渐进式暴露结合引导式干预对急诊科自杀未遂青少年的影响

目的 提高急诊科自杀未遂青少年心理弹性,预防再自杀。 方法 将158例自杀未遂青少年随机分为对照组78例、干预组80例。对照组采取常规心理护理;干预组采取渐进式暴露结合引导式心理干预,干预至患者出院时评价效果。 结果 干预后,干预组患者自杀意念、焦虑、抑郁评分显著低于对照组,心理弹性评分显著高于对照组（均P＜0.05）。 结论 渐进式暴露结合引导式护理可降低青少年自杀意念,缓解焦虑抑郁情绪,增强心理弹性,有利于预防青少年再自杀。     

神经内科抑郁症状患者自杀的预警干预

目的探讨预警干预对神经内科抑郁症状患者自杀防范的效果。方法对神经内科抑郁自评量表得分大于50分的112例患者实施预警干预,采用自杀意念自评量表测量干预前后患者的自杀意念得分。结果干预前后患者抑郁得分比较,差异有统计学意义(P0.01);自杀意念得分除掩饰因子外,其他因子及总分干预前后比较,差异有统计学意义(均P0.01)。结论基于抑郁自评量表评估的预警干预,可有效缓解神经内科住院患者抑郁症状,减轻自杀意念,对自杀防范有积极作用。     

中国住院癌症患者自杀意念发生率Meta分析

目的 了解中国住院癌症患者自杀意念发生率的总体情况,为住院癌症患者自杀行为预防及干预提供参考.方法 系统检索Web of Science、Cochrane Library、PubMed、EMbase、中国知网、中国生物医学文献服务系统、万方数据库、维普数据库自建库至2020年10月的相关文献,采用R4.0.2软件对数据进行Meta分析.结果 共纳入文献15篇,总样本量6328例.文献分析结果显示,我国住院癌症患者自杀意念发生率为21.6％[95％CI (15.9％,27.3％)].亚组分析结果显示,女性、使用多条目自杀测评工具、南方地区癌症患者自杀意念发生率较高.结论 我国住院癌症患者自杀意念发生率较高,综合医院应早期识别住院癌症患者的自杀意念,并及时对自杀意念及自杀行为采取预防及干预措施.     

自杀未遂急诊患者再自杀风险干预研究进展

对自杀未遂急诊患者及时有效的风险评估与干预是减少和防范患者再自杀的关键。通过对自杀与自杀未遂相关概念、自杀未遂急诊患者流行病学特征及主要影响因素、国内外自杀未遂急诊患者的风险评估与干预现状进行综述,以期为构建和完善我国自杀未遂急诊患者的评估和干预机制提供参考与借鉴,预防患者再自杀。     

中国抑郁症患者自杀意念发生率的Meta分析

目的 了解我国抑郁症患者自杀意念发生率,为针对性干预提供参考。方法 检索PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方数据知识服务平台、维普网,搜集建库至2021年10月发表的有关中国抑郁症患者自杀意念的文献。采用R4.0.2软件进行Meta分析。结果 纳入18篇文献,总样本量7 987例。我国抑郁症患者自杀意念发生率为48.18%(95%CI:38.96,57.39);亚组分析显示不同样本来源的抑郁症患者自杀意念发生率存在差异。结论 我国抑郁症患者自杀意念发生率较高,应予以重视,及早筛查,针对性干预,以防范抑郁症患者自杀。     

568例急诊科自杀未遂患者特征分析与管理对策

目的了解急诊科自杀未遂患者的特征,为开展针对性护理干预提供依据。方法运用回顾性调查方法,采用自行设计的急诊科自杀未遂患者信息登记表,收集患者一般人口学资料、自杀时间、自杀原因、自杀方式、病情严重程度等特征。结果 568例自杀未遂患者中女性占64.08%,男女比例为1∶1.78;青年自杀未遂者居多(53.70%)。自杀方式以服毒为主,主要使用的毒物为农药(71.13%),其次为安眠药(16.02%)。家庭矛盾为主要原因(26.94%),其次为婚恋受挫(20.95%)。结论自杀已成为一种严重的公共卫生问题,应引起社会及医护人员的高度重视,呼吁全社会及医院积极广泛开展患者心理健康促进及自杀三级预防普及工作,降低自杀率。     

