Veterans Health Administration, Washington, DC, and Texas A&M University, Corpus Christi, Texas (J.S.).
Rocky Mountain Mental Illness Research Education and Clinical Center, Denver, Colorado, and University of Colorado, Aurora, Colorado (L.B.).
Ann Intern Med. 2019 Sep 3;171(5):343-353. doi: 10.7326/M19-0687. Epub 2019 Aug 27.
In May 2019, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved an update to the 2013 joint clinical practice guideline for assessing and managing patients who are at risk for suicide. This guideline provides health care providers with a framework by which to screen for, evaluate, treat, and manage the individual needs and preferences of VA and DoD patients who may be at risk for suicide.
In January 2018, the VA/DoD Evidence-Based Practice Work Group convened to develop a joint VA/DoD guideline including clinical stakeholders and conforming to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel drafted key questions, systematically searched and evaluated the literature through April 2018, created algorithms, and advanced 22 recommendations in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.
This synopsis, which includes 3 clinical practice algorithms, summarizes the key recommendations of the guideline related to screening and evaluation, risk management and treatment, and other management methods. Risk management and treatment recommendations address both pharmacologic and nonpharmacologic approaches for patients with suicidal ideation and behavior. Other management methods address lethal means safety (such as restricting access to firearms, poisons, and medications and installing barriers to prevent jumping from lethal heights) and population health strategies.
2019 年 5 月，美国退伍军人事务部（VA）和美国国防部（DoD）批准更新 2013 年联合临床实践指南，用于评估和管理有自杀风险的患者。该指南为医疗保健提供者提供了一个框架，通过该框架对 VA 和 DoD 可能有自杀风险的患者进行筛查、评估、治疗和管理个人需求和偏好。
2018 年 1 月，VA/DoD 循证实践工作组召开会议，制定联合 VA/DoD 指南，包括临床利益相关者，并符合国家医学科学院值得信赖的临床实践指南原则。指南小组起草了关键问题，系统地搜索和评估了 2018 年 4 月之前的文献，创建了算法，并根据 GRADE（推荐评估、制定和评估分级）系统提出了 22 项建议。
本概要包括 3 个临床实践算法，总结了指南中与筛查和评估、风险管理和治疗以及其他管理方法相关的关键建议。风险管理和治疗建议包括有自杀意念和行为的患者的药物和非药物方法。其他管理方法包括致命手段安全（例如限制获得枪支、毒药和药物以及安装障碍物以防止从致命高度跳下）和人口健康策略。
