Risk for Suicidal Behavior After Psychiatric Hospitalization Among Sexual and Gender Minority Patients.
Risk for Suicidal Behavior After Psychiatric Hospitalization Among Sexual and Gender Minority Patients.
复制标题
DOI：
10.1001/jamanetworkopen.2023.33060
复制
发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
Melhem, Nadine M.
中科院分区：
文献类型：
--
作者：
Thoma, Brian C.;Hone, Emily;Roig, Alyssa;Goodfriend, Elijah;Jardas, E. J.;Brummitt, Bradley;Riston, Sarah;Sakolsky, Dara;Zelazny, Jamie;Marsland, Anna L.;Chen, Kehui;Douaihy, Antoine B.;Brent, David A.;Melhem, Nadine M.
与异性恋和顺性别个体相比，性和性别少数（SGM）患者在精神病住院后自杀行为的风险是否升高？在这项对160名年轻人进行的队列研究中，SGM患者的自杀行为风险较高，人口统计学和临床特征不能解释出院后100天内少数性别和顺性别患者之间的差异。鉴于SGM患者在住院精神病人群中的比例不成比例，以及他们从精神病护理中出院后自杀行为的风险增加，需要额外关注住院精神病环境中SGM患者的验证和有效护理。这项队列研究评估了性和性别少数（SGM）患者与异性恋和顺性别患者相比，从精神病住院出院后自杀行为的风险是否升高。精神科住院治疗后的几个月是自杀行为的高风险期。性和性别少数（SGM）个体自杀行为的风险升高，但没有先前的研究已经检查SGM住院患者是否有不成比例的自杀行为的风险从精神病院出院。评估SGM患者在精神病住院治疗出院后自杀行为的风险是否高于异性恋和顺性患者，并检查各组之间的风险差异是否由已知与自杀行为相关的人口统计学特征和临床因素解释。这项前瞻性队列研究于2017年8月至2021年7月在精神病住院期间自愿入组的18至30岁住院患者中进行。这项研究是在一家精神病住院医院进行的，通过随访和电子健康记录收集了前瞻性数据。在随访访视时和通过电子健康记录评估的精神病住院治疗出院后自杀行为的发作和/或复发。共纳入160例患者，其中56例性少数（SM）和15例性别少数（GM）患者。患者的中位（IQR）年龄为23.5（20.4-27.6）岁，77例（48%）报告出生时指定为男性，114例（71%）确定其种族为白色。在随访期间，发生了33起自杀行为事件（21%的患者）。在双变量分析中，SM（风险比[HR]，2.02; 95%CI，CI，1.02-4.00;对数秩P = .04）和GM（HR，4.27; 95%CI，1.75-10.40;对数秩P < .001）患者的自杀行为风险分别显著高于异性恋和顺性恋患者。在控制了与自杀行为相关的人口统计学特征和临床因素后，SM和异性恋患者之间的风险没有差异。即使在控制了人口统计学和临床特征后，GM患者在出院后100天内也表现出风险升高（HR，3.80; 95%CI，1.18-11.19; P = .03）。在这项精神病患者队列研究中，SGM患者出院后自杀行为的风险高于非SGM患者。虽然SM患者的风险是由临床特征解释的，但GM患者的自杀行为风险不是由他们入院时的急性精神状态解释的。未来的研究需要更大的转基因个体的子样本，住院医生必须照顾到SGM个体的独特需求，以确保他们得到肯定的服务。
Do sexual and gender minority (SGM) patients have elevated risk for suicidal behavior following psychiatric hospitalization compared with heterosexual and cisgender individuals? In this cohort study of 160 young adults, risk for suicidal behavior was higher among SGM patients, and demographic and clinical characteristics did not account for differences between gender minority and cisgender patients in the 100 days following discharge. Given the disproportionate representation of SGM patients in inpatient psychiatric populations as well as their increased risk for suicidal behavior following discharge from psychiatric care, additional attention to validating and effective care for SGM patients within inpatient psychiatric settings is warranted. This cohort study evaluates whether sexual and gender minority (SGM) patients have elevated risk for suicidal behavior following discharge from psychiatric hospitalization compared with heterosexual and cisgender patients. The months following inpatient psychiatric hospitalization are a period of high risk for suicidal behavior. Sexual and gender minority (SGM) individuals have elevated risk for suicidal behavior, but no prior research has examined whether SGM inpatients have disproportionate risk for suicidal behavior following discharge from psychiatric hospitalization. To evaluate whether SGM patients have elevated risk for suicidal behavior following discharge from psychiatric hospitalization compared with heterosexual and cisgender patients and to examine whether differences in risk across groups were accounted for by demographic characteristics and clinical factors known to be associated with suicidal behavior. This prospective cohort study was conducted from August 2017 to July 2021 among inpatients aged 18 to 30 years who were voluntarily enrolled during psychiatric hospitalization. The study was conducted at an inpatient psychiatric hospital, with prospective data collected via follow-up visits and electronic health records. Onset and/or recurrence of suicidal behavior following discharge from psychiatric hospitalization, assessed at follow-up visits and through electronic health records. A total of 160 patients were included, with 56 sexual minority (SM) and 15 gender minority (GM) patients. The median (IQR) age of the patients was 23.5 (20.4-27.6) years, 77 (48%) reported male sex assigned at birth, and 114 (71%) identified their race as White. During the follow-up period, 33 suicidal behavior events occurred (among 21% of patients). SM (hazard ratio [HR], 2.02; 95% CI, CI, 1.02-4.00; log-rank P = .04) and GM (HR, 4.27; 95% CI, 1.75-10.40; log-rank P < .001) patients had significantly higher risk for suicidal behavior compared with their heterosexual and cisgender counterparts, respectively, in bivariable analyses. Risk between SM and heterosexual patients was not different after controlling for demographic characteristics and clinical factors associated with suicidal behavior. GM patients exhibited elevated risk during the 100 days following discharge even after controlling for demographic and clinical characteristics (HR, 3.80; 95% CI, 1.18-11.19; P = .03). Within this cohort study of psychiatric patients, SGM patients had higher risk for suicidal behavior than non-SGM patients following discharge. While SM patients’ risk was accounted for by clinical characteristics, GM patients’ risk for suicidal behavior was not accounted for by their acute psychiatric state on admission. Future studies with larger subsamples of GM individuals are needed, and inpatient clinicians must attend to the unique needs of SGM individuals to ensure they receive affirming services.
登录
查看更多内容
影响因子：
5
作者：
COHEN, S;KAMARCK, T;MERMELSTEIN, R
通讯作者：
MERMELSTEIN, R
影响因子：
5.3
作者：
Haglund, Axel;Lysell, Henrik;Runeson, Bo
通讯作者：
Runeson, Bo
影响因子：
3.5
作者：
Acosta, William;Qayyum, Zheala;van Schalkwyk, Gerrit Ian
通讯作者：
van Schalkwyk, Gerrit Ian
影响因子：
4.7
作者：
Kcomt, Luisa;Gorey, Kevin M.;McCabe, Sean Esteban
通讯作者：
McCabe, Sean Esteban
自杀的流行病学和精神科观点。
DOI：
10.3390/ijerph15071425
发表时间：
2018-07-06
影响因子：
--
作者：
Bachmann S
通讯作者：
Bachmann S