知信行理论模式用于急诊科护士的患者自杀风险培训

目的探讨知信行理论模式用于急诊科护士患者自杀风险培训的效果。方法组建自杀风险教育多学科团队,采用知信行理论模式对143名急诊科护士进行为期3个月的患者自杀风险培训,比较培训前后护士的自杀态度和自杀护理行为。结果培训后,急诊科护士自杀态度总分及3个维度得分显著低于培训前,自杀护理行为得分显著高于培训前(P0.05,P0.01)。结论知信行理论模式用于急诊科护士患者自杀风险培训可有效改善护士对自杀的态度,规范其患者自杀护理行为。     

基于人工智能技术的微博"树洞"用户自杀意念分析

目的分析微博"树洞"用户留言的自杀意念相关信息,为自杀预警及网络干预提供思路。方法 "树洞"智能机器人24 h监控2018年8～10月"走饭"微博树洞留言,依据知识图谱筛选含自杀意念的信息,自动识别6～10级高自杀风险信息,进行自杀风险分级。结果 "树洞"机器人共抓取"走饭"微博树洞留言信息11.8万条。微博留言在22:00至凌晨2:00达高峰期;存在6～10级高自杀风险留言信息达711条,留言用户主要集中在16～26岁年龄段;跳楼、割腕、烧炭、自缢、跳河是高自杀风险人群表达的主要自杀方式。结论人们通过网络表达自杀意念的现象越来越普遍,人工智能技术可用于识别和救助高自杀风险人群。自杀预防工作应健全24 h危机预警及干预机制,重视青少年心理健康,并营造良好的网络社交环境。     

神经内科住院患者自杀风险分级筛查与干预

目的探讨对神经内科住院患者实施自杀风险分级筛查与干预的效果。方法将神经内科4个病区随机分为两组,每个组各2个病区,采用病人健康问卷(PHQ-9)筛查,PHQ-9总分≥15分或第9条目阳性患者纳入研究。对照组(n=147)给予神经内科预防自杀常规护理;观察组(n=138)在对照组基础上采用哥伦比亚自杀严重程度评定量表进行二级筛查,并对高风险患者实施预防自杀综合干预。结果出院时观察组PHQ-9总分及第9条目阳性率显著低于对照组(均P<0.01),干预后观察组患者自杀意念频率、持续时间及可控性显著低于干预前(均P<0.01)。结论对神经系统疾病自杀高风险住院患者,进行自杀风险二级筛查并实施预防自杀综合干预可有效降低患者自杀风险。     

预防手外科自杀入院患者再次自杀的措施探讨

目的防止手外科自杀入院患者在住院期间再次出现自杀行为,保障患者住院期间的生命安全。方法加强护理人员预防患者自杀以及患者自杀后应急预案培训,对手外科收治的30例自杀入院患者进行严格入院精神评估,对患者进行心理评估及干预,加强病房环境管理及巡视,严格交接班,加强服药监护。结果 30例患者住院期间均未出现再次自杀或自伤行为,出院时自杀意念及自杀倾向评分显著低于入院时(均P0.01)。结论预防手外科自杀入院患者再次自杀的强化措施有利于提高护理人员应急能力及风险意识,保障自杀患者安全。     

