Melhem Nadine, Moutier Christine Yu, Brent David A
Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier).
Focus (Am Psychiatr Publ). 2023 Apr;21(2):117-128. doi: 10.1176/appi.focus.20220078. Epub 2023 Apr 14.
Suicide remains a leading cause of death in the United States and globally. In this review, epidemiological trends in mortality and suicide risk are presented, with consideration given to the impact of the COVID-19 pandemic. A public health model of suicide prevention with a community and clinical framework, along with advances in scientific discovery, offer new solutions that await widespread implementation. Actionable interventions with evidence for reducing risk for suicidal behavior are presented, including universal and targeted strategies at community, public policy, and clinical levels. Clinical interventions include screening and risk assessment; brief interventions (e.g., safety planning, education, and lethal means counseling) that can be done in primary care, emergency, and behavioral health settings; psychotherapies (cognitive-behavioral, dialectical behavior, mentalization therapy); pharmacotherapy; and systemwide procedures for health care organizations (training, policies, workflow, surveillance of suicide indicators, use of health records for screening, care steps). Suicide prevention strategies must be prioritized and implemented at scale for greatest impact.
自杀在美国乃至全球仍然是主要的死亡原因。在这篇综述中，我们呈现了死亡率和自杀风险的流行病学趋势，并考虑了新冠疫情的影响。一个具有社区和临床框架的自杀预防公共卫生模型，以及科学发现的进展，提供了有待广泛实施的新解决方案。本文介绍了具有降低自杀行为风险证据的可采取行动的干预措施，包括社区、公共政策和临床层面的普遍策略和针对性策略。临床干预措施包括筛查和风险评估；可在初级保健、急诊和行为健康环境中实施的简短干预（如安全规划、教育和致命手段咨询）；心理治疗（认知行为疗法、辩证行为疗法、心理化疗法）；药物治疗；以及医疗保健组织的全系统程序（培训、政策、工作流程、自杀指标监测、利用健康记录进行筛查、护理步骤）。自杀预防策略必须被优先考虑并大规模实施，以产生最大影响。
