Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review.
Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review.
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DOI：
10.1176/appi.ajp.2020.20060864
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发表时间：
2021-07
影响因子：
17.7
通讯作者：
Auerbach, Randy P.
中科院分区：
文献类型：
--
作者：
Mann, J. John;Michel, Christina A.;Auerbach, Randy P.
确定可扩展的基于证据的自杀预防策略。在2005年9月至2019年12月期间检索PubMed和Google Scholar，识别出20，234篇文章。这些研究包括97项以自杀行为或自杀意念为主要结局的随机对照试验，以及限制使用致命手段的流行病学研究、教育方法和抗抑郁药研究。培训初级保健医生识别和治疗抑郁症可以预防自杀。对青少年进行有关抑郁和自杀行为的教育，并在精神病患者出院或出现自杀危机后积极外展，可预防自杀行为。荟萃分析发现，抗抑郁药可以预防自杀企图，但单个RCT似乎效力不足。氯胺酮可在数小时内减少自杀意念，但未对自杀行为预防进行测试。CBT和DBT可以预防自杀行为。主动筛查自杀意念或行为并没有被证明比仅仅筛查抑郁症更好。对守门人进行有关青少年自杀行为的教育缺乏有效性。未报告关于成人自杀行为预防的守门人培训的RCT。电子健康记录（EHR）筛查，基于互联网的筛查和智能手机被动监测以识别高风险患者的研究不足。包括枪支在内的手段限制可以防止自杀，但在美国很少使用，尽管美国一半的自杀案件都使用枪支培训全科医生需要在其他非精神科医生的环境中更广泛地实施和测试。要求随机对照试验比较成人守门人教育与教育高风险成人（包括大多数精神病患者）的有效性。对出院后或发生自杀相关危机的患者进行积极的随访应该是常规的，限制高危人群使用枪支应该得到更广泛的使用。医疗保健系统中的组合方法显示出减少英国自杀的希望，丹麦和美国，但评估每个组成部分的效益至关重要。进一步降低自杀率需要评估更新的方法，如EHR衍生算法，基于互联网的筛查方法，氯胺酮对预防尝试的益处以及对急性自杀风险变化的被动监测。
To identify scalable evidence-based suicide prevention strategies. Searching PubMed and Google Scholar between September 2005-December 2019 identified 20,234 articles. These included 97 RCTs with suicidal behavior or ideation as primary outcomes, and epidemiological studies of limiting access to lethal means, educational approaches and antidepressant studies. Training primary care physicians in depression recognition and treatment prevents suicide. Educating youth regarding depression and suicidal behavior, and active outreach of psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find antidepressants prevent suicide attempts, but individual RCTs appear under-powered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. CBT and DBT prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No RCTs are reported for gatekeeper training for adult suicidal behavior prevention. Algorithm-driven electronic health records (EHR) screening, internet-based screening and smartphone passive monitoring to identify high-risk patients are under-studied. Means restriction, including firearms, prevents suicide, but is rarely employed in the U.S., even though firearms are used in half of all U.S. suicides. Training general practitioners warrants wider implementation and testing in other non-psychiatrist physician settings. RCTs are required to compare effectiveness of education of adult gatekeepers versus educating higher risk adults including most psychiatric patients. Active follow-up of patients after discharge or a suicide-related crisis should be routine and restricting firearm access by at-risk individuals warrants wider-use. Combination approaches in healthcare systems show promise in reducing suicide in U.K., Denmark and U.S., but evaluating benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches like EHR-derived algorithms, internet-based screening methods, ketamine’s benefit for preventing attempts and passive monitoring of acute suicide risk change.
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