Effect of crisis response planning vs. contracts for safety on suicide risk in US Army Soldiers: A randomized clinical trial
Effect of crisis response planning vs. contracts for safety on suicide risk in US Army Soldiers: A randomized clinical trial
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DOI：
10.1016/j.jad.2017.01.028
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发表时间：
2017-04-01
影响因子：
6.6
通讯作者：
Rudd, M. David
中科院分区：
文献类型：
--
作者：
Bryan, Craig J.;Mintz, Jim;Rudd, M. David
目的：评估危机应对计划对于预防自杀未遂的有效性。方法：对科罗拉多州卡森堡现役陆军士兵（N=97）进行随机临床试验，要求进行紧急行为健康预约。参与者被随机分配接受安全合同、标准危机应对计划或增强型危机应对计划。通过自杀未遂自伤访谈评估随访期间自杀未遂的发生率。纳入标准是过去一周内存在自杀意念和/或终生自杀企图史。排除标准是存在无法获得知情同意的医疗状况（例如，活动性精神病、躁狂症）。生存曲线分析用于确定首次自杀企图的时间效果。使用纵向混合效应模型来确定自杀意念严重程度和后续心理保健利用率的效果。结果：从基线到 6 个月随访，3 名接受危机应对计划的参与者（估计比例：5%）和 5 名接受安全合同的参与者（估计比例：19%）尝试自杀（对数秩 chi(2)(1)=4.85，p=0.028； 风险比=0.24，95% CI=0.06-0.96），表明自杀企图减少了 76%。危机应对计划与自杀意念显着更快下降（F（3,195）= 18.64，p < 0.001）和住院天数更少（F（1,82）= 7.41，p < 0.001）相关。强化危机应对计划和标准危机应对计划的条件没有差异。结论：危机应对计划比安全合同在预防高危现役士兵自杀未遂、解决自杀意念和减少住院治疗方面更有效。
Objective: To evaluate the effectiveness of crisis response planning for the prevention of suicide attempts.Method: Randomized clinical trial of active duty Army Soldiers (N=97) at Fort Carson, Colorado, presenting for an emergency behavioral health appointment. Participants were randomly assigned to receive a contract for safety, a standard crisis response plan, or an enhanced crisis response plan. Incidence of suicide attempts during follow-up was assessed with the Suicide Attempt Self-Injury Interview. Inclusion criteria were the presence of suicidal ideation during the past week and/or a lifetime history of suicide attempt. Exclusion criteria were the presence of a medical condition that precluded informed consent (e.g., active psychosis, mania). Survival curve analyses were used to determine efficacy on time to first suicide attempt. Longitudinal mixed effects models were used to determine efficacy on severity of suicide ideation and follow-up mental health care utilization.Results: From baseline to the 6-month follow-up, 3 participants receiving a crisis response plan (estimated proportion: 5%) and 5 participants receiving a contract for safety (estimated proportion: 19%) attempted suicide (log-rank chi(2)(1)=4.85, p=0.028; hazard ratio=0.24, 95% CI=0.06-0.96), suggesting a 76% reduction in suicide attempts. Crisis response planning was associated with significantly faster decline in suicide ideation (F(3,195)=18.64, p < 0.001) and fewer inpatient hospitalization days (F(1,82)=7.41, p < 0.001). There were no differences between the enhanced and standard crisis response plan conditions.Conclusion: Crisis response planning was more effective than a contract for safety in preventing suicide attempts, resolving suicide ideation, and reducing inpatient hospitalization among high-risk active duty Soldiers.