Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey
Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey
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DOI：
10.1186/1471-244x-10-14
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发表时间：
2010-02-03
期刊：
影响因子：
4.4
通讯作者：
Kapur, Nav
中科院分区：
文献类型：
--
作者：
Hunt, Isabelle M.;Windfuhr, Kirsten;Kapur, Nav
背景：心理健康服务预防自杀需要了解精神科住院病人等高危人群的自杀前因。本研究的目的是描述自杀前从精神病住院病房潜逃的人的社会和临床特征，包括他们接受的临床护理的各个方面。方法：我们在英格兰和威尔士进行了一项为期10年（1997-2006）的全国临床调查，调查对象是自杀死亡的人。收集了在死亡前一年曾与精神卫生服务机构接触的人的详细数据。结果：精神科住院病人自杀1851例，占自杀总人数的14%。1292例（70%）发生在病房外。其中469名患者在逃离病房后死亡，占所有住院患者自杀人数的25%，占病房外自杀人数的38%。潜逃自杀的特点是年轻、失业和无家可归，与那些在工作人员同意下离开病房的人相比。精神分裂症是最常见的诊断，以前的暴力和药物滥用率很高。在比例上，潜逃者比同意休假的住院患者更有可能被合法拘留治疗，不遵守药物治疗，并在入院的第一周死亡。虽然潜逃的患者更有可能处于高水平的观察之下，但临床医生报告说，由于病房设计或病房里的其他患者，观察中出现了更多问题。结论：预防在住院患者中潜逃和随后自杀的措施可能包括加强对病房出口的控制，并加强对患者的观察，特别是在入院早期。改善病房环境以提供支持性和较少恐吓的体验可能有助于降低风险。
Background: Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received.Methods: We carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death.Results: There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward.Conclusion: Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.