Screening for suicide risk in adults: A summary of the evidence for the US preventive services task force
Screening for suicide risk in adults: A summary of the evidence for the US preventive services task force
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DOI：
10.7326/0003-4819-140-10-200405180-00015
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发表时间：
2004-05-18
影响因子：
39.2
通讯作者：
Lohr, KN
中科院分区：
文献类型：
--
作者：
Gaynes, BN;West, SL;Lohr, KN
自杀是美国第11大死亡原因，也是潜在寿命损失的第7大原因。虽然自杀具有重大的公共卫生意义，但其临床管理是复杂的。目的：作者系统地回顾了文献，以确定在初级保健环境中进行自杀风险筛查是否会降低发病率、死亡率或两者兼而有之。数据来源：MEDLINE（1966年至2002年10月17日）、PsycINFO、科克伦数据库、手工检索书目和专家。对于筛选，仅检查了在初级保健环境中进行的英语研究。对于治疗，随机对照试验和队列研究，如果它们是在任何环境下进行的，其中报告了自杀完成，自杀企图或自杀意念。数据提取：一个主要的审查者提取了研究样本，设计和结果的关键变量的数据;第二个审查者检查了原始文章的信息准确性。数据综合：没有研究直接探讨在初级保健中进行自杀筛查是否会降低发病率和死亡率。审查的其余部分集中在自杀风险的可靠筛选测试和干预措施的有效性，以减少抑郁症，自杀意念，自杀企图或完成的问题。一项筛查研究为初级保健环境中自杀筛查的准确性提供了有限的证据。干预研究提供了公平和混合的证据，表明治疗有自杀风险的人可以减少自杀企图或自杀完成的数量。证据表明，轻度至中度的改善干预措施解决中间的结果，如自杀意念，抑郁的严重程度降低，减少绝望，或改善水平的function.Conclusion：由于研究自杀的风险和缺乏精心设计的研究的复杂性，只有有限的证据指导初级保健临床医生的评估和管理自杀风险。
Background: Suicide is the 11th leading cause of death and the seventh leading cause of years of potential life lost in the United States. Although suicide is of great public health significance, its clinical management is complicated.Purpose: The authors systematically reviewed the literature to determine whether screening for suicide risk in primary care settings decreases morbidity, mortality, or both.Data Sources: MEDLINE (1966 to 17 October 2002), PsycINFO, Cochrane databases, hand-searched bibliographies, and experts.Study Selection: For screening, only English-language studies performed in primary care settings were examined. For treatment, randomized, controlled trials and cohort studies were included if they were performed in any setting where suicide completions, suicide attempts, or suicidal ideation were reported.Data Extraction: A primary reviewer abstracted data on key variables of study sample, design, and outcomes; a second reviewer checked information accuracy against the original articles.Data Synthesis: No study directly addressed whether screening for suicide in primary care reduces morbidity and mortality. The remainder of the review focused on the questions of reliable screening tests for suicide risk and the effectiveness of interventions to decrease depression, suicidal ideation, and suicide attempts or completion. One screening study provided limited evidence for the accuracy of suicide screening in a primary care setting. Intervention studies provided fair and mixed evidence that treating those at risk for suicide reduces the number of suicide attempts or completions. The evidence suggests mild to moderate improvement for interventions addressing intermediate outcomes such as suicidal ideation, decreased depressive severity, decreased hopelessness, or improved level of function.Conclusion: Because of the complexity of studying the risk for suicide and the paucity of well-designed research studies, only limited evidence guides the primary care clinician's assessment and management of suicide risk.