Department of Clinical Sciences Lund, Psychiatry, Lund University, 22100 Lund, Sweden.
Office of Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, 22185 Lund, Sweden.
Int J Environ Res Public Health. 2021 Dec 28;19(1):300. doi: 10.3390/ijerph19010300.
Evidence is lacking on how to manage imminent suicidality in adolescents with self-harm. Brief Admission by Self-referral (BA) is a crisis-management intervention, developed for adults with self-harm at risk for suicide. Structured, individualized and based on responsible autonomy, BA aims to provide a respite while minimizing negative effects of hospitalization. This qualitative interview study illuminates adolescents' experiences of BA, adapted for this target group. Nineteen adolescents aged 14 to 19 years, described BA as helpful for timely rest and recovery to save themselves from impulses to self-harm. The individual contract, which is a prerequisite for access to BA, was perceived to give access to professional support in a safe environment, also among adolescents not using their contract. Being trusted with responsibility to self-admit was also hard work with struggles of self-doubt. Challenges included experiencing distrust from staff and fear of not being able to abstain from self-harm, which BA is conditioned upon. However, this condition was also perceived to induce self-motivation and growth. BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm. Suggestions for improvement included continually informing staff about important features of BA. To further evaluate benefits and challenges of BA, future research may evaluate clinical and health-economic outcomes and perspectives from parents and caregivers.
目前缺乏如何管理有自杀意念的青少年自残问题的相关证据。自我转诊的短暂住院治疗（BA）是一种危机管理干预措施，专为有自杀风险的自残成年人开发。BA 以负责任的自主为基础，采用结构化和个体化方法，旨在为患者提供喘息机会，同时将住院治疗的负面影响降至最低。本定性访谈研究阐明了适应于青少年的 BA 体验。19 名年龄在 14 至 19 岁的青少年表示，BA 有助于及时休息和恢复，从而避免冲动自残。对于那些没有使用合同的青少年来说，个人合同是获得 BA 的前提条件，这被认为是在安全环境中获得专业支持的一种方式。青少年被赋予自我管理的责任，这也是一项艰巨的工作，他们会自我怀疑。挑战包括遭受工作人员的不信任和担心无法戒除自残，BA 就是以戒除自残为条件的。然而，这种条件也被认为可以激发自我激励和成长。BA 似乎非常适合目标群体，满足了可预测性、自主性和恢复机会的需求，以防止自残。改进建议包括不断向工作人员告知 BA 的重要特征。为了进一步评估 BA 的益处和挑战，未来的研究可以评估临床和健康经济效益以及来自父母和照顾者的观点。
