Department of Emergency Medicine, Seoul National University Hospital, South Korea.
Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea.
Am J Emerg Med. 2020 Sep;38(9):1743-1747. doi: 10.1016/j.ajem.2020.05.030. Epub 2020 May 16.
The emergency department (ED) is one of the first gateways when suicide attempt patients seek health care services. The purpose of this study was to analyze the hypothesis that people who received emergency psychiatric services in previous suicide attempts will have a lower mortality rate in current ED visits owing to subsequent suicide attempts.
This retrospective study included patients who visited six EDs, and participated in the injury surveillance and in-depth suicide surveillance for 10 years, from January 2008 to December 2017. The study subjects were adult patients 18 years or older who visited EDs due to suicide attempts. The main explanatory variable is whether psychiatric treatment was provided in previous suicide attempts. The main outcome variable was suicide related mortality.
The study included 2144 suicide attempt patients with a previous history of suicide attempts. Among these, 1335 patients (62.2%) had received psychiatric treatment in previous suicide attempts. Mortality was significantly different between the psychiatric consultation group (n = 33, 2.5%) and non-consultation group (n = 47, 5.8%) (P < 0.01). In multivariate logistic regression analysis, previous psychiatric consultation showed a significant association with low mortality (adjusted OR 0.41; 95% CI [0.23-0.72]) and selecting non-fatal suicide methods (adjusted OR 0.47; 95% CI [0.36-0.61]).
Patients who received psychiatric consultation in previous suicide attempts had a lower suicide-related mortality in current ED visits as compared to patients who did not, and this may have been related to choosing non-fatal suicide methods.
急诊科是自杀未遂患者寻求医疗服务的第一个主要途径之一。本研究的目的是分析以下假设，即在之前的自杀尝试中接受过紧急精神科服务的人，由于随后的自杀尝试，在当前的急诊科就诊中死亡率会降低。
本回顾性研究纳入了 2008 年 1 月至 2017 年 12 月 10 年间，6 家急诊科就诊且参与伤害监测和深入自杀监测的患者。研究对象为因自杀企图而就诊急诊科的 18 岁及以上成年患者。主要解释变量是之前的自杀尝试中是否提供了精神科治疗。主要结局变量是与自杀相关的死亡率。
研究共纳入 2144 例有自杀未遂既往史的自杀未遂患者。其中，1335 例（62.2%）患者在之前的自杀尝试中接受过精神科治疗。在有精神科咨询组（n=33，2.5%）和无咨询组（n=47，5.8%）之间，死亡率差异有统计学意义（P<0.01）。在多变量逻辑回归分析中，之前的精神科咨询与低死亡率显著相关（调整后的 OR 0.41；95%CI [0.23-0.72]），并与选择非致命自杀方法显著相关（调整后的 OR 0.47；95%CI [0.36-0.61]）。
与未接受精神科咨询的患者相比，在之前的自杀尝试中接受过精神科咨询的患者，在当前的急诊科就诊中与自杀相关的死亡率较低，这可能与选择非致命的自杀方法有关。
