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首页> 外文期刊>JAMA psychiatry >Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department
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Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department

机译：在急诊部门治疗的许可患者的随访vs常规治疗安全规划干预比较

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Importance? Suicidal behavior is a major public health problem in the United States. The suicide rate has steadily increased over the past 2 decades; middle-aged men and military veterans are at particularly high risk. There is a dearth of empirically supported brief intervention strategies to address this problem in health care settings generally and particularly in emergency departments (EDs), where many suicidal patients present for care.Objective? To determine whether the Safety Planning Intervention (SPI), administered in EDs with follow-up contact for suicidal patients, was associated with reduced suicidal behavior and improved outpatient treatment engagement in the 6 months following discharge, an established high-risk period.Design, Setting, and Participants? Cohort comparison design with 6-month follow-up at 9 EDs (5 intervention sites and 4 control sites) in Veterans Health Administration hospital EDs. Patients were eligible for the study if they were 18 years or older, had an ED visit for a suicide-related concern, had inpatient hospitalization not clinically indicated, and were able to read English. Data were collected between 2010 and 2015; data were analyzed between 2016 and 2018.Interventions? The intervention combines SPI and telephone follow-up. The SPI was defined as a brief clinical intervention that combined evidence-based strategies to reduce suicidal behavior through a prioritized list of coping skills and strategies. In telephone follow-up, patients were contacted at least 2 times to monitor suicide risk, review and revise the SPI, and support treatment engagement.Main Outcomes and Measures? Suicidal behavior and behavioral health outpatient services extracted from medical records for 6 months following ED discharge.Results? Of the 1640 total patients, 1186 were in the intervention group and 454 were in the comparison group. Patients in the intervention group had a mean (SD) age of 47.15 (14.89) years and 88.5% were men (n?=?1050); patients in the comparison group had a mean (SD) age of 49.38 (14.47) years and 88.1% were men (n?=?400). Patients in the SPI+ condition were less likely to engage in suicidal behavior (n?=?36 of 1186; 3.03%) than those receiving usual care (n?=?24 of 454; 5.29%) during the 6-month follow-up period. The SPI+ was associated with 45% fewer suicidal behaviors, approximately halving the odds of suicidal behavior over 6 months (odds ratio, 0.56; 95% CI, 0.33-0.95, P?=?.03). Intervention patients had more than double the odds of attending at least 1 outpatient mental health visit (odds ratio, 2.06; 95% CI, 1.57-2.71; P??.001).Conclusions and Relevance? This large-scale cohort comparison study found that SPI+ was associated with a reduction in suicidal behavior and increased treatment engagement among suicidal patients following ED discharge and may be a valuable clinical tool in health care settings.
机译：重要性自杀行为是美国的一个主要公共卫生问题。在过去20年中，自杀率稳步上升；中年男子和退伍军人的风险尤其高。在卫生保健环境中，尤其是在急诊科（EDs）中，缺乏经验支持的短期干预策略来解决这个问题，因为急诊科有许多自杀患者需要治疗。客观的确定在有后续接触自杀患者的EDs中实施的安全计划干预（SPI）是否与出院后6个月内自杀行为的减少和门诊治疗参与度的提高有关，这是一个确定的高危期。设计、设置和参与者？队列比较设计，在退伍军人健康管理医院EDs的9个EDs（5个干预点和4个对照点）进行6个月的随访。如果患者年龄在18岁或18岁以上，因自杀相关问题进行了ED就诊，住院治疗没有临床指征，并且能够阅读英语，则符合研究条件。数据收集于2010年至2015年间；对2016年至2018年间的数据进行了分析。干预？干预措施结合了SPI和电话随访。SPI被定义为一种简短的临床干预，结合循证策略，通过一系列优先的应对技能和策略来减少自杀行为。在电话随访中，患者至少被联系了2次，以监测自杀风险，审查和修订SPI，并支持治疗参与。主要成果和措施？从ED出院后6个月的医疗记录中提取的自杀行为和行为健康门诊服务。后果在1640例患者中，干预组1186例，对照组454例。干预组患者的平均（SD）年龄为47.15（14.89）岁，88.5%为男性（n？=1050）；对照组患者的平均（SD）年龄为49.38（14.47）岁，88.1%为男性（n？=400）。在6个月的随访期内，与接受常规护理的患者（454例中24例，5.29%）相比，处于SPI+状态的患者发生自杀行为的可能性更小（1186例中36例，3.03%）。SPI+与自杀行为减少45%相关，在6个月内自杀行为的几率大约减少一半（优势比，0.56；95%可信区间，0.33-0.95，P=0.03）。干预患者至少参加一次门诊心理健康检查的几率是对照组的两倍以上（比值比，2.06；95%可信区间，1.57-2.71；P？；0.001）。结论和相关性？这项大规模队列比较研究发现，SPI+与ED出院后自杀患者的自杀行为减少和治疗参与度增加有关，可能是医疗保健环境中一种有价值的临床工具。

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