Determinants and Predictive Value of Clinician Assessment of Short-Term Suicide Risk
Determinants and Predictive Value of Clinician Assessment of Short-Term Suicide Risk
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DOI：
10.1111/sltb.12462
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发表时间：
2019-04-01
影响因子：
3.2
通讯作者：
Galynker, Igor
中科院分区：
文献类型：
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作者：
Barzilay, Shira;Yaseen, Zimri S.;Galynker, Igor
我们考察了临床医生对患者自杀风险的判断、临床医生的情绪反应以及自杀想法和行为的短期预测中的标准危险因素之间的相互关系。有终生自杀意念/企图史的精神科门诊患者(n=153)和他们的治疗临床医生(n=67)在入院时被评估。临床医生完成了标准的自杀风险量表(改良的SAD人群量表)、对患者自杀风险判断的10分Likert量表评估(临床医生预测量表)以及他们对患者的情绪反应的测量(治疗师反应问卷-自杀表格)。采用哥伦比亚自杀严重程度评定量表和Beck自杀意念评定量表进行为期一个月的随访评估(n=114，74.5%)。临床医生对风险的判断显著预测了随访时的自杀念头和行为。标准自杀风险量表和临床医生的情绪反应都对临床医生的风险评估起到了独立的作用，而临床医生的风险评估反过来又调节了他们与自杀想法和行为的关系。我们的发现证实了临床判断在评估自杀风险中的重要性。临床判断似乎同时受到具体风险因素和临床医生对自杀患者的情绪反应的影响，强调情绪意识是一个有希望的研究和培训领域。
We examine the interrelations among clinicians' judgment of patients' suicide risk, clinicians' emotional responses, and standard risk factors in the short-term prediction of suicidal thoughts and behaviors. Psychiatric outpatients (n=153) with a lifetime history of suicide ideation/attempt and their treating clinicians (n=67) were evaluated at intake. Clinicians completed a standard suicide risk instrument (modified SAD PERSONS scale), a 10-point Likert scale assessment of judgment of patient suicide risk (Clinician Prediction Scale), and a measure of their emotional responses to the patient (Therapist Response Questionnaire-Suicide Form). The Columbia Suicide Severity Rating Scale and the Beck Scale for Suicide Ideation were administered at a one-month follow-up assessment (n=114, 74.5%). Clinician judgment of risk significantly predicted suicidal thoughts and behaviors at follow-up. Both the standard suicide risk instrument and clinician emotional responses contributed independently to the clinician assessment of risk, which, in turn, mediated their relationships with suicidal thoughts and behaviors. Our findings validate the importance of clinical judgment in assessing suicide risk. Clinical judgment appears to be informed both by concrete risk factors and clinicians' emotional responses to suicidal patients, highlighting emotional awareness as a promising area for research and training.