Shimazaki Hiromi, Utagawa Itaru, Sano Chiemi, Sakurada Shinobu, Yamashita Kyouhei, Shibata Nobuto, Ota Tuneyoshi, Fukushima Tadashi
Juntendo Iji Zasshi. 2022 Jun 9;68(3):261-270. doi: 10.14789/jmj.JMJ22-0002-OA. eCollection 2022.
This study retrospectively explores the objective signs of imminent suicide risk in psychiatric in-patients.
The study analysed the diagnostic and nursing records of a psychiatric hospital that covered the last 14 days before the suicide attempts of 18 people, who, between March 2008 and July 2019, were found to have died by suicide during their hospital stay.
Three professionals used a fishbone diagram to separately identify the factors that led to each person's suicide, the objective signs that indicated imminent suicide risk, possible preventive strategies, and other observations. They compared their findings and used the KJ method (Kawakita Jiro Method) to categorise the items on which they all agreed.
Objective signs of imminent suicide risk were condensed into five categories: 'signs emanating from the patient', 'signs gleaned through engagement', 'signs from response to treatment', 'signs associated with reports from the family', and 'signs inferred from multiple sources of information'. Five categories describing issues with the way in which the hospital staff handled information were extracted, namely 'omission in diagnostic records during admission', 'omission in conference records', 'communication lapse during transfer', 'need for integrated information', and 'systemic issues'.
The findings offer insights on assessing suicide risk and preventing suicide.
本研究回顾性探讨精神科住院患者自杀风险迫近的客观迹象。
该研究分析了一家精神病院的诊断和护理记录，这些记录涵盖了2008年3月至2019年7月期间18名在住院期间自杀死亡患者自杀未遂前的最后14天。
三名专业人员使用鱼骨图分别确定导致每个人自杀的因素、表明自杀风险迫近的客观迹象、可能的预防策略以及其他观察结果。他们比较了各自的发现，并使用KJ法（川喜田二郎法）对他们都认同的项目进行分类。
自杀风险迫近的客观迹象被浓缩为五类：“患者自身出现的迹象”、“通过接触收集到的迹象”、“对治疗反应的迹象”、“与家属报告相关的迹象”以及“从多源信息推断出的迹象”。提取了五类描述医院工作人员处理信息方式存在问题的内容，即“入院诊断记录中的遗漏”、“会诊记录中的遗漏”、“转科时的沟通失误”、“信息整合的必要性”以及“系统性问题”。
这些发现为评估自杀风险和预防自杀提供了见解。
