An Emergency Department Intervention for Linking Pediatric Suicidal Patients to Follow-Up Mental Health Treatment
An Emergency Department Intervention for Linking Pediatric Suicidal Patients to Follow-Up Mental Health Treatment
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DOI：
10.1176/ps.62.11.pss6211_1303
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发表时间：
2011-11-01
影响因子：
3.8
通讯作者：
Tang, Lingqi
中科院分区：
文献类型：
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作者：
Asarnow, Joan Rosenbaum;Baraff, Larry J.;Tang, Lingqi
目的：自杀是青少年死亡的第三大原因。许多在急诊室接受治疗的有自杀倾向的年轻人没有得到《预防自杀国家战略》所倡导的后续治疗。比较了两种提高随访治疗率的策略。研究方法：在一项随机对照试验中，两个急诊室的自杀青年（N=181;年龄10至18岁）在2003年4月至2005年8月期间被单独分配到以下两种情况之一：一种强化的心理健康干预措施，包括以家庭为基础的认知行为治疗，旨在增加后续治疗和安全的动力，在急诊科出院后通过护理联系电话联系或通过提供者教育加强的常规急诊科护理进行补充。在基线和从急诊科或医院出院后约两个月进行评估。主要结果指标是出院后的门诊心理健康治疗率。结果：干预患者比常规护理患者更有可能参加门诊治疗（92%对76%; p= 0.004）。干预组的心理治疗率（76%对49%; p= 0.001）、心理治疗和药物联合治疗率（58%对37%; p= 0.003）和心理治疗访视率（平均5.3对3.1; p= 0.003）也显著较高。急诊科干预和社区门诊治疗（探索性分析）均与临床或功能结局改善无显著相关性。结论：结果支持加强急诊科干预的有效性，以改善与门诊心理健康治疗的联系，但强调需要改善社区门诊治疗，以防止自杀，自杀企图，以及在急诊科治疗的自杀青年的临床和功能结果不佳。（精神病学服务62：1303-1309，2011）
Objective: Suicide is the third leading cause of death among adolescents. Many suicidal youths treated in emergency departments do not receive follow-up treatment as advocated by the National Strategy for Suicide Prevention. Two strategies for improving rates of follow-up treatment were compared. Methods: In a randomized controlled trial, suicidal youths at two emergency departments (N=181; ages ten to 18) were individually assigned between April 2003 and August 2005 to one of two conditions: an enhanced mental health intervention involving a family-based cognitive-behavioral therapy session designed to increase motivation for follow-up treatment and safety, supplemented by care linkage telephone contacts after emergency department discharge, or usual emergency department care enhanced by provider education. Assessments were conducted at baseline and approximately two months after discharge from the emergency department or hospital. The primary outcome measure was rates of outpatient mental health treatment after discharge. Results: Intervention patients were significantly more likely than usual care patients to attend outpatient treatment (92% versus 76%; p=.004). The intervention group also had significantly higher rates of psychotherapy (76% versus 49%; p=.001), combined psychotherapy and medication (58% versus 37%; p=.003), and psychotherapy visits (mean 5.3 versus 3.1; p=.003). Neither the emergency department intervention nor community outpatient treatment (in exploratory analyses) was significantly associated with improved clinical or functioning outcomes. Conclusions: Results support efficacy of the enhanced emergency department intervention for improving linkage to outpatient mental health treatment but underscore the need for improved community outpatient treatment to prevent suicide, suicide attempts, and poor clinical and functioning outcomes for suicidal youths treated in emergency departments. (Psychiatric Services 62:1303-1309, 2011)