Suicide Within Two Weeks of Discharge From Psychiatric Inpatient Care: A Case-Control Study
Suicide Within Two Weeks of Discharge From Psychiatric Inpatient Care: A Case-Control Study
复制标题
DOI：
10.1176/appi.ps.201200026
复制
发表时间：
2013-07-01
影响因子：
3.8
通讯作者：
Kapur, Navneet
中科院分区：
文献类型：
--
作者：
Bickley, Harriet;Hunt, Isabelle M.;Kapur, Navneet
目的：精神科住院患者出院后自杀风险很高，尤其是在最初的几周内。这项研究的目的是确定患者在出院后两周内自杀的风险因素和保护因素(即与自杀风险降低相关的因素)，包括接受的医疗保健的差异。方法：这是一项全国性的以人群为基础的回顾性病例对照研究，研究对象为英国的100名精神病患者(2004-2006年)，年龄18-65岁，出院后两周内自杀身亡。这些患者的出院日期与100名活着的对照组患者相匹配。结果：55%的自杀发生在出院后一周内，其中49%的人在第一次复诊前死亡。条件Logistic回归分析表明，近期不良生活事件和最终入院时间短(不到一周)与出院后自杀独立相关，年龄较大和合并精神障碍也是如此。接受加强的善后照料(根据关怀方案办法)是对自杀的保护。结论：被认为有高自杀风险的出院患者需要立即进行社区随访。精神卫生服务机构应该注意患者在短暂入院后出院。有害生活经历的潜在作用表明，精神健康临床医生需要意识到患者出院时的情况。采用更高水平的护理，如护理方案提供的方法，可能在防止出院后两周内自杀方面发挥强有力的作用。
Objective: Suicide risk after discharge from psychiatric inpatient care is high, particularly in the first few weeks. The aim of the study was to identify risk factors and protective factors (that is, factors associated with a reduced risk of suicide), including variation in health care received, for suicide among patients in the two-week postdischarge period. Methods: This was a national population-based retrospective case-control study of 100 psychiatric patients in England (2004-2006), age 18-65, who died by suicide within two weeks of hospital discharge. These patients were matched on discharge date with 100 living control group patients. Results: Fifty-five percent of suicides occurred within a week of discharge, 49% of whom died before their first follow-up appointment. Conditional logistic regression analyses indicated that recent adverse life events and a short (less than one week) final admission were independently associated with postdischarge suicide, as were older age and comorbid psychiatric disorders. Receiving enhanced aftercare (under the Care Programme Approach) was protective of suicide. Conclusions: Discharged patients viewed as being at high risk of suicide require immediate community follow-up. Mental health services should be mindful of discharging patients after a short admission. The potential role of detrimental life experiences indicates that mental health clinicians need to be aware of the circumstances into which patients are being discharged. Use of enhanced levels of care, such as that offered by the Care Programme Approach, may play a strong role in preventing suicide within two weeks of discharge.