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华盛顿州自杀预防与意识宣传

Washington State Suicide Prevention and Awareness

作者信息

O'Rourke Maria C., Jamil Radia T., Siddiqui Waquar

机构信息

Dignity Health - STMC - Stockton, CA

Allama Iqbal Medical College

Abstract

Suicide is a major public health problem not only in the United States but also in many western nations. In Washington state, the suicide rate from 2015-2019 has always been higher than the national average. In 2019, the Washington state suicide rate was 16.6 and the national average was 14.5%. In 2017, it was the 8th leading cause of death, accounting for nearly 1,292 deaths each year. Per the Washington Department of Health, suicide is the 2nd leading cause of death for 10-34-year-olds in Washington. Suicide in Washington state is also the seventh leading cause of years of the potential loss of life, surpassing liver disease, diabetes, and HIV. Each year, nearly half a million individuals present to the emergency departments in the United States following attempted suicide. Data indicate that nearly 1 out of every 7 young adults admits to having some type of suicidal ideation at some point in their lives, and at least 5% have made a suicide attempt. Suicide has repercussions way beyond the affected individual. It costs the US healthcare system over $70 billion, and untold billions of dollars are lost by the families affected in terms of loss of earnings. Suicides are at an all-time high and affect both genders. Men are nearly 3.5 times more likely than women to commit suicide, and on average, 123 people kill themselves every day. The World Health Organization (WHO) has predicted that in the next 2 years, depression will be the leading cause of disability globally. Depression is not only a North American phenomenon but is now being diagnosed in almost every nation. The annual prevalence of major depressive disorders in North America is 4.5%, but this is a gross underestimate because many individuals do not seek medical help. Depression is a serious medical disorder and associated with a high risk of suicide. Data reveals that more than 90% of individuals with a major depressive disorder see a healthcare provider within the first 12 months of the episode, and at least 45% of suicide victims have had some contact with a primary health care provider within the 4 weeks of suicide. This indicates that if their healthcare providers are more vigilant and alert, suicide could be prevented in these individuals. These grim statistics have led to a National Strategy for Suicide Prevention in the United States. Considering that many individuals who commit suicide have a mental health disorder and have visited their primary caregiver, the focus now is on health care providers becoming aware of the factors that increase the risk of suicide and refer these individuals to mental health professionals for some type of intervention. The current United States Preventive Services Task Force (USPSTF) recommendations are that primary caregivers should screen adolescents and adults for depression only when there are appropriate systems in place to ensure adequate diagnosis, treatment, and follow-up. Many factors have been identified in individuals who commit suicides or have attempted suicide. These factors include the following: Advanced age. Availability of a firearm. Chronic illness. A family history of suicides. Financial difficulties. Negative life experiences. Loss of job. Marital status divorced. Medications. Mental illnesses such as depression, anxiety, post-traumatic stress disorder (PTSD). Continuous pain. A physical illness that has led to disability. Race: white. Gender: Male. Social media. Stress. A sense of no purpose in life. Over the years, several other factors have been identified that increases the risk of suicide, and they include: Major childhood adverse events, for example, sexual abuse. Discriminated for being gay, lesbian, transgender, or bisexual. Having access to lethal means. A long history of being bullied. Chronic sleep problems. Loss of job or unemployment. Low income. Neurosis. Social isolation. Spousal loss, bereavement. Affective disease. Functional impairment. Physical illness. Traumatic brain injury. PTSD. Other mental health issues. The most important thing to understand is that having just one risk factor has very limited predictive value. Millions of Americans have one of these factors at any one point in time, but very few attempt suicide, and even fewer die as a result. One has to look at the entire clinical picture to increase the predictive values of these risk factors.

摘要

自杀不仅在美国,而且在许多西方国家都是一个重大的公共卫生问题。在华盛顿州,2015 - 2019年的自杀率一直高于全国平均水平。2019年,华盛顿州的自杀率为16.6,而全国平均水平为14.5%。2017年,自杀是第八大死因,每年导致近1292人死亡。根据华盛顿州卫生部的数据,自杀是华盛顿州10至34岁人群的第二大死因。华盛顿州的自杀也是潜在生命年损失的第七大原因,超过了肝病、糖尿病和艾滋病。每年,美国有近50万人在自杀未遂后前往急诊科就诊。数据显示,每7名年轻人中就有近1人承认在其生命中的某个时刻有某种类型的自杀念头,至少5%的人曾尝试自杀。自杀的影响远远超出受影响的个人。它给美国医疗系统造成了超过700亿美元的损失,受影响的家庭在收入损失方面损失了无数亿美元。自杀率创历史新高,且对男女都有影响。男性自杀的可能性几乎是女性的3.5倍,平均每天有123人自杀。世界卫生组织(WHO)预测,在未来2年,抑郁症将成为全球致残的主要原因。抑郁症不仅是北美现象,现在几乎在每个国家都有诊断。北美的重度抑郁症年患病率为4.5%,但这是一个严重低估,因为许多人没有寻求医疗帮助。抑郁症是一种严重的医学疾病,与高自杀风险相关。数据显示,超过90%的重度抑郁症患者在发病的前12个月内会去看医疗服务提供者,至少45%的自杀受害者在自杀前4周内曾与初级医疗服务提供者有过接触。这表明,如果他们的医疗服务提供者更加警惕,这些人的自杀是可以预防的。这些严峻的统计数据促成了美国的国家预防自杀战略。考虑到许多自杀的人都有精神健康障碍并曾拜访过他们的初级护理人员,现在的重点是医疗服务提供者要意识到增加自杀风险的因素,并将这些人转介给心理健康专业人员进行某种干预。美国预防服务工作组(USPSTF)目前的建议是,只有在有适当系统确保充分诊断、治疗和随访的情况下,初级护理人员才应对青少年和成年人进行抑郁症筛查。在自杀或曾尝试自杀的个体中已发现许多因素。这些因素包括:高龄。可获得枪支。慢性病。自杀家族史。经济困难。负面生活经历。失业。婚姻状况为离婚。药物。精神疾病,如抑郁症、焦虑症、创伤后应激障碍(PTSD)。持续疼痛。导致残疾的身体疾病。种族:白人。性别:男性。社交媒体。压力。生活无意义感。多年来,还发现了其他一些增加自杀风险的因素,包括:儿童时期的重大不良事件,例如性虐待。因同性恋、双性恋、跨性别身份而受到歧视。可获得致命手段。长期受欺凌史。慢性睡眠问题。失业或失去工作。低收入。神经症。社会隔离。配偶死亡、丧亲之痛。情感疾病。功能障碍。身体疾病。创伤性脑损伤。PTSD。其他心理健康问题。需要理解的最重要的一点是,仅有一个风险因素的预测价值非常有限。数以百万计的美国人在任何时候都有这些因素中的一个,但很少有人尝试自杀,更少有人因此死亡。必须综合考虑整个临床情况以提高这些风险因素的预测价值。

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