PolicyLab, Center for Pediatric Clinical Effectiveness, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Pediatrics, University of Pennsylvania, Philadelphia.
JAMA Psychiatry. 2020 Oct 1;77(10):1021-1030. doi: 10.1001/jamapsychiatry.2020.1586.
To prevent suicide deaths, acute care settings need tools to ensure individuals at risk of suicide access mental health care and remain safe until they do so.
To examine the association of brief acute care suicide prevention interventions with patients' subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up.
Ovid MEDLINE, Scopus, CINAHL, PsychINFO, Embase, and references of included studies using concepts of suicide, prevention, and clinical trial to identify relevant articles published January 2000 to May 2019.
Studies describing clinical trials of single-encounter suicide prevention interventions were included. Two reviewers independently reviewed all articles to determine eligibility for study inclusion.
Two reviewers independently abstracted data according to PRISMA guidelines and assessed studies' risk of bias using the Cochrane Risk of Bias tool. Data were pooled for each outcome using random-effects models. Small study effects including publication bias were assessed using Peter and Egger regression tests.
Three primary outcomes were examined: subsequent suicide attempts, linkage to follow-up care, and depression symptoms at follow-up. Suicide attempts and linkage to follow-up care were measured using validated patient self-report measures and medical record review; odds ratios and Hedges g standardized mean differences were pooled to estimate effect sizes. Depression symptoms were measured 2 to 3 months after the encounter using validated self-report measures, and pooled Hedges g standardized mean differences were used to estimate effect sizes.
A total of 14 studies, representing outcomes for 4270 patients, were included. Pooled-effect estimates showed that brief suicide prevention interventions were associated with reduced subsequent suicide attempts (pooled odds ratio, 0.69; 95% CI, 0.53-0.89), increased linkage to follow-up (pooled odds ratio, 3.04; 95% CI, 1.79-5.17) but were not associated with reduced depression symptoms (Hedges g = 0.28 [95% CI, -0.02 to 0.59).
In this meta-analysis, breif suicide prevention interventions were associated with reduced subsequent suicide attempts. Suicide prevention interventions delivered in a single in-person encounter may be effective at reducing subsequent suicide attempts and ensuring that patients engage in follow-up mental health care.
为了防止自杀死亡，急性护理环境需要工具来确保有自杀风险的个人获得心理健康护理，并在获得护理之前保持安全。
研究短期急性护理预防自杀干预措施与患者随后的自杀企图、与后续护理的联系以及后续随访时的抑郁症状之间的关联。
Ovid MEDLINE、Scopus、CINAHL、PsychINFO、Embase，并使用自杀、预防和临床试验的概念检索纳入研究的参考文献，以确定 2000 年 1 月至 2019 年 5 月发表的相关文章。
纳入描述单次预防自杀干预的临床试验的研究。两名审查员独立审查所有文章，以确定研究纳入的资格。
两名审查员根据 PRISMA 指南独立提取数据，并使用 Cochrane 风险偏倚工具评估研究的风险偏倚。使用随机效应模型对每个结果进行汇总。使用 Peter 和 Egger 回归检验评估小样本研究效果，包括发表偏倚。
研究考察了三个主要结果：随后的自杀企图、与后续护理的联系以及后续随访时的抑郁症状。使用经过验证的患者自我报告测量和医疗记录审查来测量自杀企图和与后续护理的联系；使用汇总的优势比和 Hedges g 标准化均数差来估计效应大小。使用经过验证的自我报告测量在接触后 2 至 3 个月测量抑郁症状，并使用汇总的 Hedges g 标准化均数差来估计效应大小。
共纳入 14 项研究，涉及 4270 名患者的结局。汇总效应估计表明，短期预防自杀干预措施与降低随后的自杀企图相关（汇总优势比，0.69；95%置信区间，0.53-0.89），与增加与后续护理的联系相关（汇总优势比，3.04；95%置信区间，1.79-5.17），但与降低抑郁症状无关（Hedges g=0.28[95%置信区间，-0.02 至 0.59]）。
在这项荟萃分析中，简短的自杀预防干预措施与降低随后的自杀企图有关。在单次面对面的交流中提供的自杀预防干预措施可能在降低随后的自杀企图和确保患者接受后续心理健康护理方面是有效的。
