Mann J John, Michel Christina A, Auerbach Randy P
Division of Molecular Imaging and Neuropathology (Mann, Michel) and Division of Child and Adolescent Psychiatry (Auerbach), New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York (Mann, Auerbach); Division of Clinical Developmental Neuro- science, Sackler Institute for Developmental Psychobiology, Columbia University, New York (Auerbach).
Focus (Am Psychiatr Publ). 2023 Apr;21(2):182-196. doi: 10.1176/appi.focus.23021004. Epub 2023 Apr 14.
The authors sought to identify scalable evidence-based suicide prevention strategies.
A search of PubMed and Google Scholar identi- fied 20,234 articles published between September 2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment.
Training primary care physicians in depression rec- ognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active out- reach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are under-studied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides.
Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physi- cian settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record-derived algorithms, Internet-based screening methods, ketamine's potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.Reprinted from , with permission from American Psychiatric Association Publishing. Copyright © 2021.
作者试图确定可扩展的循证自杀预防策略。
检索PubMed和谷歌学术，共识别出2005年9月至2019年12月发表的20234篇文章，其中97篇为随机对照试验，以自杀行为或想法为主要结局，或为关于限制获取致命手段、采用教育方法以及抗抑郁治疗影响的流行病学研究。
培训初级保健医生识别和治疗抑郁症可预防自杀。对青少年进行抑郁症和自杀行为教育，以及在出院或自杀危机后对精神病患者进行积极随访，可预防自杀行为。荟萃分析发现抗抑郁药可预防自杀企图，但个别随机对照试验的效力似乎不足。氯胺酮能在数小时内减少自杀念头，但尚未进行预防自杀行为的测试。认知行为疗法和辩证行为疗法可预防自杀行为。主动筛查自杀想法或行为并未被证明比仅筛查抑郁症更有效。向守门人开展青少年自杀行为教育缺乏有效性。尚无关于守门人预防成人自杀行为培训的随机试验报告。算法驱动的电子健康记录筛查、基于互联网的筛查以及智能手机被动监测以识别高危患者的研究不足。限制手段，包括限制枪支获取，可预防自杀，但在美国虽有一半自杀事件涉及枪支，却很少采用。
培训全科医生值得在其他非精神科医生环境中更广泛地实施和测试。出院或自杀相关危机后对患者进行积极随访应成为常规，限制高危个体获取枪支值得更广泛应用。医疗保健系统中的联合方法在几个国家显示出降低自杀率的前景，但评估每个组成部分的益处至关重要。进一步降低自杀率需要评估更新的方法，如基于电子健康记录的算法、基于互联网的筛查方法、氯胺酮预防自杀企图的潜在益处以及对急性自杀风险变化的被动监测。经美国精神病学协会出版许可转载。版权所有©2021。
