Firearm suicide mortality among emergency department patients with physical health problems.
Firearm suicide mortality among emergency department patients with physical health problems.
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DOI：
10.1016/j.annepidem.2020.09.007
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发表时间：
2021-03
影响因子：
5.6
通讯作者：
Bhat H
中科院分区：
文献类型：
--
作者：
Goldman-Mellor S;Hall C;Cerdá M;Bhat H
身体和精神健康状况不佳的人可能面临更高的自杀风险，特别是枪支自杀。这项回顾性队列研究使用全州范围内的、与医疗相关的艾德患者记录和死亡率数据，研究急诊科（艾德）患者中出现一系列身体健康问题的12个月火器自杀发生率。参与者包括2009年至2013年到加州艾德就诊的所有居民，他们接受了非致命性的躯体诊断，这些诊断被假设会增加自杀风险，包括心肌梗死、充血性心力衰竭、脑血管疾病、慢性阻塞性肺病、糖尿病、癌症、背痛、头痛、关节疾病和受伤。对于每个患者诊断组，我们计算了每10万人年的枪支自杀率和相对于人口统计学匹配的加州人口的标准化死亡率（SMR）。每100，000人年的枪支自杀率范围为9.6（意外伤害患者）至55.1（癌症诊断患者），SMR为1.48至7.45（所有p<0.05）。心血管疾病患者的SMR范围为2.45至5.10。男性和老年人的枪支自杀率较高，使用枪支的自杀死者比例存在很大的组间差异。艾德患者表现为故意自伤、物质使用和癌症，特别是在枪支自杀的风险。为了避免错过预防自杀的机会，急诊科医生应该实施循证自杀干预措施，作为患者的最佳实践。
Individuals with poor physical and mental health may face elevated risk for suicide, particularly suicide by firearm. This retrospective cohort study used statewide, longitudinally-linked ED patient record and mortality data to examine 12-month incidence of firearm suicide among emergency department (ED) patients presenting with a range of physical health problems. Participants included all residents presenting to a California ED in 2009-2013 with nonfatal visits for somatic diagnoses hypothesized to increase suicide risk, including myocardial infarction, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, cancer, back pain, headache, joint disorder, and injuries. For each patient diagnostic group, we calculated rates of firearm suicide per 100,000 person-years and standardized mortality ratios (SMRs) relative to the demographically matched California population. Firearm suicide rates per 100,000 person-years ranged from 9.6 (among patients presenting with unintentional injury) to 55.1 (patients with cancer diagnoses), with SMRs from 1.48 to 7.45 (all p<0.05). SMRs for patients with cardiovascular conditions ranged from 2.45 to 5.10. Males and older individuals had higher firearm suicide rates, and there was substantial between-group variability in the proportion of suicide decedents who used a firearm. ED patients presenting with deliberate self-harm injuries, substance use, and cancer were especially at risk for firearm suicide. To avoid missed suicide-prevention opportunities, EDs should implement evidence-based suicide interventions as a best practice for their patients.
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