Attempted suicide and the elderly trauma patient: risk factors and outcomes

OBJECTIVE: To analyze the scope and burden of hospitalizations for suicide attempts among elderly patients in the United States. METHODS: The National Trauma Data Bank (NTDB, American College of Surgeons, Chicago, IL, 2002) was used for this study. It is a multistate database of hospitalizations for traumatic injury in the United States. Information on all patients reported to the database from 1995 to 2002 was analyzed. Logistic regression was used to analyze the risk factors for suicide attempt in elderly patients, compared with both a younger suicidal cohort and a cohort of elderly patients injured in a motor vehicle collision (MVC). The impact of age on outcome after failed suicide attempt was also analyzed. RESULTS: A total of 1,812 persons aged 65 and over were hospitalized for suicide attempts during the study period, comprising 9.5% of total hospitalizations for suicide attempts. Regression analysis demonstrated that elderly patients who attempted suicide were more likely to be male, white, to have used a firearm, and to have insurance than younger patients. They were more likely to have a psychiatric condition but less likely to have insurance than elderly patients hospitalized for MVCs. Mortality was higher for elderly patients hospitalized for suicide attempts than for younger patients who attempted suicide. Suicidal elderly were less likely to be discharged to home than either younger suicidal patients or elderly patients hospitalized after MVCs. CONCLUSIONS: The failed suicide attempt is an opportunity for intervention. By better understanding risk factors and outcomes of suicide attempts among elderly patients, we can identify higher risk groups and begin to tailor social service programs, psychiatric interventions, and medical care. A multimodality approach to suicide prevention for the elderly would include compassionate, appropriate, psychosocial interventions, and could be studied prospectively to analyze its impact.     

Trauma,attempted suicide,and morning cortisol in a community sample of adolescents

Individuals exposed to trauma or who have attempted suicide may show abnormal cortisol profiles; those exposed to significant trauma show reduced, while those who attempt suicide show increased cortisol output, although the evidence is inconsistent. This study explores the associations between morning cortisol, trauma, and suicide attempts or ideation among young people. In a community‐based sample of 501 15‐year‐olds, using data from a DSM‐IV‐compatible interview on suicidal‐behavior/ideation, trauma, and morning cortisol, we found no association between these factors and morning cortisol. A significant gender interaction was found for those threatened with a weapon—men showing a negative and women a positive association, suggesting that any cortisol/trauma association may be partially explained by coexisting behavioral problems and gender.     

Intervention suizidaler Krisen in der Notfallmedizin

Management of suicide and deliberate self-harm in emergency medicine deals with one of the most difficult crisis in human life. In emergency medicine this topic is dealt with rarely, however, though there is not a large amount of knowledge amongst emergency physicians, they regard this as an important issue of their training. A review is given about parameters of suicidal crisis in emergency medicine and management of psychiatric patients in these situations. Moreover symptomatology of suicidal ideation, reasons for self harm and methods of risk assessment are described. As useful methods to enhance understanding of suicidal patients and the risk involved the models of the “presuidical syndrome” and that of the course of a suicidal crisis is demonstrated. In dealing with suicidal patients basic and advanced rules including four steps of favourable management in emergency medicine are described. This is completed by suggestions to improve coping mechanisms of emergency physicians involved.     

Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans

Posttraumatic stress disorder (PTSD) was examined as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans (N = 407) referred to Veterans Affairs mental health care. The authors also examined if risk for suicidal ideation was increased by the presence of comorbid mental disorders in veterans with PTSD. Veterans who screened positive for PTSD were more than 4 times as likely to endorse suicidal ideation relative to non‐PTSD veterans. Among veterans who screened positive for PTSD (n = 202), the risk for suicidal ideation was 5.7 times greater in veterans who screened positive for two or more comorbid disorders relative to veterans with PTSD only. Findings are relevant to identifying risk for suicide behaviors in Iraq and Afghanistan War veterans.     

Traumatic events and suicidality in a German adolescent community sample

Exposure to traumatic events has been related to suicide attempts and suicidal ideation in adolescents. This study analyzes the association between suicidality and preceding traumatic life events in 665 German school students with an average age of 14.81 (SD = 0.66). Forty-three (6.5%) students reported suicide attempts and 239 (35.9%) reported suicidal ideation. Adolescents with a history of suicide attempts reported sexual abuse 6 months before their suicidal behavior significantly more often than students with only suicidal ideation. Sexual victimization seems to be especially linked to a risk for suicide attempts during adolescence. Screening for students at risk for developing suicidality should include assessment of traumatic events.     

Is self-immolation a distinct method for suicide? A comparison of Iranian patients attempting suicide by self-immolation and by poisoning

Objective

Patients who attempted suicide by self-immolation were compared to patients who attempted suicide by poisoning to identify features that might discriminate risk of self-immolation from other suicide methods.

