A Randomized Controlled Trial to Engage in Care of Adolescent Emergency Department Patients With Mental Health Problems That Increase Suicide Risk
A Randomized Controlled Trial to Engage in Care of Adolescent Emergency Department Patients With Mental Health Problems That Increase Suicide Risk
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DOI：
10.1097/pec.0b013e3182767ac8
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发表时间：
2012-12-01
影响因子：
1.4
通讯作者：
Olfson, Mark
中科院分区：
文献类型：
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作者：
Grupp-Phelan, Jacqueline;McGuire, Leslie;Olfson, Mark
背景资料：在儿科急诊科（ED），有自杀风险的青少年往往逃避检测和成功转诊门诊心理healthcare.Objective：本研究旨在评估一个简短的，基于ED的心理健康服务参与干预的有效性，以增加与门诊心理健康服务的联系。设计/方法：对目前未接受精神卫生服务的儿童艾德就诊的青少年进行自杀相关风险因素筛查（哥伦比亚自杀量表）。如果呈阳性，则对年轻人进行损伤，酒精使用和抑郁症的筛查。那些在哥伦比亚自杀量表和酒精、损伤或抑郁筛查中筛查为阳性的人被随机分配到干预组（简短的动机访谈、障碍减少、建立门诊预约、预约前提醒）或标准转诊组（精神健康提供者的电话号码）。研究组进行了比较，就屏幕的可接受性和门诊心理卫生保健的联系和抑郁症状的变化，在60天后的指数艾德visit.Results：共204个家庭参加。总体而言，24名青少年（12%）筛选出自杀风险因素阳性，并随机分配到干预组（n = 11）或标准转诊组（n = 13）。两组在屏幕可接受性的几个指标上没有显着差异。与标准转诊组（15.4%）相比，干预组（63.6%）在随访期间更有可能参加心理健康预约（Fisher精确检验，P = 0.03）。也有更大的改善抑郁症状的干预比标准转诊组（t = 1.79，df = 18，P = 0.09）。结论：当青少年被确定在艾德与以前未被认识到的心理健康问题，增加自杀风险，一个简短的动机和障碍减少干预提高联系门诊心理健康服务。
Background: In pediatric emergency departments (EDs), adolescents at risk for suicide often escape detection and successful referral for outpatient mental health care.Objective: This study aimed to assess the effectiveness of a brief, ED-based mental health service engagement intervention to increase linkage to outpatient mental health services.Design/Methods: Adolescents presenting to a pediatric ED who were not currently receiving mental health services were screened for suicide-related risk factors (Columbia Suicide Scale). If positive, youths were then screened for impairment, alcohol use, and depression. Those screening positive on the Columbia Suicide Scale and the alcohol, impairment, or depression screen were randomly assigned to the intervention (short motivational interview, barrier reduction, outpatient appointment established, reminders before scheduled appointment) or standard referral (telephone number for a mental health provider). Study groups were compared with respect to screen acceptability and outpatient mental health care linkage and change in depression symptoms at 60 days after the index ED visit.Results: A total of 204 families were enrolled. Overall, 24 adolescents (12%) screened positive for suicide risk factors and were randomized to the intervention (n = 11) or standard referral (n = 13) groups. The groups did not significantly differ on several measures of screen acceptability. As compared with the standard referral group (15.4%), the intervention group (63.6%) was significantly more likely to attend a mental health appointment during the follow-up period (Fisher exact test, P = 0.03). There was also a nonsignificant trend toward greater improvement of depressive symptoms in the intervention than standard referral group (t = 1.79, df = 18, P = 0.09).Conclusions: When adolescents are identified in the ED with previously unrecognized mental health problems that increase suicide risk, a brief motivational and barrier-reducing intervention improves linkage to outpatient mental health services.