将风险管理协议的潜在混杂影响最小化的同时，充分保护人类参与者，尤其是自杀患者。
