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首页> 外文期刊>The Australian and New Zealand journal of psychiatry >Systems modelling and simulation to inform strategic decision making for suicide prevention in rural New South Wales (Australia)
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Systems modelling and simulation to inform strategic decision making for suicide prevention in rural New South Wales (Australia)

机译：系统建模与仿真，以通报新南威尔士州自杀预防战略决策（澳大利亚）

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Background: The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government's 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world. Methods: A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period. Results: Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87-6.42%) and 5.45% (4.68-6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23-3.46%; suicide deaths: 4.38%, 95% interval 3.78-5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning. Conclusion: Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources.
机译：背景：澳大利亚政府2015年的心理健康改革促进了自杀预防的循证、区域性方法的发展，从而使人们有必要了解和应对农村地区自杀行为的独特特征和驱动因素。然而，一个关键的挑战是复杂的决策环境，以及缺乏适当的工具来促进证据、数据和专家知识的使用，从而为产生最大影响的适当战略提供信息。本文报告了一个高级决策支持工具的共同开发，该工具使区域决策者能够在现实世界中实施决策之前探索其决策可能产生的影响。方法：建立新南威尔士州西部农村和偏远人口集水区的系统动力学模型。该模型基于心理健康护理和自杀行为的既定途径，再现了该地区自杀未遂（自残住院）和自杀死亡发生率的历史趋势。研究人员调查了一系列干预情景，以预测它们在10年内对自杀行为的影响。结果：自杀未遂后的果断善后护理预计将产生最大的影响，将自残住院人数和自杀死亡人数分别减少5.65%（95%间隔，4.87-6.42%）和5.45%（4.68-6.22%）。社区支持项目也预计会减少（自残住院：2.83%，95%间隔2.23-3.46%；自杀死亡：4.38%，95%间隔3.78-5.00%）。一些场景产生的非直觉影响或影响大小远远低于传统的基于证据的自杀预防方法所预期的，并提供了学习机会。结论：系统建模和模拟为区域决策者更好地理解和应对其流域自杀行为的独特特征和驱动因素，以及更有效地分配有限的卫生资源提供了巨大潜力。

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