Trust is the Basis for Effective Suicide Risk Screening and Assessment in Veterans
Trust is the Basis for Effective Suicide Risk Screening and Assessment in Veterans
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DOI：
10.1007/s11606-013-2412-6
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发表时间：
2013-09-01
影响因子：
5.7
通讯作者：
Dobscha, Steven K.
中科院分区：
文献类型：
--
作者：
Ganzini, Linda;Denneson, Lauren M.;Dobscha, Steven K.
为了减少退伍军人的自杀率，退伍军人事务部 (VA) 指定对抑郁症或创伤后应激障碍筛查呈阳性的退伍军人进行自杀风险评估作为国家绩效目标。许多退伍军人管理局医疗中心 (VAMC) 正在使用在非心理健康门诊护理环境中进行的简短自杀意念筛查，作为评估过程的第一步。为了探讨退伍军人对自杀筛查和风险评估过程的看法、披露自杀想法的障碍和促进因素，以及对披露自杀想法可能产生的后果的看法。研究人员记录了与每位退伍军人的半结构化访谈。使用修改后的扎根理论方法对成绩单进行分析。34 名持久自由行动/伊拉克自由行动 (OEF/OIF) 退伍军人于 2009 年和 2010 年在非心理健康门诊护理机构中筛查出自杀意念呈阳性。退伍军人接受了评估自杀风险的必要性。他们越来越多地经历了压抑和避免自杀念头的尝试，这让他们感到沉重和疲惫。尽管如此，退伍军人在筛查时往往未能透露严重且普遍的自杀念头，因为：（1）他们认为自杀念头是可耻的，是软弱的表现；（2）他们认为自杀念头是可耻的，是软弱的表现。 （2）他们认为自杀的想法是私人的，不能透露给陌生人； (3) 他们担心披露会导致不必要的住院治疗或药物建议； (4) 模板化的计算机提醒流程被认为是敷衍且不尊重的。相比之下，承认并与专注于建立关系、表现出真诚和同理心、提供有关自杀风险评估基本原理的信息并使用简单易懂的语言的医疗服务提供者讨论自杀想法，所有这些都促进了信任，从而导致更诚实地披露自杀想法。在门诊护理环境中，提供者的行为和系统修改都可能导致更诚实地披露自杀想法。 (C) 普通内科学会 2013
To reduce suicides among Veterans, the Department of Veterans Affairs (VA) has designated suicide risk assessments for Veterans who screen positive for depression or post-traumatic stress disorder as a national performance goal. Many VA Medical Centers (VAMCs) are using brief suicidal ideation screens, administered in non-mental health ambulatory care settings, as the first step in the assessment process.To explore Veterans' perceptions of the suicide screening and risk assessment process, the barriers and facilitators to disclosing suicidal thoughts, and perceptions of possible consequences of revealing suicidal thoughts.Investigators recorded one semi-structured interview with each Veteran. Transcripts were analyzed using a modified grounded theory approach.Thirty-four Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who screened positive for suicidal ideation in non-mental health ambulatory care settings in 2009 and 2010.Veterans accepted the need to assess suicide risk. They increasingly experienced attempts to suppress and avoid thoughts of suicide as burdensome and exhausting. Despite this, Veterans often failed to disclose severe and pervasive suicidal thoughts when screened because: (1) they considered suicidal thoughts as shameful and a sign of weakness; (2) they believed suicidal thoughts were private and not to be divulged to strangers; (3) they worried that disclosure would lead to unwanted hospitalization or medication recommendations; and (4) the templated computer reminder process was perceived as perfunctory and disrespectful. In contrast, admitting and discussing thoughts of suicide with a health provider who focused on building a relationship, demonstrated genuineness and empathy, offered information on the rationale for suicide risk assessment, and used straightforward and understandable language, all promoted trust that resulted in more honest disclosure of suicidal thoughts.In ambulatory care settings, both provider behaviors and system modifications may lead to more honest disclosure of suicidal thoughts. (C) Society of General Internal Medicine 2013