Ogeil Rowan P, Witt Katrina, Scott Deborah, Smith Karen, Lubman Dan I
Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia; Turning Point, Eastern Health, 110 Church St., Richmond, VIC 3121, Australia; Monash Addiction Research Centre, Frankston, VIC 3199, Australia.
Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia; Turning Point, Eastern Health, 110 Church St., Richmond, VIC 3121, Australia; Monash Addiction Research Centre, Frankston, VIC 3199, Australia.
J Affect Disord. 2020 Mar 15;265:364-371. doi: 10.1016/j.jad.2019.11.158. Epub 2019 Dec 2.
Sleep disturbances are among the top-ten warning signs for suicide, however there has been limited investigation of the relationship between these variables in acute presentations, particularly community settings. We examined ambulance attendances for suicide ideation and attempt to explore the role of sleep and co-morbid factors (mental health symptoms, attendance time, and alcohol and benzodiazepine use).
Coded clinical records from Ambulance Victoria for the period 1 January 2012 to 30 June 2017 were analysed.
Paramedics attended 97,198 cases of suicidal ideation or suicide attempt during the study period. Just over half (56.4%) of these were for suicidal ideation, and 43.6% were for attempted suicide. Depression symptomology-related attendances were more common than those for anxiety and despite a lower proportion of both sleep and current anxiety-related symptoms, benzodiazepine use was significantly more common in attendances for suicide attempts (25.9%) than for ideation (2.2%). Co-morbid benzodiazepine use was associated with attempted suicide (OR: 10.37 (10.04-10.72), in a hierarchical regression model.
Data represent self-report/paramedic observation only, and do include validated measures of sleep or drug use. Sleep disturbance is likely under recorded in ambulance attendances given the primary role of paramedics is to stabilise patients, and minimise risk of harm during transport.
This study reports internationally unique data, and provides the first examination of ambulance coded clinical records for suicide ideation and attempt. Sleep disturbances had a unique role in these attendances, over and above common co-occurring factors including drug use and mental health diagnoses.
睡眠障碍是自杀的十大预警信号之一，然而，在急性发作（尤其是社区环境）中，对这些变量之间关系的研究有限。我们调查了因自杀意念和自杀未遂而呼叫救护车的情况，以探讨睡眠及共病因素（心理健康症状、就诊时间、酒精和苯二氮䓬类药物使用情况）的作用。
分析了维多利亚救护车服务中心2012年1月1日至2017年6月30日期间的编码临床记录。
在研究期间，护理人员共处理了97198例自杀意念或自杀未遂病例。其中略超过一半（56.4%）是自杀意念，43.6%是自杀未遂。与抑郁症状相关的就诊比焦虑相关的更常见，尽管睡眠和当前焦虑相关症状的比例较低，但苯二氮䓬类药物在自杀未遂就诊病例中的使用（25.9%）明显比自杀意念就诊病例（2.2%）更常见。在分层回归模型中，共病苯二氮䓬类药物使用与自杀未遂相关（比值比：10.37（10.04 - 10.72））。
数据仅代表自我报告/护理人员观察结果，不包括睡眠或药物使用的有效测量。鉴于护理人员的主要职责是使患者稳定，并在转运过程中尽量降低伤害风险，睡眠障碍在救护车就诊记录中可能记录不足。
本研究报告了国际上独一无二的数据，并首次对救护车编码临床记录中的自杀意念和自杀未遂情况进行了检查。睡眠障碍在这些就诊情况中具有独特作用，超出了包括药物使用和心理健康诊断在内的常见共病因素。
