Department of child and adolescent psychiatry,Université Paris Cité, AP-HP, Academic Hospital Necker-Enfants Malades, Reference center for autism and learning disorders, Paris, France.
Department of psychiatry, CHU Bicêtre, APHP, Le Kremlin-Bicêtre, France; Department of psychiatry, CHU Nimes, Nimes, France; Department of Psychiatry, School of Medicine, Paris-Saclay University, le Kremlin-Bicêtre, France; McGill University, McGill Group for Suicide Studies, Montreal, Canada; Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France.
Med Educ Online. 2023 Dec;28(1):2199469. doi: 10.1080/10872981.2023.2199469.
Suicide is a major cause of preventable death worldwide. Adequate training in risk assessment and intervention is key to suicide prevention. The use of simulation (role plays, simulated patients, virtual reality…) for practical training is a promising tool in mental health. The purpose of this study was to assess the effectiveness of simulation training in suicide risk assessment and intervention for healthcare professionals and gatekeepers.
We conducted a systematic review in Medline and PsycINFO up to 31 July 2021 of randomized controlled trials (RCTs), non-randomized controlled trials, and pre/post-test studies. RCTs were furthermore included in a meta-analysis. We assessed the methodological quality of all studies with the Medical Education Research Study Quality Instrument, and the Cochrane Risk of Bias tool 2.0 for RCTs. Primary outcomes were changes in Kirkpatrick criteria: attitudes, skills, knowledge, behaviors, and patient outcomes.
We included 96 articles representing 43,656 participants. Most pre/post-test (n = 65) and non-randomized controlled (n = 14) studies showed significant improvement in attitudes, skills, knowledge, and behaviors. The meta-analysis of 11 RCTs showed positive changes in attitudes immediately after training and at 2-4 months post-training; in self-perceived skills at 6 months post-training; but not in factual knowledge. Studies assessing benefits for patients are still limited.
The heterogeneity of methodological designs, interventions, and trained populations combined with a limited number of RCTs and studies on patients' outcomes limit the strength of the evidence. However, preliminary findings suggest that simulation is promising for practical training in suicidal crisis intervention and should be further studied.
自杀是全球可预防死亡的主要原因。充分的风险评估和干预培训是预防自杀的关键。模拟（角色扮演、模拟患者、虚拟现实……）在心理健康方面是一种很有前途的实践培训工具。本研究的目的是评估模拟培训在医疗保健专业人员和守门人自杀风险评估和干预中的效果。
我们在 Medline 和 PsycINFO 上进行了系统评价，截至 2021 年 7 月 31 日，纳入了随机对照试验（RCT）、非随机对照试验和前后测试研究。RCT 还进行了荟萃分析。我们使用医疗教育研究质量工具评估所有研究的方法学质量，使用 Cochrane 风险偏倚工具 2.0 评估 RCT 的风险偏倚。主要结果是根据柯克帕特里克标准（态度、技能、知识、行为和患者结局）的变化。
我们纳入了 96 篇文章，代表了 43656 名参与者。大多数前后测试（n=65）和非随机对照（n=14）研究显示态度、技能、知识和行为均有显著改善。11 项 RCT 的荟萃分析显示，培训后立即和 2-4 个月后态度有积极变化，6 个月后自我感知技能有积极变化，但事实知识没有变化。评估患者获益的研究仍然有限。
方法学设计、干预措施和受训人群的异质性，再加上 RCT 数量有限和对患者结局的研究有限，限制了证据的强度。然而，初步研究结果表明，模拟在自杀危机干预的实践培训中具有潜力，应该进一步研究。
