Lessons from a comprehensive clinical audit of users of psychiatric services who committed suicide
Lessons from a comprehensive clinical audit of users of psychiatric services who committed suicide
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DOI：
10.1176/appi.ps.51.12.1555
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发表时间：
2000-12-01
影响因子：
3.8
通讯作者：
Croke, E
中科院分区：
文献类型：
--
作者：
Burgess, P;Pirkis, J;Croke, E
目的：对自杀患者的特征进行检查，以了解他们死前接受的治疗情况，并确定服务系统是否可以以及如何预防自杀。方法：将非自然死亡登记册与澳大利亚维多利亚州的精神病病例登记册相匹配，以识别有公共部门精神科服务使用史且在 1989 年 7 月 1 日至 1994 年 6 月 30 日期间自杀的人的自杀情况。三位经验丰富的临床医生检查了患者和治疗特征的数据，他们判断如果服务系统的反应不同，是否可以预防自杀。对定量和定性数据进行了描述性分析。结果：共确定了 629 名自杀的精神病患者。 72%的患者为男性，62%年龄在40岁以下，51%未婚。他们患有一系列疾病，最常见的是精神分裂症或分裂情感障碍（36%）。百分之六十七的人此前曾尝试过自杀。共有 311 名患者（49%）在死亡后 4 周内接受了护理。百分之二十的自杀被认为是可以预防的。与可预防性相关的关键因素是医患关系不佳、评估不完整、抑郁症和心理问题评估和治疗不佳以及护理连续性差。结论：精神科服务系统有机会在多个层面上改变做法，从而减少患者自杀。
Objective: Characteristics of patients who committed suicide were examined to provide a picture of the treatment they received before death and to determine whether and how the suicides could have been pre vented by the service system. Methods: The unnatural-deaths register was matched to the psychiatric case register in the state of Victoria in Australia to identify suicides by people with a history of public-sector psychiatric service use who committed suicide between July 1, 1989, and June 30, 1994. Data on patient and treatment characteristics were examined by three experienced clinicians, who made judgments about whether the suicide could have been prevented had the service system responded differently. Quantitative and qualitative data were descriptively analyzed. Results: A total of 629 psychiatric patients who had committed suicide were identified. Seventy-two percent of the patients were male, 62 percent were under 40 years old, and 51 percent were unmarried. They had a range of disorders, with the most common being schizophrenia or schizoaffective disorder (36 percent). Sixty-seven percent had previously attempted suicide. A total of 311 patients (49 percent) received care within four weeks of death. Twenty percent of the suicides were considered preventable. Key factors associated with preventability were poor staff-patient relationships, incomplete assessments, poor assessment and treatment of depression and psychological problems, and poor continuity of care. Conclusions: Opportunities exist for the psychiatric service system to alter practices at several levels and thereby reduce patient suicides.