Beaudry Gabrielle, Canal-Rivero Manuel, Ou Jianjun, Matharu Jaskiran, Fazel Seena, Yu Rongqin
Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
Hospital Universitario Virgen del Rocío, Seville, Spain.
Front Psychiatry. 2022 Jun 30;13:871213. doi: 10.3389/fpsyt.2022.871213. eCollection 2022.
Two OxRisk risk assessment tools, the Oxford Mental Illness and Suicide (OxMIS) and the Oxford Mental Illness and Violence (OxMIV), were developed and validated using national linked registries in Sweden, to assess suicide and violence risk in individuals with severe mental illness (schizophrenia-spectrum disorders and bipolar disorders). In this study, we aim to examine the feasibility and acceptability of the tools in three different clinical services.
We employed a two-step mixed-methods approach, by combining quantitative analyses of risk scores of 147 individual patients, and thematic analyses of qualitative data. First, 38 clinicians were asked to use OxMIS and OxMIV when conducting their routine risk assessments in patients with severe mental illness. The risk scores for each patient (which provide a probability of the outcome over 12 months) were then compared to the unstructured clinical risk assessment made by the treating clinician. Second, we carried out semi-structured interviews with the clinicians on the acceptability and utility of the tools. Thematic analysis was conducted on the qualitative data to identify common themes, in terms of the utility, accuracy, and acceptability of the tools. The investigations were undertaken in three general adult psychiatric clinics located in the cities of Barcelona and Sevilla (Spain), and Changsha (China).
Median risk probabilities over 12 months for OxMIS were 1.0% in the Spanish patient sample and 1.9% in the Chinese sample. For OxMIV, they were 0.7% (Spanish) and 0.8% (Chinese). In the thematic analysis, clinicians described the tools as easy to use, and thought that the risk score improved risk management. Potential additions to predictors were suggested, including family history and the patient's support network. Concordance rates of risk estimates between the tools and clinicians was high for violence (94.4%; 68/72) and moderate for suicide (50.0%; 36/72).
Both OxMIS and OxMIV are feasible and practical in different general adult psychiatric settings. Clinicians interviewed found that both tools provide a useful structured approach to estimate the risk of suicide and violence. Risk scores from OxMIS and OxMIV can also be used to assist clinical decision-making for future management.
两种OxRisk风险评估工具，即牛津精神疾病与自杀风险评估工具（OxMIS）和牛津精神疾病与暴力风险评估工具（OxMIV），已在瑞典利用全国性关联登记系统进行了开发和验证，用于评估重度精神疾病（精神分裂症谱系障碍和双相情感障碍）患者的自杀和暴力风险。在本研究中，我们旨在检验这两种工具在三种不同临床服务中的可行性和可接受性。
我们采用了两步混合方法，结合对147例个体患者风险评分的定量分析以及对定性数据的主题分析。首先，要求38名临床医生在对重度精神疾病患者进行常规风险评估时使用OxMIS和OxMIV。然后将每位患者的风险评分（给出12个月内发生相应结果的概率）与主治医生进行的非结构化临床风险评估进行比较。其次，我们就这些工具的可接受性和实用性对临床医生进行了半结构化访谈。对定性数据进行主题分析，以确定关于这些工具的实用性、准确性和可接受性方面的共同主题。调查在位于西班牙巴塞罗那和塞维利亚以及中国长沙的三家普通成人精神科诊所进行。
在西班牙患者样本中，OxMIS在12个月内的风险概率中位数为1.0%，在中国样本中为1.9%。对于OxMIV，西班牙样本为0.7%，中国样本为0.8%。在主题分析中，临床医生称这些工具易于使用，并认为风险评分改善了风险管理。他们还建议了可能增加的预测因素，包括家族史和患者的支持网络。工具与临床医生之间在暴力风险估计方面的一致性较高（94.4%；68/72），在自杀风险估计方面为中等（50.0%；36/72）。
OxMIS和OxMIV在不同的普通成人精神科环境中都是可行且实用的。接受访谈的临床医生发现，这两种工具都为估计自杀和暴力风险提供了有用的结构化方法。OxMIS和OxMIV的风险评分也可用于辅助未来管理的临床决策。
