Pediatric emergency department suicidal patients: Two-site evaluation of suicide ideators, single attempters, and repeat attempters
Pediatric emergency department suicidal patients: Two-site evaluation of suicide ideators, single attempters, and repeat attempters
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DOI：
10.1097/chi.0b013e3181799ee8
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发表时间：
2008-08-01
影响因子：
13.3
通讯作者：
Tang, Lingqi
中科院分区：
文献类型：
--
作者：
Asarnow, Joan Rosenbaum;Baraff, Larry J.;Tang, Lingqi
目标：减少青少年自杀和自杀未遂是国家优先事项。自杀青少年急诊科 (ED) 患者面临重复自杀和致命企图的高风险，但缺乏指导服务提供的信息。在一项针对有自杀倾向的青少年 ED 患者的最大临床研究中，我们检查了意念者、单次尝试者和重复尝试者，目的是阐明 ED 管理和风险评估的最佳策略。方法：从两个急诊室 (N = 210) 连续入院的自杀青少年（10-18 岁）完成了一份评估社会人口统计、临床、服务使用和环境压力变量的调查问卷。结果：尽管背景特征存在差异，但不同地点均观察到高水平的抑郁、外化行为、创伤后应激症状、物质使用和思维问题。自杀企图风险的定义是从意念到单次尝试再到重复尝试的连续过程，是通过较高水平的临床症状、服务使用和环境压力来预测的。与自杀企图风险增加相关的具体压力包括感情破裂、自杀/自杀企图以及自己或伴侣怀孕。在男性亚组中，预测尝试风险的重要因素是抑郁、思想问题、之前就诊过的急诊室以及浪漫的分手。结论：有自杀意念、单次尝试和重复尝试的儿童 ED 患者的风险呈连续增加趋势。男性的自杀未遂风险与高水平的抑郁症相关，但与治疗率的增加无关，这表明男性的治疗不足，而男性是自杀死亡风险特别高的群体。必须解决治疗障碍，以实现我们减少青少年自杀/自杀未遂的国家目标。
Objective: Reducing youth suicide and suicide attempts are national priorities. Suicidal youth emergency department (ED) patients are at high risk for repeat and fatal attempts, yet information is lacking to guide service delivery. In one of the largest clinical studies of youth ED patients presenting with suicidality, we examine ideators, single attempters, and repeat attempters with the aim of clarifying optimal strategies for ED management and risk assessment. Method: Consecutively admitted suicidal youths (10-18 years) from two EDs (N = 210) completed a questionnaire assessing sociodemographic, clinical, service use, and environmental stress variables. Results: Despite differences in background characteristics, high levels of depression, externalizing behavior, posttraumatic stress symptoms, substance use, and thought problems were observed across sites. Suicide attempt risk, defined along a continuum ranging from ideation to single attempts to repeat attempts, was predicted by higher levels of clinical symptoms, service use, and environmental stress. Specific stresses associated with increased suicide attempt risk were romantic breakups, exposure to suicide/suicide attempts, and pregnancy in self or partner. Significant predictors of attempt risk in the male-only subgroup were depression, thought problems, previous ED visits, and romantic breakups. Conclusions: Pediatric ED patients presenting with suicidal ideation, single attempts, and repeat attempts fall along a continuum of increasing risk. Suicide attempt risk in males is associated with high levels of depression, but not with increased treatment rates, suggesting undertreatment in males, a group with particularly high risk for death by suicide. Treatment barriers must be addressed to achieve our national goal of reducing suicide/suicide attempts in youths.