Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Clinical Trial.
Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Clinical Trial.
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DOI：
10.1001/jamapsychiatry.2015.1880
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发表时间：
2015-12
期刊：
影响因子：
25.8
通讯作者：
Sen S
中科院分区：
文献类型：
--
作者：
Guille C;Zhao Z;Krystal J;Nichols B;Brady K;Sen S
在美国，每天大约有一名医生自杀。实习医生的自杀风险尤其高，在实习一年的前三个月，自杀意念增加了四倍以上。尽管出现了这种急剧增长，但在培训医生中，预防自杀念头升级的努力却很少。评估基于网络的认知行为疗法（wCBT）项目在实习开始前预防医学实习生自杀意念的有效性。2009-10学年或2011-12学年在两所大学医院进行的随机对照试验，199名来自多个专业的实习生。实习生被随机分配到研究组（wCBT组，n=100；注意控制组（ACG）， n=99），在实习年开始前的四周内，每周完成30分钟的学习活动。分配到wCBT组的受试者完成了在线cbt模块，分配到ACG组的受试者收到了关于抑郁症、自杀想法和当地心理健康提供者的一般信息的电子邮件。病人健康问卷（PHQ-9）被用来评估自杀想法（即，“你死了会更好的想法，或者以某种方式伤害自己”）在实习年度开始之前和全年每3个月一次。62.2%（199/320）的个体同意参加本研究。在实习期间至少一个时间点，12%（12/100）被分配到wCBT的实习生认可了自杀意念，相比之下，21%（21/99）的实习生被分配到ACG。在对事先确定的会增加自杀意念风险的协变量进行调整后，与ACG组相比，分配到wCBT组的实习生在实习期间赞同自杀意念的可能性要低60% （RR: 0.40, 95% CI 0.17-0.91; p=0.03）。本研究表明，一个免费的、容易获得的、简短的wCBT计划可以帮助减少医疗实习生自杀意念的发展。具有这些特点的预防方案可以很容易地推广到全国的医疗培训方案中。
In the United States, approximately one physician dies by suicide every day. Training physicians are at particularly high risk, with suicidal ideation increasing over four-fold during the first three months of internship year. Despite this dramatic increase, very few efforts have been made to prevent the escalation of suicidal thoughts among training physicians. To assess the effectiveness of a Web-based Cognitive Behavioral Therapy (wCBT) program delivered prior to the start of internship year in the prevention of suicidal ideation in medical interns. A randomized controlled trial conducted at two university hospitals with 199 interns from multiple specialties during academic years 2009-10 or 2011-12. Interns were randomly assigned to study groups (wCBT, n=100; attention-control group (ACG), n=99), and completed study activities lasting 30-minutes each week for four weeks prior to starting internship year. Subjects assigned to wCBT completed online-CBT modules and subjects assigned to ACG received emails with general information about depression, suicidal thinking and local mental health providers. The Patient Health Questionnaire (PHQ-9) was employed to assess suicidal ideation (i.e., “thoughts that you would be better off dead, or hurting yourself in some way”) prior to the start of intern year and at 3-month intervals throughout the year. 62.2% (199/320) of individuals agreed to take part in the study. During at least one time point over the course of internship year 12% (12/100) of interns assigned to wCBT endorsed suicidal ideation, compared to 21%(21/99) of interns assigned to ACG. After adjusting for covariates identified a priori that have previously shown to increase the risk for suicidal ideation, interns assigned to wCBT were 60% less likely to endorse suicidal ideation during internship year (RR: 0.40, 95% CI 0.17-0.91; p=0.03), compared to those assigned to ACG. This study demonstrates that a free, easily accessible, brief wCBT program can help reduce the development of suicidal ideation among medical interns. Prevention programs with these characteristics could be easily disseminated to medical training program across the country.