New York State Office of Mental Health, New York City (Layman, Finnerty) and Albany (Kammer, Leckman-Westin, Carruthers); Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland (Hogan); Education Development Center, Waltham, Massachusetts (Goldstein Grumet); New York State Psychiatric Institute and Columbia University, New York City (Labouliere, Stanley).
Psychiatr Serv. 2021 Oct 1;72(10):1118-1125. doi: 10.1176/appi.ps.202000525. Epub 2021 Mar 18.
This study tested the hypothesis that fidelity of clinics to Zero Suicide (ZS) organizational practices is inversely related to suicidal behaviors of patients under clinical care.
Using cross-sectional analyses, the authors examined the fidelity of 110 outpatient mental health clinics to ZS organizational best practices and suicidal behaviors of clinic patients in the year before a large-scale Zero Suicide implementation. Fidelity to ZS organizational best practices was assessed over a 1-year period with an adapted version of the ZS Organizational Self-Study instrument (17 items self-rated on a Likert scale of 1-5). Suicidal behaviors of patients were identified by extracting information on suicide attempts and deaths from a mandated statewide incident-reporting system database. Clinics were dichotomized into any or no suicide incidents during the year of observation. Logistic regression analyses were used to adjust for clinic census and population type (majority child or adult).
The clinics (N=110) served 30,257 patients per week. Clinics' total average fidelity score was 3.1±0.6 (range=1.41-4.12). For each point increase in fidelity, clinics had a significantly reduced likelihood of having a suicide incident (adjusted odds ratio=0.31, 95% confidence interval=0.14-0.69). Exploratory analysis identified significant differences for seven of 17 ZS organizational practices, with the largest effect sizes for suicide-specific quality improvement policies and activities (η=0.097) and lethal means reduction (η=0.073).
These findings support an association between clinics' use of ZS organizational best practices and lower suicidal behaviors of patients under their care. Findings also support the validity of the ZS Organizational Self-Study instrument.
本研究检验了以下假设，即诊所对“零自杀”（ZS）组织实践的遵从度与接受临床治疗的患者的自杀行为呈反比关系。
采用横断面分析，作者检验了 110 家门诊心理健康诊所对 ZS 组织最佳实践的遵从度，以及在大规模实施 ZS 之前一年诊所患者的自杀行为。在为期一年的时间里，使用 ZS 组织自我评估工具（ZS Organizational Self-Study instrument）的改编版评估了对 ZS 组织最佳实践的遵从度（17 项内容采用 1-5 分的李克特量表自评）。通过从全州强制性事件报告系统数据库中提取自杀企图和死亡信息来确定患者的自杀行为。将诊所分为在观察年度内是否发生自杀事件。使用逻辑回归分析调整诊所人数和人口类型（以儿童或成人为主）。
这些诊所（N=110）每周服务 30257 名患者。诊所的总平均遵从度得分为 3.1±0.6（范围为 1.41-4.12）。遵从度每增加一个点，诊所发生自杀事件的可能性就会显著降低（调整后的优势比=0.31，95%置信区间=0.14-0.69）。探索性分析确定了 17 项 ZS 组织实践中的 7 项存在显著差异，其中自杀特异性质量改进政策和活动（η=0.097）和致命手段减少（η=0.073）的效果量最大。
这些发现支持了诊所使用 ZS 组织最佳实践与接受其治疗的患者自杀行为降低之间的关联。研究结果还支持了 ZS 组织自我评估工具的有效性。
