住院抑郁症病人自杀未遂情况调查

[目的]探讨住院抑郁症病人自杀发生率、性别差异、自杀因素及护理干预对策。[方法]利用问卷调查表对150例自杀未遂的抑郁症病人自杀相关资料进行回顾性调查。[结果]住院抑郁症病人出现自杀意念、自杀意图、自杀行为较高;女性病人自杀行为明显多于男性,但男性自杀行为的后果更为严重;精神病家族史、自杀家族史、家庭环境等均与自杀行为密切相关。[结论]住院抑郁症病人存在较多的自杀问题,特别是病程长、多次住院、具有精神病家族史和自杀家族史者是自杀预防的重点人群。     

1例老年胃癌术后自杀未遂患者的护理

自杀是一种由于自身意识的动作或行为所造成的死亡,是人类的悲剧,是由于社会、家庭、自身因素导致人心理失衡,从而采取一些极端的方式自行结束自己生命的行为。据统计,全球每年有100万～120万人自杀死亡,世界上每40s就有1人成功自杀,每3min有1人自杀未遂\[1\]。自杀是有自杀意念到自杀未遂或自杀死亡的自杀行为的连续过程。有自杀意念不一定发生自杀行为,但自杀行为发生之前肯定有自杀意念\[2 3\]。因此,对住院患者自杀行为的预见及早期预防尤为重要。本文回顾了我科1例老年胃癌术后患者的自杀事件,经护理后该患者放弃自杀的念头,配合治疗,治愈出院。电话随访6个月,患者生活态度积极乐观,未出现再次自杀行为。现将护理体会报告如下。     

自杀风险评估在精神科病房管理中的应用

精神疾病是自杀的高危因素,其中抑郁症的危险性最高.抑郁症患者的自杀风险比其他精神疾病高近20倍,自杀观念和行为是抑郁症患者最严重而危险的症状.25%的重性抑郁症患者有过自杀未遂[1],其中15%的患者最终死于自杀[2].近年来抑郁症的自杀干预已逐渐受到广泛重视.本文对抑郁症的自杀风险进行了连续、动态的护理评估,为提高对抑郁症患者自杀行为的预测性和精神科病房更好地实施风险管理提供依据.     

抑郁症患者自杀行为与自杀意念及领悟社会支持相关性研究

目的：探讨抑郁症患者自杀行为与自杀意念、领悟社会支持的相关性。方法选取59例惠爱医院住院的抑郁症患者为研究对象。根据近3个月是否有自杀行为,将患者归入自杀行为组（n＝28）和非自杀行为组（n＝31）;采用自杀意念自评量表、领悟社会支持量表及自编一般资料调查表对两组患者进行评估。结果伴自杀行为组自杀意念较未伴自杀行为组强烈（t＝3．03,P＜0．05）,领悟社会支持度低于未伴自杀行为组（t＝2．99,P＜0．05）。中介效应分析表明,领悟社会支持在自杀意念与自杀行为间发挥完全中介作用,自杀意念会削弱抑郁症患者的领悟社会支持,导致自杀风险增加。结论领悟社会支持在自杀意念与自杀行为间发挥重要中介作用,故在自杀干预中既要丰富社会支持资源和支持方式,又要引导患者主动利用,减少自杀行为的发生。     

54例精神病人自杀行为的心理分析及护理

精神病人自杀行为的发生，是精神病房管理中一个非常重要的课题。为提高护理质量，减少自杀行为发生，本文对我院1994年1月至2003年12月十年间54例有自杀行为的患者进行心理分析后发现，自杀行为的发生，除与生物、心理、社会学因素有关外，患者精神素质及心理素质缺陷，是病理生理的基础，而精神分裂症命令性幻听、抑郁症的自罪妄想、情绪的低落，是自杀行为的潜在危机。对此，从护理的角度，我们对有自杀行为的患者进行心理分析，从中掌握患者的心理状态，全面掌握和了解患者的思维、情感和行为，做好有自杀意念和自杀行为患者护理。     

