Jerant Anthony, Duberstein Paul, Kravitz Richard L, Stone Deborah M, Cipri Camille, Franks Peter
Department of Family and Community Medicine, University of California Davis (UCD) School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA, 95817, USA.
Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
J Gen Intern Med. 2020 Jul;35(7):2050-2058. doi: 10.1007/s11606-020-05769-3. Epub 2020 Mar 17.
Middle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controlled trial, we examined the effect of a tailored interactive computer program designed to encourage middle-aged men's discussion of suicide with PCCs.
We recruited men 35-74 years old reporting recent (within 4 weeks) active suicide thoughts from the panels of 42 PCCs (the unit of randomization) in eight offices within a single California health system. In the office before a visit, men viewed the intervention corresponding to their PCC's random group assignment: Men and Providers Preventing Suicide (MAPS) (20 PCCs), providing tailored multimedia promoting discussion of suicide thoughts, or control (22 PCCs), composed of a sleep hygiene video plus brief non-tailored text encouraging discussion of suicide thoughts. Logistic regressions, adjusting for patient nesting within physicians, examined MAPS' effect on patient-reported suicide discussion in the subsequent office visit.
Sixteen of the randomized PCCs had no patients enroll in the trial. From the panels of the remaining 26 PCCs (12 MAPS, 14 control), 48 men (MAPS 21, control 27) were enrolled (a mean of 1.8 (range 1-5) per PCC), with a mean age of 55.9 years (SD 11.4). Suicide discussion was more likely among MAPS patients (15/21 [65%]) than controls (8/27 [35%]). Logistic regression showed men viewing MAPS were more likely than controls to discuss suicide with their PCC (OR 5.91, 95% CI 1.59-21.94; P = 0.008; nesting-adjusted predicted effect 71% vs. 30%).
In addressing barriers to discussing suicide, the tailored MAPS program activated middle-aged men with active suicide thoughts to engage with PCCs around this customarily taboo topic.
中年男性自杀风险较高。虽然约有一半自杀者在死前不久会去看初级保健医生（PCC），但在当前的临床实践中，很少有人在就诊时主动透露自杀想法，而且PCC很少询问此类想法。在一项随机对照试验中，我们研究了一个量身定制的交互式计算机程序的效果，该程序旨在鼓励中年男性与PCC讨论自杀问题。
我们从加利福尼亚州一个卫生系统内八个办公室的42个PCC（随机分组单位）的患者名单中招募了35 - 74岁且报告近期（4周内）有主动自杀想法的男性。在就诊前的办公室里，男性观看与其PCC随机分组对应的干预措施：男性与提供者预防自杀（MAPS）（20个PCC），提供量身定制的多媒体资料以促进对自杀想法的讨论；或对照组（22个PCC），由睡眠卫生视频加简短的非量身定制文本组成，鼓励讨论自杀想法。在对医生内部的患者嵌套情况进行调整后，通过逻辑回归分析研究MAPS对患者报告的后续就诊时自杀讨论情况的影响。
随机分组的PCC中有16个没有患者参与试验。在其余26个PCC（12个MAPS组，14个对照组）的患者名单中，有48名男性（MAPS组21名，对照组27名）被纳入研究（每个PCC平均1.8名（范围1 - 5名）），平均年龄为55.9岁（标准差11.4）。MAPS组患者中进行自杀讨论的可能性（15/21 [65%]）高于对照组（8/27 [35%]）。逻辑回归显示，观看MAPS的男性比对照组更有可能与他们的PCC讨论自杀问题（比值比5.91，95%置信区间1.59 - 21.94；P = 0.008；经嵌套调整后的预测效果为71%对30%）。
在解决自杀讨论障碍方面，量身定制的MAPS项目促使有主动自杀想法的中年男性围绕这个通常禁忌的话题与PCC进行交流。
