Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
Clinical Psychology Course, Department of Psycho-Social Studies, School of Arts and Letters, Meiji University, Tokyo, Japan.
Psychiatry Clin Neurosci. 2020 Jun;74(6):362-370. doi: 10.1111/pcn.12999. Epub 2020 Apr 7.
Suicide attempters have a high risk of repeated suicide attempts and completed suicide. There is evidence that assertive case management can reduce the incidence of recurrent suicidal behavior among suicide attempters. This study evaluated the effect of an assertive-case-management training program.
This multicenter, before-and-after study was conducted at 10 centers in Japan. Participants were 274 medical personnel. We used Japanese versions of the Attitudes to Suicide Prevention Scale, the Gatekeeper Self-Efficacy Scale, the Suicide Intervention Response Inventory (SIRI), and the Attitudes Toward Suicide Questionnaire. We evaluated the effects with one-sample t-tests, and examined prognosis factors with multivariable analysis.
There were significant improvements between pre-training and post-training in the Attitudes to Suicide Prevention Scale (mean: -3.07, 95% confidence interval [CI]: -3.57 to -2.57, P < 0.001), the Gatekeeper Self-Efficacy Scale (mean: 10.40, 95%CI: 9.48 to 11.32, P < 0.001), SIRI-1 (appropriate responses; mean: 1.15, 95%CI: 0.89 to 1.42, P < 0.001), and SIRI-2 (different to the expert responses; mean: -4.78, 95%CI: -6.18 to -3.38, P < 0.001). Significant improvements were found on all Attitudes Toward Suicide Questionnaire subscale scores, except Unjustified Behavior. The effect of training was influenced by experience of suicide-prevention training and experience of working with suicidal patients.
The training program (which was developed to implement and disseminate evidence-based suicide-prevention measures) improved attitudes, self-efficacy, and skills for suicide prevention among medical personnel. Specialized suicide-prevention training and experience with suicidal patients are valuable for enhancing positive attitudes and self-efficacy; furthermore, age and clinical experience alone are insufficient for these purposes.
自杀未遂者有很高的再次自杀和自杀成功的风险。有证据表明，果断的个案管理可以降低自杀未遂者再次发生自杀行为的发生率。本研究评估了一项果断个案管理培训计划的效果。
这是一项在日本 10 个中心进行的多中心前后对照研究。参与者为 274 名医务人员。我们使用了日本版的自杀预防态度量表、守门员自我效能量表、自杀干预反应量表（SIRI）和自杀态度问卷。我们使用单样本 t 检验评估效果，并使用多变量分析检查预后因素。
在培训前后，自杀预防态度量表（平均：-3.07，95%置信区间[CI]：-3.57 至-2.57，P<0.001）、守门员自我效能量表（平均：10.40，95%CI：9.48 至 11.32，P<0.001）、SIRI-1（适当反应；平均：1.15，95%CI：0.89 至 1.42，P<0.001）和 SIRI-2（不同于专家反应；平均：-4.78，95%CI：-6.18 至-3.38，P<0.001）均有显著改善。除了不合理行为外，自杀态度问卷的所有分量表评分都有显著改善。培训效果受到预防自杀培训经验和与自杀患者合作经验的影响。
该培训计划（旨在实施和传播基于证据的自杀预防措施）提高了医务人员预防自杀的态度、自我效能和技能。专门的自杀预防培训和与自杀患者的合作经验对于增强积极的态度和自我效能是有价值的；此外，年龄和临床经验本身不足以达到这些目的。