癌症患者自杀行为原因分析与护理对策

目的探讨住院癌症患者发生自杀行为的相关因素，制定有针对性的心理护理及安全管理措施。方法按时间顺序逐个调查2004年7月-2007年6月在东南大学附属中大医院肿瘤科住院期间发生自杀行为的29例患者临床资料，进行自杀行为分类，并分析自杀原因，在此基础上采取相应心理护理、安全管理措施，比较针对性护理措施后的效果。结果29例发生自杀行为的患者中，自杀成功3例，占10．3％，自杀未遂8例，占27．6％，有自杀准备4例，占13．8％，有自杀计划2例，占6．9％，有自杀意念12例，占41．4％。发生自杀行为的原因与心理障碍、情感支持缺乏、疼痛、生活质量下降和经济负担过重等有关。通过有针对性的干预，自杀行为人数逐渐下降（P〈0．05）。结论加强对患者的心理疏导，强化病区护理安全管理，增强医护人员法律意识，能使住院癌症患者自杀行为减少。     

认知行为治疗对抑郁症患者病耻感和应对方式的影响

目的探讨认知行为治疗对抑郁症患者病耻感和应对方式的影响。方法选取50例抑郁症患者并对其实施认知行为治疗,分析其认知行为治疗前后自杀意念量表、应对方式量表和病耻感量表评分情况。结果认知行为治疗后,50例抑郁症患者自杀意念量表中各项评分高于治疗前,病耻感量表中各项评分低于治疗前,应对方式量表中各项评分优于治疗前,差异均有统计学意义(P0.05)。结论认知行为治疗可显著减轻抑郁症患者的病耻感,改善自杀行为认知和意念,值得临床推广。     

动机性访谈对自杀意念的抑郁症患者抑郁水平和自杀意念的影响

目的探讨动机性访谈对自杀意念的抑郁症患者抑郁水平和自杀意念的影响。方法将120例有自杀意念的抑郁症患者采用随机数字表法将其分为干预组和对照组,每组各60例。两组患者均服用抗抑郁药,对照组按照抑郁症的护理常规护理,干预组在执行护理常规的同时开展动机性访谈。在干预前与干预第12周后分别运用汉密尔顿抑郁量表(Hamilton depression scale,HAMD)和自杀意念自评量表(self-rating idea of suicide scale,SIOSS)对抑郁症患者进行评价。结果干预前两组患者抑郁评分和自杀意念评分比较,差异无统计学意义(P0.05);干预后干预组患者抑郁评分和自杀意念评分均低于对照组,两组比较,差异有统计学意义(均P0.01)。结论动机性访谈能降低抑郁症患者的抑郁水平,缓解自杀意念的程度,促进心理健康。     

护理干预在抑郁症伴有自杀行为患者中的应用

目的探讨护理干预在抑郁症伴有自杀行为患者中的应用效果。方法对10例抑郁症伴有自杀倾向患者进行风险评估、评估自杀高危因素、严格执行安全管理制度与保护制度、改变患者认知结构等。结果抑郁症伴有自杀倾向患者的自杀行为包括顿服大量药物、喝农药、割腕、溺水、自缢。患者自杀行为均被及时发现,自杀未遂。10例患者经治疗和护理均康复出院。结论对抑郁症伴有自杀行为患者实施有效的护理干预,可有效降低医疗风险和患者自杀的发生率。     

综合护理干预在抑郁症伴自杀行为患者中的应用

目的探讨综合护理干预在抑郁症伴自杀行为患者中的应用效果。方法选取我科2017年1—12月抑郁症伴自杀行为患者30例作为研究对象,采用综合护理干预对患者进行护理,比较干预前、干预后1,2个月后患者的汉密尔顿抑郁量表(HAMD)、自尊量表(SES)、贝克自杀意念量表(SSI)和健康调查量表(SF-36)评分情况。结果护理干预后1,2个月患者的HAMD,SSI评分均低于干预前,SF-36,SES均高于干预前,差异有统计学意义(P 0. 05)。结论对抑郁症伴自杀行为患者进行综合护理干预可有效改善患者的抑郁程度,减少其自杀意念,提高其总体健康水平,值得临床推广应用。     

Dispositional Optimism as a Moderator of the Relationship Between Negative Life Events and Suicide Ideation and Attempts

Relatively little research has focused on the role that positive psychological characteristics, such as optimism, might play in the mitigation of stressors and reduction of psychopathology. Dispositional optimism is a trait-like characteristic reflecting a positive attitude or mood regarding the future. This study examined the moderating effect of dispositional optimism on the relationship between negative life experiences and suicide ideation and attempts in a college student sample. Negative life events were associated with current suicide ideation and previous suicide attempts, and dispositional optimism moderated these relationships, after controlling for hopelessness and severity of depression. Individuals with greater optimism have reduced risk for suicide ideation and attempts in the face of low to moderate negative life events; however, this association is changed at the highest levels of negative life events. Implications for treatment include strengthening active and future-focused coping in patients who have experienced negative or potentially traumatic life events to protect against suicidal thoughts and behaviors.     

Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk

This study describes suicidal behavior in a cross-sectional sample of chronic pain patients and evaluates factors associated with increased risk for suicidal ideation. One hundred-fifty-three adults with nonmalignant pain (42% back pain) who were consecutively referred to a tertiary care pain center completed a Structured Clinical Interview for Suicide History, the McGill Pain Questionnaire, and the Beck Depression Inventory. Nineteen-percent reported current passive suicidal ideation (PSI), 13% had active thoughts of committing suicide (ASI), 5% had a current suicide plan, and 5% reported a previous suicide attempt. Drug overdose was the most commonly reported plan and method of attempt (75%). Thirteen-percent reported a family history of suicide attempt/completion. Pain-specific and traditional suicide risk factors were evaluated as predictors of current PSI and ASI. Logistic regression analyses revealed that a family history of suicide attempts/completions was associated with a 7.5 fold increase in risk of PSI (P=0.001) and a 6.6 fold increase in ASI (P=0.003), after adjusting for significant covariates. Having abdominal pain was associated with an adjusted 5.5 fold increase in PSI (P=0.05) and a 4.2 fold increase in ASI (P=0.10). Neuropathic pain significantly reduced risk for both PSI (P=0.002) and ASI (P=0.01). Demographics, pain severity, and depression severity were not associated with suicidal ideation in multivariate analyses. These findings highlight the need for routine evaluation and monitoring of suicidal behavior in chronic pain, especially for patients with family histories of suicide, those taking potentially lethal medications, and patients with abdominal pain.     

Emotion Dysregulation and Vulnerability to Suicidal Ideation and Attempts

This study investigated the predictive utility of a six-dimensional conceptualization of emotion dysregulation for suicidal ideation, as well as its ability to distinguish among individuals with differing histories of suicidality. Young adults (N = 96) with current suicidal ideation but no suicide attempt history (n = 17), a history of a single (n = 20) or multiple attempts (n = 17), or no current ideation/no past attempts (n = 42) completed measures of emotion dysregulation, suicidal ideation, depression, hopelessness, and a diagnostic interview. Multiple suicide attempters differed from participants with no suicidal ideation/no past attempts on two emotion dysregulation dimensions—nonacceptance of emotional responses and perceived limited access to emotion regulation strategies. After adjusting for depression symptoms and the presence of a mood or anxiety diagnosis, limited access to emotion regulation strategies significantly predicted current suicidal ideation, a relation that was found to be statistically mediated by hopelessness.     

Thwarted Belongingness Mediates the Relationship Between Fear of Negative Evaluation and Suicidal Ideation

Fear of negative evaluation has been documented as a mechanism that explains variations in feelings of belongingness. According to the interpersonal theory of suicide (Joiner 2005), feelings of thwarted belongingness, that one does not belong, can significantly increase desire and risk for suicide. We proposed that differences in thwarted belongingness may explain variations in suicidal ideation and behavior as a function of levels of fear of negative evaluation. This hypothesis was tested by examining self-reported fears of negative evaluation, thwarted belongingness, and suicidal ideation in 107 young adults, many who were explicitly targeted for recruitment due to a history of suicidal ideation and behavior [13.1 % had thoughts about suicide without a previous attempt; 15.9 % reported at least one previous attempt (max = 5 attempts)]. Mediation analyses were conducted with suicidal ideation entered as the outcome variable. Results indicated that greater fears of negative evaluation were significantly and positively associated with levels of suicidal ideation. Differences in thwarted belongingness fully accounted for the relationship between fears of negative evaluation and suicidal ideation. We conclude with clinical implications and future directions.     

