INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France -
Fondation Santé des Etudiants de France (FSEF), Service Hospitalo-Universitaire de Santé Mentale de l'Adolescent et du Jeune Adulte (SAMAJA), Paris, France -
Eur J Phys Rehabil Med. 2022 Oct;58(5):749-756. doi: 10.23736/S1973-9087.22.07341-5. Epub 2022 Sep 1.
Persons who have attempt suicide by jumping often require intensive treatment for their somatic injuries and the high risk of future completed suicide. The FSEF (French Student Health Foundation) developed a Transdisciplinary unit specifically designed for these people.
The aim of this study was to investigate psychiatric and somatic factors associated with Length Of Stay (LOS) in this unit.
Cohort observational retrospective study.
The Transdisciplinary unit provide a dual approach, combining rehabilitation (physiotherapy, balneotherapy, occupational therapy, speech therapy, cognitive rehabilitation, social and family support) and psychiatric care.
Men and women admitted into the Transdisciplinary unit, after a suicide attempt by jumping from a height with severe somatic injuries.
We examined the associations between potential predictors and LOS with Stepwise regressions: model 1 included all variables assessed at admission (age, sex, occupational status, psychiatric disorder history, height of the fall, type of injury, LOS in acute care units and dependences at admission); model 2: all variables at discharge (main psychiatric diagnosis, orientation at discharge, psychotropic treatments, pain treatments, arms mobility limitation, legs mobility limitation, sphincter disorders and dependences at discharge); final model: all significant variables in models 1 and 2.
One hundred ninety-seven subjects were included (49.7% of men; mean age: 25.6 years, ±6.21). Most factors associated with LOS were related to injuries due to the suicide attempt. LOS in the Transdisciplinary unit increased with longer LOS in acute care (β=0.589; P=0.003), higher dependence for continence at admission (β=44.640; P<0.001) and sphincter disorders at discharge (β=78.034; P<0.001). LOS was also longer with higher dependence for behavior at discharge (β=30.182; P=0.042) and unemployed status (β=59.496; P=0.008), which could reflect psychiatric disorders severity. LOS was shorter when subjects had arms mobility limitation at discharge (β=-42.591; P=0.018).
The persons admitted into this unit have serious physical injuries due to their fall. These injuries require intensive rehabilitation and their severity is the largest contributing factor to the LOS. Some findings also advocate for influence of psychiatric factors on LOS, underlying the need for both concomitant psychiatric and somatic care for these people.
People should ideally receive both psychiatric and rehabilitation care after a suicide attempt by jumping.
跳楼自杀未遂者通常需要接受躯体损伤的强化治疗，并且未来自杀完成的风险很高。法国学生健康基金会（French Student Health Foundation）专门为此类人群成立了跨学科单位。
本研究旨在调查该单位中与住院时间（Length Of Stay，LOS）相关的精神和躯体因素。
队列观察性回顾性研究。
跨学科单位提供双重方法，结合康复治疗（物理治疗、水疗、职业治疗、言语治疗、认知康复、社会和家庭支持）和精神科护理。
从高处跳下造成严重躯体损伤后，被送入跨学科单位的男性和女性。
我们使用逐步回归分析检查了潜在预测因素与 LOS 之间的关联：模型 1 纳入了入院时评估的所有变量（年龄、性别、职业状况、精神疾病史、坠落高度、损伤类型、急性护理单元的 LOS 和入院时的依赖情况）；模型 2：出院时的所有变量（主要精神科诊断、出院时的定向、精神科治疗、疼痛治疗、手臂活动受限、腿部活动受限、括约肌障碍和出院时的依赖情况）；最终模型：模型 1 和模型 2 中所有有意义的变量。
共纳入 197 例患者（49.7%为男性；平均年龄：25.6 岁，±6.21）。与 LOS 相关的大多数因素都与自杀企图造成的伤害有关。跨学科单位的 LOS 随着急性护理单元的 LOS 延长而增加（β=0.589；P=0.003），入院时控便依赖程度较高（β=44.640；P<0.001）和出院时括约肌障碍（β=78.034；P<0.001）。出院时行为依赖程度较高（β=30.182；P=0.042）和失业状态（β=59.496；P=0.008）也会导致 LOS 延长，这可能反映了精神疾病的严重程度。当患者出院时手臂活动受限（β=-42.591；P=0.018）时，LOS 更短。
该单位收治的患者因坠落造成严重的躯体损伤。这些损伤需要强化康复治疗，其严重程度是 LOS 最长的影响因素。一些发现还表明，精神因素对 LOS 有影响，这表明这些人需要同时进行精神和躯体护理。
跳楼自杀未遂者理想情况下应在自杀后同时接受精神和康复护理。
