SELF-RATED EXPECTATIONS OF SUICIDAL BEHAVIOR PREDICT FUTURE SUICIDE ATTEMPTS AMONG ADOLESCENT AND YOUNG ADULT PSYCHIATRIC EMERGENCY PATIENTS
SELF-RATED EXPECTATIONS OF SUICIDAL BEHAVIOR PREDICT FUTURE SUICIDE ATTEMPTS AMONG ADOLESCENT AND YOUNG ADULT PSYCHIATRIC EMERGENCY PATIENTS
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DOI：
10.1002/da.22514
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发表时间：
2016-06-01
影响因子：
7.4
通讯作者：
King, Cheryl A.
中科院分区：
文献类型：
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作者：
Czyz, Ewa K.;Horwitz, Adam G.;King, Cheryl A.
背景资料：本研究的目的是检查在精神科急诊（PE）部门实施的一项简短措施的预测有效性和临床实用性，该措施评估青少年自己对未来自杀行为风险的预期;并确定青少年的评分是否在临床医生评估后有所提高自杀想法严重程度。结果是长达18个月后的自杀企图。研究方法：在这项医疗记录审查研究中，340名连续提出的青少年（13-24岁）寻求体育服务超过7个月的时间。随后的PE访视和自杀企图进行了长达18个月的回顾性跟踪。在研究中心常规使用3项量表评估患者对自身自杀行为风险的感知和临床医生管理的意念严重程度量表。结果如下：考克斯回归结果显示，即使在调整了关键协变量之后，年轻人对自杀行为的预期与自杀企图风险的增加独立相关。结果不受性别、自杀企图史或年龄的影响。受试者操作特征（ROC）分析表明，自我评估的风险预期提高了临床医生管理的自杀意念措施的预测准确性。结论：青年人的评级表明在维持安全性方面的信心较低，这是唯一预测随访尝试的指标，并提供了超过临床医生评估的增量有效性，并提高了其准确性，表明其有可能增加自杀风险。评估青少年对自杀风险的看法似乎在临床上是有用的，在体育环境中实施是可行的，如果复制的话，有希望提高对有自杀行为风险的青少年的识别。抑郁和焦虑33：512-519，2016。(C)2016 Wiley Periodicals，Inc.
Background: This study's purpose was to examine the predictive validity and clinical utility of a brief measure assessing youths' own expectations of their future risk of suicidal behavior, administered in a psychiatric emergency (PE) department; and determine if youths' ratings improve upon a clinician-administered assessment of suicidal ideation severity. The outcome was suicide attempts up to 18 months later. Methods: In this medical record review study, 340 consecutively presenting youths (ages 13-24) seeking PE services over a 7-month period were included. Subsequent PE visits and suicide attempts were retrospectively tracked for up to 18 months. The 3-item scale assessing patients' perception of their own suicidal behavior risk and the clinician-administered ideation severity scale were used routinely at the study site. Results: Cox regression results showed that youths' expectations of suicidal behavior were independently associated with increased risk of suicide attempts, even after adjusting for key covariates. Results were not moderated by sex, suicide attempt history, or age. Receiver-operating characteristic (ROC) analyses indicated that self-assessed expectations of risk improved the predictive accuracy of the clinician-administered suicidal ideation measure. Conclusions: Youths' ratings indicative of lower confidence in maintaining safety uniquely predicted follow-up attempts and provided incremental validity over and above the clinician-administered assessment and improved its accuracy, suggesting their potential for augmenting suicide risk formulation. Assessing youths' own perceptions of suicide risk appears to be clinically useful, feasible to implement in PE settings, and, if replicated, promising for improving identification of youth at risk for suicidal behavior. Depression and Anxiety 33: 512-519, 2016. (C) 2016 Wiley Periodicals, Inc.