Smith T
Tayside Health Board, Dundee.
Br J Gen Pract. 1995 Sep;45(398):458-62.
Self-inflicted injury and self-poisoning are major causes of hospital admission of young adults throughout the United Kingdom, while in Scotland, suicide is the leading cause of death each year in persons aged 15 to 40 years. General practitioners are in a unique position in that they may have contact with the patient before the attempted suicide and later play a supportive role along with other health service and social work professionals.
This study set out to examine the differences between 72 general practices in Tayside in the hospital admission rates for self-inflicted injury/poisoning among their patients, and the extent to which these differences were related to the socioeconomic conditions prevailing in the patients' areas of residence and in the areas in which practices were located. The study also aimed to examine the agents of self-inflicted injury/poisoning most commonly used by different age groups.
Details of admissions to hospitals in Tayside for self-inflicted injury/poisoning, from 1991 to 1993 inclusive, were obtained from a national, hospital inpatient discharge summary scheme, loaded onto a microcomputer and analysed using standard commercial software. Data from the 1991 census at the postcode sector level and death registrations summaries were obtained from the office of the registrar general for Scotland. The deprivation categories used were based on 1991 census data.
In the study period, 52% of hospital admissions for self-inflicted injury/poisoning were of patients aged 30 years or over. Overall, the number of admissions of females exceeded that of males by 26%. Annual hospital admission rates for self-inflicted injury/poisoning per 1000 registered patients averaged over the Tayside practices correlated closely with the male unemployment rate in, and deprivation category of, the postcode sector in which the practice was located. Rates ranged from an average of 1.1 admissions per 1000 registered patients per year in sectors with less than 5% male unemployment of 4.6 where male unemployment was 15% or over. Similarly, the admission rates ranged from 1.1 per 1000 registered patients per year in the most affluent sectors to 3.3 in the most deprived sectors. The proportion of older patients who used sedatives, hypnotics and tranquillizers to poison themselves was greater than that of younger patients; analgesics, such as paracetamol, were the agents most commonly used for self-poisoning by the younger age groups.
The routine monitoring at national level of hospital admission rates for self-inflicted injury/poisoning, using established computerized information systems, would enable the identification of those practices that have a relatively high proportion of such admissions. This would provide a starting point for the identification of pilot sites for the development of protocols for offering multi-agency support to high-risk groups of patients.
在英国，自我伤害和自我中毒是导致年轻人住院的主要原因，而在苏格兰，自杀是15至40岁人群每年的首要死因。全科医生处于独特的地位，因为他们可能在患者自杀未遂之前就与其接触，随后与其他医疗服务和社会工作专业人员一起发挥支持作用。
本研究旨在调查泰赛德地区72家全科诊所的患者中，自我伤害/中毒的住院率差异，以及这些差异与患者居住地区和诊所所在地区普遍存在的社会经济状况的相关程度。该研究还旨在调查不同年龄组最常用的自我伤害/中毒手段。
获取了1991年至1993年（含）期间泰赛德地区因自我伤害/中毒而住院的详细信息，这些信息来自一个全国性的医院住院患者出院总结计划，录入微机并使用标准商业软件进行分析。1991年邮政编码区一级的人口普查数据和死亡登记摘要来自苏格兰总登记官办公室。所使用的贫困类别基于1991年的人口普查数据。
在研究期间，因自我伤害/中毒而住院的患者中，52%年龄在30岁及以上。总体而言，女性的住院人数比男性多26%。泰赛德地区各诊所每1000名注册患者中自我伤害/中毒的年住院率与诊所所在邮政编码区的男性失业率以及贫困类别密切相关。比率范围从男性失业率低于5%的地区每年每1000名注册患者平均1.1例住院，到男性失业率为15%或更高的地区的4.6例。同样，住院率从最富裕地区每年每1000名注册患者1.1例到最贫困地区的3.3例不等。使用镇静剂、催眠药和安定药进行自我中毒的老年患者比例高于年轻患者；对乙酰氨基酚等镇痛药是年轻年龄组最常用的自我中毒手段。
利用现有的计算机化信息系统在国家层面定期监测自我伤害/中毒的住院率，将能够识别出此类住院比例相对较高的诊所。这将为确定试点地点提供一个起点，以便制定为高危患者群体提供多机构支持的方案。
