Suicide Rates After Discharge From Psychiatric Facilities A Systematic Review and Meta-analysis
Suicide Rates After Discharge From Psychiatric Facilities A Systematic Review and Meta-analysis
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DOI：
10.1001/jamapsychiatry.2017.1044
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发表时间：
2017-07-01
期刊：
影响因子：
25.8
通讯作者：
Large, Matthew Michael
中科院分区：
文献类型：
--
作者：
Chung, Daniel Thomas;Ryan, Christopher James;Large, Matthew Michael
重要性精神科住院后自杀率高的报道在许多研究中，但增加的幅度和潜在的因素仍然不清楚。结论量化从精神科设施出院后自杀率，并检查是什么缓和这些率。数据来源英语，同行评议的出版物从1946年1月1日，到2016年5月1日，使用MEDLINE、PsychINFO和EMBASE，检索词为（（suicid*）。ti AND（住院或出院 * 或住院或住院 *）。ab和（（死亡率或结果 * 或死亡 *）和（心理 * 或精神 *））。ti AND（入院 * 或入院 * 或住院 * 或出院 *）。AB.研究选择报告从精神病机构出院的患者中自杀人数和暴露人数-年数的研究，以及可以计算这些数据的研究。数据提取和综合荟萃分析遵循系统评价和荟萃分析的首选报告项目（PRISMA）和流行病学观察性研究的荟萃分析（MOOSE）指南。随机效应模型用于计算每100000人年的出院后自杀率的合并估计值。主要结果和测量从精神病院出院后的自杀率是主要结果，随访持续时间和采样年份之间的关系是主要的先验调节因素。结果共有100项研究报告了183例患者样本（50例女性样本，49例男性样本，84例混合性别样本; 129例成人或未指明患者，20例青少年，19例老年患者，15例来自长期或法医出院机构），包括在4725445人年期间总计17857例自杀。合并估计的出院后自杀率为484例/10万人年（95%CI，422-555例/10万人年;预测区间，89-2641），样本间异质性较高（I-2 = 98%）。出院后3个月内的自杀率最高（1132; 95% CI，874-1467），在有自杀想法或行为的住院患者中自杀率最高（2078; 95% CI，1512-2856）。在随访期为3个月至1年的研究中，每10万患者-年的合并自杀率为654，在随访期为1至5年的研究中为494，在随访期为5至10年的研究中为366，在随访期超过10年的研究中为277。在1995-2004年（656; 95%CI，518-831）和2005-2016年（672; 95%CI，428-1055）期间收集的样本中，自杀率高于早期samples.Conclusions和相关性立即出院后时期是一个显着的风险，但自杀率仍然很高，出院后多年。因自杀念头或行为而入院的患者以及出院后最初几个月的患者应特别关注。以前入院的病人应该能够获得长期护理和帮助。
IMPORTANCE High rates of suicide after psychiatric hospitalization are reported in many studies, yet the magnitude of the increases and the factors underlying them remain unclear.OBJECTIVES To quantify the rates of suicide after discharge from psychiatric facilities and examine what moderates those rates.DATA SOURCES English-language, peer-reviewed publications published from January 1, 1946, to May 1, 2016, were located using MEDLINE, PsychINFO, and EMBASE with the search terms ((suicid*). ti AND (hospital or discharg* OR inpatient or in-patient OR admit*). ab and ((mortality OR outcome* OR death*) AND (psych* OR mental*)). ti AND (admit* OR admis* or hospital* OR inpatient* OR in-patient* OR discharg*). ab. Hand searching was also done.STUDY SELECTION Studies reporting the number of suicides among patients discharged from psychiatric facilities and the number of exposed person-years and studies from which these data could be calculated.DATA EXTRACTION AND SYNTHESIS The meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. A random-effects model was used to calculate a pooled estimate of postdischarge suicides per 100 000 person-years.MAIN OUTCOMES AND MEASURES The suicide rate after discharge from psychiatric facilities was the main outcome, and the association between the duration of follow-up and the year of the sampling were the main a priori moderators.RESULTS A total of 100 studies reported 183 patient samples (50 samples of females, 49 of males, and 84 of mixed sex; 129 of adults or unspecified patients, 20 of adolescents, 19 of older patients, and 15 from long-term or forensic discharge facilities), including a total of 17 857 suicides during 4 725 445 person-years. The pooled estimate postdischarge suicide rate was 484 suicides per 100 000 person-years (95% CI, 422-555 suicides per 100 000 person-years; prediction interval, 89-2641), with high between-sample heterogeneity (I-2 = 98%). The suicide rate was highest within 3 months after discharge (1132; 95% CI, 874-1467) and among patients admitted with suicidal ideas or behaviors (2078; 95% CI, 1512-2856). Pooled suicide rates per 100 000 patients-years were 654 for studies with follow-up periods of 3 months to 1 year, 494 for studies with follow-up periods of 1 to 5 years, 366 for studies with follow-up periods of 5 to 10 years, and 277 for studies with follow-up periods longer than 10 years. Suicide rates were higher among samples collected in the periods 1995-2004 (656; 95% CI, 518-831) and 2005-2016 (672; 95% CI, 428-1055) than in earlier samples.CONCLUSIONS AND RELEVANCE The immediate postdischarge period is a time of marked risk, but rates of suicide remain high for many years after discharge. Patients admitted because of suicidal ideas or behaviors and those in the first months after discharge should be a particular focus of concern. Previously admitted patients should be able to access long-term care and assistance.