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[围产期自杀行为:对专科医院中心围产期住院女性自杀意念相关因素的描述性研究]

[Suicidality in the perinatal period: Descriptive study on factors associated with suicidal ideation among women hospitalized in the perinatal period at the specialized hospital center].

作者信息

Dejean D, Chan-Chee C, Legendre G, Picard A, Krembel A, Gillard P, Gohier B, Duverger P, Riquin E

机构信息

Service de Psychiatrie et d'Addictologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.

Direction Santé Environnement Travail, Agence nationale de santé publique, 12, rue du Val d'Osne, 94415 Saint-Maurice cedex.

出版信息

Encephale. 2022 Apr;48(2):139-147. doi: 10.1016/j.encep.2021.02.007. Epub 2021 May 13.

DOI:10.1016/j.encep.2021.02.007
PMID:33994157
Abstract

OBJECTIVES

Suicide is the leading cause of maternal mortality in high-resource countries. The onset of suicidal ideation is a major risk factor for suicide attempts. Suicidality has a major impact on the mother-baby relationship and on child development. The main objective of the study was to identify factors associated with the occurrence of perinatal suicidal ideation in women requiring hospitalization. The secondary objectives of the study were to describe the socio-demographic and clinical characteristics of this specific population, to specify the follow-up procedures at hospital discharge and to develop a semi-directed interview framework for psychiatric evaluation of perinatal patients admitted to a psychiatric hospital in order to better identify those at risk of suicide and improve overall management, particularly in terms of referral to existing perinatal care services.

METHODS

Descriptive and retrospective study carried out at the Specialized Hospital Center of women hospitalized in the perinatal period between 2014 and 2019. The inclusion criteria were: inpatient pregnant or postpartum within one year of delivery, 16 to 43 years. A keyword search was performed to retrieve the computerized records. All records matching the inclusion criteria were included. We studied the occurrence of suicidal ideation according to the main known clinical and socio-demographic risk factors.

RESULTS

The sample included 25 pregnant patients and 57 post-partum patients. The presence of a psychiatric history increased the risk of suicidal ideation by 4.38 (P<0.03). The association between the occurrence of a stressful life event and the risk of suicidal ideation onset was close to significant (P<0.10). One third of the patients had been admitted for a reason related to suicidality. Less than one-third of the patients had been referred to existing perinatal services.

CONCLUSIONS

Suicidality in the perinatal period has a major impact on the dyad as well as on the whole family. The search for suicidal ideas must be systematic during psychiatric interviews, a fortiori when a psychiatric history has been authenticated. Every patient hospitalized in adult psychiatry should be referred to specialized outpatient perinatal psychiatry services. Prevention involves raising awareness and training of all health professionals, networking, but also informing the general public.

摘要

目的

在资源丰富的国家,自杀是孕产妇死亡的主要原因。自杀意念的出现是自杀未遂的主要危险因素。自杀倾向对母婴关系和儿童发育有重大影响。本研究的主要目的是确定与需要住院治疗的女性围产期自杀意念发生相关的因素。该研究的次要目的是描述这一特定人群的社会人口学和临床特征,明确出院后的随访程序,并为入住精神病院的围产期患者制定一个半指导性访谈框架,以便更好地识别有自杀风险的患者并改善整体管理,特别是在转介到现有的围产期护理服务方面。

方法

对2014年至2019年期间在围产期住院的妇女专科医院中心进行描述性和回顾性研究。纳入标准为:分娩后一年内住院的孕妇或产后妇女,年龄在16至43岁之间。进行关键词搜索以检索计算机化记录。所有符合纳入标准的记录均被纳入。我们根据主要已知的临床和社会人口学危险因素研究自杀意念的发生情况。

结果

样本包括25名孕妇和57名产后患者。有精神病史会使自杀意念的风险增加4.38倍(P<0.03)。生活应激事件的发生与自杀意念发作风险之间的关联接近显著(P<0.10)。三分之一的患者因与自杀倾向相关的原因入院。不到三分之一的患者被转介到现有的围产期服务机构。

结论

围产期自杀倾向对母婴二元组以及整个家庭都有重大影响。在精神科访谈期间必须系统地筛查自杀想法,尤其是在精神病史得到证实的情况下。每一位入住成人精神科的患者都应转介到专门的围产期精神科门诊服务机构。预防工作包括提高所有卫生专业人员的认识和培训、建立网络,同时也要向公众宣传。

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