Routine, Self-Administered, Touch-Screen, Computer-Based Suicidal Ideation Assessment Linked to Automated Response Team Notification in an HIV Primary Care Setting
Routine, Self-Administered, Touch-Screen, Computer-Based Suicidal Ideation Assessment Linked to Automated Response Team Notification in an HIV Primary Care Setting
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DOI：
10.1086/651420
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发表时间：
2010-04-15
影响因子：
11.8
通讯作者：
Schumacher, Joseph E.
中科院分区：
文献类型：
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作者：
Lawrence, Sarah T.;Willig, James H.;Schumacher, Joseph E.
背景人类免疫缺陷病毒（HIV）和艾滋病仍然与自杀意念、自杀未遂和自杀未遂的风险相关。自杀意念是随后自杀未遂和自杀未遂的重要预测因素。我们试图使用计算机化的患者报告结果（PRO）评估来实施自杀意念和相关疾病的常规筛查。两个地理位置不同的学术艾滋病毒初级保健诊所登记的患者参加了2005年12月至2009年2月的定期访问。在常规临床护理中实施基于触摸屏、计算机的PRO评估。药物滥用，酒精消费，抑郁和焦虑进行了评估。9项患者健康问卷评估了前2周内自杀意念的频率。“几乎每天”的回答触发了一个自动页面，以预先确定的诊所人员，谁完成了更详细的自我伤害评估。总体而言，1216例患者（740例来自伯明翰的亚拉巴马大学，476例来自华盛顿大学）在研究期间完成了初始PRO评估。患者主要为白色（646例[53%]）和男性（959例[79%]），平均年龄（+/-标准差）为44 ± 10岁。在接受调查的患者中，170人（14%）赞同某种程度的自杀意念，而33人（3%）几乎每天都承认自杀意念。在多变量分析中，自杀意念风险随着年龄的增长而降低（比值比[OR]，0.74/10年; 95%置信区间[CI]，0.58-0.96），并且随着当前药物滥用而增加（OR，1.88; 95%CI，1.03-3.44）和更严重的抑郁（中度抑郁OR，3.91 [95%CI，2.12-7.22]和重度抑郁OR，25.55 [95%CI，12.73-51.30]）。自杀意念与目前的药物滥用和抑郁症有关。使用新技术将自杀意念和其他健康领域的常规自我报告筛查结合起来，可以及时发现和干预这种危及生命的疾病。
Background. Human immunodeficiency virus (HIV) and AIDS continue to be associated with an underrecognized risk for suicidal ideation, attempted suicide, and completed suicide. Suicidal ideation represents an important predictor for subsequent attempted and completed suicide. We sought to implement routine screening of suicidal ideation and associated conditions using computerized patient-reported outcome (PRO) assessments.Methods. Two geographically distinct academic HIV primary care clinics enrolled patients who attended scheduled visits from December 2005 through February 2009. Touch-screen, computer-based PRO assessments were implemented into routine clinical care. Substance abuse, alcohol consumption, depression, and anxiety were assessed. The 9-item Patient Health Questionnaire assesses the frequency of suicidal ideation in the preceding 2 weeks. A response of "nearly every day" triggered an automated page to predetermined clinic personnel, who completed more detailed self-harm assessments.Results. Overall, 1216 patients (740 from the University of Alabama at Birmingham and 476 from the University of Washington) completed the initial PRO assessment during the study period. Patients were predominantly white (646 [53%]) and male (959 [79%]), with a mean age (+/- standard deviation) of 44 +/- 10 years. Among surveyed patients, 170 (14%) endorsed some level of suicidal ideation, whereas 33 (3%) admitted suicidal ideation nearly every day. In multivariable analysis, suicidal ideation risk was lower with advancing age (odds ratio [OR], 0.74 per 10 years; 95% confidence interval [CI], 0.58-0.96) and was increased with current substance abuse (OR, 1.88; 95% CI, 1.03-3.44) and more-severe depression (OR, 3.91 for moderate depression [95% CI, 2.12-7.22] and 25.55 for severe depression [95% CI, 12.73-51.30]).Discussion. Suicidal ideation was associated with current substance abuse and depression. The use of novel technologies to incorporate routine self-reported screening for suicidal ideation and other health domains allows for timely detection and intervention for this life-threatening condition.