Outcomes of a program to reduce depression

Depression is increasing among Korean college students. Moreover, it is common for depressed individuals to consider attempting suicide. The purpose of this study therefore was to develop and examine the effectiveness of an intervention to reduce suicidal ideation and depression among female college students. Study participants were assigned to either an intervention (n = 27) or control (n = 31) group. The intervention group received a depression-reducing program in eight 1-hr weekly sessions. Measures of suicidal ideation and depression were administered. The program has effects on suicidal ideation and depression among female college students. The findings suggest that the study program may be useful in reducing suicidal ideation and depression among female college students.     

The Interactive Effects of the Capability for Suicide and Major Depressive Episodes on Suicidal Behavior in a Military Sample

Major depressive symptoms are associated with increased risk for suicidal ideation and behavior. Suicide is fearsome; as such, the interpersonal theory of suicide proposes that individuals who engage in suicidal behavior possess not only the desire to die, but also the acquired capability (AC) for suicide. This study examined whether major depressive episodes (MDEs) may be particularly relevant to suicidal behavior when considered in the context of AC. History of MDEs, AC, and suicide attempt history were examined in a large (n = 3377) sample of military members. Data were analyzed using hierarchical multiple regression. Results indicated that among individuals with high AC, the number of MDEs was significantly, positively associated with number of previous suicide attempts; MDEs were not significantly related to suicide attempt history among individuals with low AC. Findings held in the presence of robust covariates associated with suicidal behavior. Findings suggest that a history of MDEs alone may not indicate severe suicide risk—increased AC for suicide appears necessary for increased suicide risk. Implications for suicide treatment and prevention in military personnel are discussed.     

Suicidal intent in patients with chronic pain

Suicidal ideation among individuals suffering from chronically painful conditions has not been widely studied, although rates of completed suicide are believed to be elevated in this population relative to the general population. The psychiatric literature on suicide documents the importance of controlling for the severity of depression when studying factors associated with suicidal ideation, attempts, or completion. The present study examined the relationships between suicidal ideation and the experience of pain, pain-related disability, and pain coping efforts among a sample of individuals experiencing chronically painful conditions. Of 200 patients evaluated on an inpatient rehabilitation unit in a psychiatric service, 13 individuals (6.5%) reported suicidal intent on a commonly used self-report measure of symptoms of depression, the Beck Depression Inventory. This group was compared to a matched (age, sex, pain duration) group of similarly depressed individuals (N=13) and a matched group of non-depressed individuals (N=13) on measures of pain, disability, pain beliefs, and pain coping strategies. A history of a suicide attempt was associated with suicidal intent. Family history of substance abuse was significantly more prevalent among the depressed groups, regardless of suicidal thinking. The depressed/suicidal group and depressed/non-suicidal groups reported higher levels of pain, higher levels of pain-related disability, lower use of active coping, and higher use of passive coping compared to the non-depressed group. The depressed groups did not differ from one another on any of the measures of pain experience. Depression, not suicidal status, consistently predicted level of functioning. The prevalence of suicidal intent was comparable to rates observed in other studies and relatively low. When individuals with chronic pain report suicidal intent, it is imperative that measures preventing self-harm be implemented immediately and the patient's depression be treated aggressively.     

Thoughts of death and suicidal ideation in nonpsychiatric human immunodeficiency virus seropositive individuals

The present study examines the prevalence of death thoughts and suicidality in HIV infection. Subjects (n = 246) were examined for psychiatric morbidity and suicidality. Compared to high risk HIV seronegatives, HIV seropositives (HIV +) had significantly increased frequency and severity of both suicidal ideation and death thoughts. Two-thirds of seropositives had suicidal ideation at some point; half of the seropositives reported suicide plans and one quarter suicide attempts; and third of seropositives reported current suicidal ideation. Suicidal ideation did not increase with advancing disease. The high prevalence of suicidal ideation suggests inclusion of its assessment in HIV treatment regardless of stage.     

Posttraumatic stress disorder, depression, and suicide in veterans

Suicidal behavior is a critical problem in war veterans. Combat veterans are not only more likely to have suicidal ideation, often associated with posttraumatic stress disorder (PTSD) and depression, but they are more likely to act on a suicidal plan. Especially since veterans may be less likely to seek help from a mental health professional, non-mental-health physicians are in a key position to screen for PTSD, depression, and suicidal ideation in these patients. The authors discuss the association of PTSD, depression, and suicide in veterans, keys to assessment of suicide risk, and interventions.