Suicide in recently discharged psychiatric patients: a case-control study
Suicide in recently discharged psychiatric patients: a case-control study
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DOI：
10.1017/s0033291708003644
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发表时间：
2009-03-01
影响因子：
6.9
通讯作者：
Appleby, L.
中科院分区：
文献类型：
--
作者：
Hunt, I. M.;Kapur, N.;Appleby, L.
背景。很少有对照研究专门调查了与最近出院的精神病患者自杀风险相关的心理保健方面。我们的目的是确定出院后 3 个月内自杀的风险因素，包括接受的医疗保健的变化。方法。我们对 238 名出院后 3 个月内自杀死亡的精神病患者进行了一项全国性人群病例对照研究，并在出院日期与 238 名活着的对照组进行了匹配。结果。 43% 的自杀发生在出院一个月内，其中 47% 在第一次后续预约之前死亡。出院后第一周和第一天是特别高风险的时期。自杀的危险因素包括自残史、情感障碍的初步诊断、最近最后一次与服务机构的接触以及在最后一次与工作人员接触时表现出的临床症状。自杀案件更有可能自行出院并错过最后一次服务预约。最后一次入院时被拘留接受强制治疗的患者，或者接受了加强程度的善后护理的患者，自杀死亡的可能性较小。结论。从精神科护理出院后的几周是自杀风险的关键时期。可以降低风险的措施包括密集的早期社区随访。风险评估应包括已确定的风险因素以及当前的精神状态，并对自放电者应有明确的后续程序。最近的拘留催生了《心理健康法》和当前使用的强化善后护理可能具有保护作用。
Background. Few controlled studies have specifically investigated aspects of mental health care in relation to suicide risk among recently discharged psychiatric patients. We aimed to identify risk factors, including variation in healthcare received, for suicide within 3 months of discharge.Method. We conducted a national population-based case-control study of 238 psychiatric patients dying by suicide within 3 months of hospital discharge, matched on date of discharge to 238 living controls.Results. Forty-three per cent of suicides occurred within a month of discharge, 47%, of whom died before their first follow-up appointment. The first week and the first day after discharge were particular high-risk periods. Risk factors for suicide included a history of self-harm, a primary diagnosis of affective disorder, recent last contact with services and expressing clinical symptoms at last contact with staff. Suicide cases were more likely to have initiated their own discharge and to have missed their last appointment with services. Patients who were detained for compulsory treatment at last admission, or who were subject to enhanced levels of aftercare, were less likely to die by suicide.Conclusions. The weeks after discharge from psychiatric care represent a critical period for suicide risk. Measures that could reduce risk include intensive and early community follow-up. Assessment of risk should include established risk factors as well as current mental state and there should be clear follow-up procedures for those who have self-discharged. Recent detention tinder the Mental Health Act and current use of enhanced levels of aftercare may be protective.