Department of Family Medicine, Faculty of Health Science, Walter Sisulu University, Uitenhage, South Africa; and, Department of Family Medicine, Dore Nginza Hospital, Uitenhage.
S Afr Fam Pract (2004). 2022 Apr 26;64(1):e1-e4. doi: 10.4102/safp.v64i1.5496.
The strategic location of primary care providers (PCPs) in clinics, private general practices and emergency departments is critical to the detection and appropriate management of patients with suicidal behaviour. Their position within the primary care setting and responsibility for preventive and promotive care require PCPs to possess good clinical skills and evidence-based knowledge to assist patients presenting with suicidal ideation and behaviour. The objective of this article is to provide guidelines for the management of suicidal behaviour within the primary care setting, with the goal of reducing deaths from suicide, and the frequency and intensity of suicide attempts. The priority in the management of patients presenting at health facilities following suicide attempts is medical resuscitation and stabilisation. As soon as the patient is medically stable, a thorough suicide risk assessment, which evaluates suicidal ideation/intent, preceding circumstances, predisposing and protective factors, should be conducted. An assessment of current and ongoing suicide risk will assist in determining the safest place to manage the patient. For those with a low level of suicide risk, outpatient management may be considered in the presence of a good social support system at home and a well-documented safety plan. Measures should be put in place to address the modifiable psychosocial risk factors for suicide, whilst appropriate pharmacotherapy is instituted for co-existing mental illness. Post-discharge care such as referral to psychologist, psychiatrist or social worker should be initiated by the primary care practitioner to ensure continuity of care. Support and psycho-education should also be extended to immediate family members of patients with suicidal behaviour for their own well-being and their ability to support the patient.
初级保健提供者（PCP）在诊所、私人全科诊所和急诊部门的战略位置对于发现和适当管理有自杀行为的患者至关重要。他们在初级保健环境中的位置和预防保健的责任要求 PCP 具备良好的临床技能和循证知识，以帮助有自杀意念和行为的患者。本文的目的是为初级保健环境中自杀行为的管理提供指导，以降低自杀死亡率，以及自杀企图的频率和强度。在医疗机构就诊的自杀未遂患者的管理重点是医疗复苏和稳定。一旦患者在医疗上稳定，就应进行彻底的自杀风险评估，评估自杀意念/意图、先前情况、易患和保护因素。对当前和持续自杀风险的评估将有助于确定管理患者的最安全地点。对于自杀风险低的患者，如果家中有良好的社会支持系统且有详细的安全计划，可考虑门诊管理。应采取措施解决可改变的自杀社会心理风险因素，同时为并存的精神疾病实施适当的药物治疗。初级保健医生应开始进行出院后护理，如转介给心理学家、精神科医生或社会工作者，以确保护理的连续性。还应向有自杀行为的患者的直系亲属提供支持和心理教育，以确保他们自身的健康和支持患者的能力。
