Effect of Housing First on Suicidal Behaviour: A Randomised Controlled Trial of Homeless Adults with Mental Disorders
Effect of Housing First on Suicidal Behaviour: A Randomised Controlled Trial of Homeless Adults with Mental Disorders
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DOI：
10.1177/0706743717694836
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发表时间：
2017-07-01
影响因子：
4
通讯作者：
Sareen, Jitender
中科院分区：
文献类型：
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作者：
Aquin, Joshua P.;Roos, Leslie E.;Sareen, Jitender
目的：本研究试图确定住房优先（HF）与常规治疗（TAU）相比，是否减少了无家可归的精神障碍患者的自杀意念和尝试，这是一个明显具有高自杀行为风险的人群。方法：At Home/Chez Soi项目是一项非盲、随机对照试验，于2009年至2013年在加拿大5个城市（温哥华、温尼伯、多伦多、蒙特利尔、蒙克顿）进行。通过社区机构招募诊断为严重精神健康障碍的无家可归的成年人，并随机分为HF （n = 1265）和TAU （n = 990）两组。为高频参与者提供了私人住房单位，并获得了病例管理支助服务。TAU参与者仍可获得现有的社区支持。在基线和6、12、18和21/24个月时测量过去一个月的自杀意念。在基线和21/24个月的随访中测量自杀企图史。结果：与基线相比，过去一个月自杀意念总体呈下降趋势（估计= -）。57, SE = 0.05, P < 0.001)，治疗组无影响（即HF vs TAU；估计= -）。04, se =.06, p = 0.51)。此外，治疗状态没有影响（估计= -）。10, SE = 0.16, P = 0.52)在2年随访期间的自杀企图患病率（HF = 11.9%, TAU = 10.5%）。结论：本研究未发现HF在减少自杀意念和企图方面优于TAU的证据。我们建议心衰干预考虑补充心理治疗，已被证明对减少自杀行为有效。在住房优先干预中，哪种自杀预防干预（如果有的话）在进一步降低自杀风险方面特别有效，还有待确定。
Objective: This study attempted to determine if Housing First (HF) decreased suicidal ideation and attempts compared to treatment as usual (TAU) amongst homeless persons with mental disorders, a population with a demonstrably high risk of suicidal behaviour.Method: The At Home/Chez Soi project is an unblinded, randomised control trial conducted across 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, Moncton) from 2009 to 2013. Homeless adults with a diagnosed major mental health disorder were recruited through community agencies and randomised to HF (n = 1265) and TAU (n = 990). HF participants were provided with private housing units and received case management support services. TAU participants retained access to existing community supports. Past-month suicidal ideation was measured at baseline and 6, 12, 18, and 21/24 months. A history of suicide attempts was measured at baseline and the 21/24-month follow-up.Results: Compared to baseline, there was an overall trend of decreased past-month suicidal ideation (estimate = -. 57, SE =.05, P < 0.001), with no effect of treatment group (i.e., HF vs. TAU; estimate = -. 04, SE =.06, P = 0.51). Furthermore, there was no effect of treatment status (estimate = -. 10, SE =.16, P = 0.52) on prevalence of suicide attempts (HF = 11.9%, TAU = 10.5%) during the 2-year follow-up period.Conclusion: This study failed to find evidence that HF is superior to TAU in reducing suicidal ideation and attempts. We suggest that HF interventions consider supplemental psychological treatments that have proven efficacy in reducing suicidal behaviour. It remains to be determined what kind of suicide prevention interventions (if any) are specifically effective in further reducing suicidal risk in a housing-first intervention.