Methods

Consecutive referrals for attempted suicide were recruited over a 4-month period (June-September 2008) from Kermanshah Imam Khomeini Hospital, Iran. Using questionnaire and interview techniques, demographic characteristics (age, gender, marital status, education level), psychosocial risk factors (prior suicide attempt, family history of suicide attempt, previous history of physical and mental disorders, family/marital conflict), and suicidal intent behavior were assessed from 200 patients who had attempted suicide (n = 63 by self-immolation; n = 137 by poisoning).

Results

Several significant differences between the groups emerged. Patients who had attempted suicide by self-immolation were more frequently female (p < 0.001), older (p < 0.007), less educated (p < 0.001), and married (p < 0.001). Suicidal intent was associated with increased risk of suicide by poisoning (p < 0.001). No other significant differences were found.

Conclusion

In Iran, patients who attempt suicide by self-immolation have distinct and specific risk factors compared to patients who commit suicide by poisoning. Results have implications for intervention development targeting at-risk populations.     

Suicide in anaesthetists: a systematic review

Evidence suggests that healthcare professionals are at an increased risk of dying by suicide, with anaesthetists at particularly high risk. However, much of the data on which this is based are historical. With a focus on the epidemiology and methods used, we conducted a systematic review of evidence regarding suicide and suicidal behaviour among anaesthetists to provide a more contemporary summary. The systematic review process was adapted from a previous similar study in veterinary surgeons and was consistent with recommended guidance. We identified 54 articles published in or after 1990 that had anaesthetist-specific data and met the inclusion criteria. Seven of these reported epidemiological data, of which four were published after 2000. Although none of the more recent studies reported standardised mortality rates specific to suicide in anaesthetists, the proportion of anaesthetists dying by suicide was increased with respect to comparator groups, which is consistent with previous findings. Eleven studies that included information on suicidal behaviour reported suicidal ideation in 3.2–25% of individuals (six studies) and suicide attempts in 0.5–2% (four studies). Studies reporting methods of suicide highlighted the use of anaesthetic drugs, particularly propofol, supporting the suggestion that the increased risk of suicide in anaesthetists may be related to the availability of the means. We discuss our findings in relation to other recently published data and guidance concerning mental health problems in anaesthetists.     

Decreasing suicide risk among patients with prostate cancer: Implications for depression,erectile dysfunction,and suicidal ideation screening

Objective

Prostate cancer is the most common malignancy among males, accounting for 19% of cancers, and the third most common cancer-related cause of death. Suicide rates in the United States have increased among males over the last decade. Further, suicide rates are higher in oncology patients, including patients with prostate cancer, compared to the general population. The objective of this article is to review the current literature and address the relationship between prostate cancer, depression, erectile dysfunction, and suicidal ideation.

Suicidality in people surviving a traumatic brain injury: Prevalence, risk factors and implications for clinical management

Background: A systematic search was conducted of the literature addressing suicidality after traumatic brain injury (TBI). Results from population-based studies found that people with TBI have an increased risk of death by suicide (3-4 times greater than for the general population), as well as significantly higher levels of suicide attempts and suicide ideation. Clinical studies have also reported high levels of suicide attempts (18%) and clinically significant suicide ideation (21-22%) in TBI samples.

Methods and Results: In reviewing risk factors, two prognostic studies using multivariate analysis were identified. Adjusted risk statistics from these studies found an elevated risk of suicide for people with severe TBI in comparison to concussion (hazard ratio 1.4, 95% CI 1.15-1.75) and an elevated risk of suicide attempts among people displaying post-injury suicide ideation (adjusted odds ratio 4.9, 95% CI 1.79-13.17) and psychiatric/emotional distress (adjusted odds ratio 7.8, 95% CI 2.11-29.04).

Conclusions: To date, little evidence exists for the role of pre-morbid psychopathology, neuropathology, neuropsychological impairments or post-injury psychosocial factors as major risk factors for post-injury suicidality. Finally, there has been little empirical examination of approaches to suicide prevention. Therefore, current best practice is based on clinical judgement and the untested extrapolation of prevention approaches from other clinical populations.