SUICIDE AFTER-DISCHARGE FROM PSYCHIATRIC INPATIENT CARE
SUICIDE AFTER-DISCHARGE FROM PSYCHIATRIC INPATIENT CARE
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DOI：
10.1016/0140-6736(93)91822-4
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发表时间：
1993-07-31
期刊：
影响因子：
168.9
通讯作者：
HAWTON, K
中科院分区：
文献类型：
--
作者：
GOLDACRE, M;SEAGROATT, V;HAWTON, K
有精神疾病史的人比没有精神疾病史的人自杀的风险更高。减少精神科住院治疗的政策可能意味着一些自杀风险已经从医院转移到社区环境。我们在英国牛津卫生区进行了一项基于人群的研究，量化了精神病患者出院后一年内的自杀风险，计算了每1000人年的自杀率（从出院到死亡、随后再入院或研究结束的时间）和自杀的标准化死亡率比（SMR），将一般人群的值取为1。在男性患者中，出院后前28天内自杀的SMR（定义为死因裁判官的自杀判决）为213（95% CI 137-317）;女性患者的等效SMR为134（67-240）。当我们将自杀更广泛地定义为自杀，开放式或不幸的判决时，结果是相似的。出院后前28天的自杀率，男性患者是出院后第一年剩余48周自杀率的7.1（4.1-12）倍，女性患者是3.0（1.5-6.0）倍。大多数被研究的病人（包括自杀的和没有自杀的）都只是短期的精神病住院病人。研究结果证实，有显着的集群自杀后不久，从精神病护理出院。社区高危患者出院后的熟练支持至关重要。对出院后不久发生的自杀事件进行审计可能有助于确定最高风险的患者，从而减少可避免的死亡人数。
People with a history of psychiatric disorder are at higher risk of suicide than people without such a history. The policy of reducing inpatient care in psychiatry has probably meant that some of the risk of suicide has shifted from the hospital to the community setting. We have quantified the risk of suicide within a year of psychiatric discharge in a population-based study in the Oxford health region, UK.We calculated suicide rates per 1000 person-years at risk (time from discharge to death, subsequent readmission, or the end of the study) and the standardised mortality ratio (SMR) for suicide, taking the value among the general population as 1. Among male patients the SMR for suicide (defined by coroner's verdict of suicide) in the first 28 days after discharge from inpatient care was 213 (95% CI 137-317); the equivalent SMR for female patients was 134 (67-240). The result was similar when we defined suicide more broadly as a suicide, open, or misadventure verdict. The suicide rate in the first 28 days after discharge was 7.1 (4.1-12) times higher for male patients and 3.0 (1.5-6.0) times higher for female patients than the rate during the remaining 48 weeks of the first year after discharge. Most of the patients studied (both those who committed suicide and those who did not) had been psychiatric inpatients for only a short time. The findings confirm that there is significant clustering of suicide soon after discharge from psychiatric care. Skilled support after discharge for high-risk patients in the community is essential. Audit of suicides that occur soon after discharge may help identify the patients at highest risk and thereby reduce the number of avoidable deaths.