Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation
Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation
复制标题
DOI：
10.1136/bmjopen-2018-023883
复制
发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Large, Matthew
中科院分区：
文献类型：
--
作者：
Chung, Daniel;Hadzi-Pavlovic, Dusan;Large, Matthew
目的评估出院后第一周和第一个月的自杀率的大小，精神病hospitalisation.Design相关的英文，同行评议的论文发表在MEDLINE，PsycINFO或Embase之间的01 1月1945年和31日2017年3月，并辅以手工检索和个人沟通。广义线性效应模型拟合自杀人数，泊松分布，对数链接和人年的对数作为偏移。采用随机效应模型计算总体合并率和敏感性分析中的亚组内自杀率。结果测量精神病住院患者出院后第一周和第一个月内每10万人年的自杀率。结果纳入的34篇论文包括29篇报道出院后第一个月自杀的研究（222546患者年中有3551例自杀）和24项研究报告了出院后第一周的自杀事件（60880患者年中有1928例自杀）。出院后第一个月自杀率的汇总估计值为2060/100 000人年（95% CI=1300 - 3280，I-2=90）。出院后第一周自杀率的汇总估计值为每10万人年2950例自杀（95% CI=1740 - 5000，I-2=88）。八项研究，包括个人通信后，有较低的合并自杀率比研究后，包括数据提取和有证据表明，发表偏向论文报告率较高的出院后suiction.Conclusion承认存在显着异质性的研究和偏倚的可能性，对研究发表报告率较高的出院后自杀率，精神科住院后出院后的第一周和第一个月是自杀风险极高的时期。应加强对出院患者的短期随访，更加注重从医院到社区护理的安全过渡。
Objective To assess the magnitude of suicide rates in the first week and first month postdischarge following psychiatric hospitalisation.Design Meta-analysis of relevant English-language, peer-reviewed papers published in MEDLINE, PsycINFO or Embase between 01 January 1945 and 31 March 2017 and supplemented by hand searching and personal communication. A generalised linear effects model was fitted to the number of suicides, with a Poisson distribution, log link and log of person years as an offset. A random effects model was used to calculate the overall pooled rates and within subgroups in sensitivity analyses.Outcome measures Suicides per 100 000 person years in the first week and the first month after discharge from psychiatric hospitalisation.Results Thirty-four included papers comprised 29 studies that reported suicides in the first month postdischarge (3551 suicides during 222 546 patient years) and 24 studies that reported suicides in the first week postdischarge (1928 suicides during 60 880 patient years). The pooled estimate of the suicide rate in the first month postdischarge suicide was 2060 per 100 000 person years (95% CI=1300 to 3280, I-2=90). The pooled estimate of the suicide rate in the first week postdischarge suicide was 2950 suicides per 100 000 person years (95% CI=1740 to 5000, I-2=88). Eight studies that were included after personal communication had lower pooled rates of suicide than studies included after data extraction and there was evidence of publication bias towards papers reporting a higher rate of postdischarge suicide.Conclusion Acknowledging the presence of marked heterogeneity between studies and the likelihood of bias towards publication of studies reporting a higher postdischarge suicide rate, the first week and first month postdischarge following psychiatric hospitalisation are periods of extraordinary suicide risk. Short-term follow-up of discharged patients should be augmented with greater focus on safe transition from hospital to community care.