Department of Psychiatry, Helgeland Hospital Trust, 8802 Sandnessjøen, Norway.
Department of Health and Care Sciences, UiT The Arctic University of Tromsø, 9037 Tromsø, Norway.
Int J Environ Res Public Health. 2022 Aug 27;19(17):10686. doi: 10.3390/ijerph191710686.
Underlying patterns and factors behind suicides of patients in treatment are still unclear and there is a pressing need for more studies to address this knowledge gap. We analysed 278 cases of suicide reported to The Norwegian System of Patient Injury Compensation, drawing on anonymised data, i.e., age group, gender, diagnostic category, type of treatment provided, inpatient vs. outpatient status, type of treatment facility, and expert assessments of medical errors. The data originated from compensation claim forms, expert assessments, and medical records. Chi-square tests for independence, multinominal logistic regression, and Bayes factors for independence were used to analyse whether the age group, gender, diagnostic category, inpatient/outpatient status, type of institution, and type of treatment received by patients that had died by suicide were associated with different types of medical errors. Patients who received medication tended to be proportionally more exposed to an insufficient level of observation. Those who received medication and psychotherapy tended to be proportionally more exposed to inadequate treatment, including inadequate medication. Inpatients were more likely to be exposed to inappropriate diagnostics and inadequate treatment and follow up while outpatients to insufficient level of observation and inadequate suicide risk assessment. We conclude that the patients who had received medication as their main treatment tended to have been insufficiently observed, while patients who had received psychotherapy and medication tended to have been provided insufficient treatment, including inadequate medication. These observations may be used as learning points for the suicide prevention of patients in treatment in Norwegian psychiatric services.
自杀患者治疗背后的潜在模式和因素仍不清楚，迫切需要更多的研究来填补这一知识空白。我们分析了向挪威患者伤害赔偿系统报告的 278 例自杀案例，这些案例的数据来源于匿名的赔偿申请表、专家评估和医疗记录，涉及年龄组、性别、诊断类别、提供的治疗类型、住院与门诊状态、治疗机构类型以及患者接受的治疗类型。我们使用独立性卡方检验、多分类逻辑回归和独立性贝叶斯因子来分析自杀患者的年龄组、性别、诊断类别、住院/门诊状态、机构类型和治疗类型是否与不同类型的医疗失误有关。接受药物治疗的患者更容易出现观察不足的情况。接受药物和心理治疗的患者更容易出现治疗不足的情况，包括药物剂量不足。住院患者更容易出现诊断不当和治疗及随访不足的情况，而门诊患者更容易出现观察不足和自杀风险评估不足的情况。我们的结论是，接受药物治疗的患者往往观察不足，而接受心理治疗和药物治疗的患者往往治疗不足，包括药物剂量不足。这些观察结果可作为挪威精神科服务中治疗患者自杀预防的学习点。
