Danish Research Institute for Suicide Prevention, CORE- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark.
Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Soc Psychiatry Psychiatr Epidemiol. 2024 Jun;59(6):1053-1061. doi: 10.1007/s00127-023-02585-y. Epub 2023 Nov 23.
The risk of suicidal behavior after discharge from psychiatric admission is high. The aim of this study was to examine whether the SAFE intervention, an implementation of a systematic safer discharge procedure, was associated with a reduction in suicidal behavior after discharge.
The SAFE intervention was implemented at Mental Health Center Copenhagen in March 2018 and consisted of three systematic discharge procedures: (1) A face-to-face meeting between patient and outpatient staff prior to discharge, (2) A face-to-face meeting within the first week after discharge, and (3) Involvement of relatives. Risk of suicide attempt at six-month post-discharge among patients discharged from the SAFE intervention was compared with patients discharged from comparison mental health centers using propensity score matching.
7604 discharges took place at the intervention site, which were 1:1 matched with discharges from comparison sites. During the six months of follow-up, a total of 570 suicide attempts and 25 suicides occurred. The rate of suicide attempt was 11,652 per 100,000 person-years at the SAFE site, while it was 10,530 at comparisons sites. No observable difference in suicide attempt 1.10 (95% CI: 0.89-1.35) or death by suicide (OR = 1.27; 95% CI:0.58-2.81) was found between sites at 6-month follow-up.
No difference in suicidal behavior between the sites was found in this pragmatic study. High rates of suicidal behavior were found during the 6-months discharge period, which could suggest that a preventive intervention should include support over a longer post-discharge period than the one-week follow-up offered in the SAFE intervention.
精神科住院患者出院后的自杀行为风险较高。本研究旨在探讨 SAFE 干预措施（一种系统的更安全出院程序的实施）是否与出院后自杀行为的减少相关。
SAFE 干预措施于 2018 年 3 月在哥本哈根心理健康中心实施，包括三个系统的出院程序：（1）患者与门诊工作人员在出院前进行面对面会议，（2）出院后第一周内进行面对面会议，以及（3）亲属参与。通过倾向评分匹配，比较 SAFE 干预组和对照组出院患者在出院后 6 个月时的自杀企图风险。
干预点共进行了 7604 次出院，与对照组出院进行了 1:1 匹配。在随访的 6 个月中，共发生了 570 次自杀企图和 25 例自杀。SAFE 组的自杀企图发生率为每 100000 人年 11652 例，而对照组为每 100000 人年 10530 例。在 6 个月随访时，两组在自杀企图方面没有明显差异（比值比为 1.10，95%可信区间：0.89-1.35）或自杀死亡（OR=1.27，95%可信区间：0.58-2.81）。
本实用研究中未发现两组之间的自杀行为存在差异。在 6 个月的出院期间，自杀行为发生率较高，这可能表明预防干预措施应包括在出院后提供比 SAFE 干预措施提供的一周随访更长的随访期的支持。
