Major Depressive Disorder, Suicides, and the Role of Dimensional Psychiatry for Triaging in Primary Care Settings: A Case Series Retroanalysis.

Q3 Medicine
Innovations in clinical neuroscience Pub Date : 2022-10-01
Atmaram Yarlagadda, Adrian R Johnson, Cheyenne M Bickerstaff, Joseph R Yancey, Samuel L Preston, Liquori L Etheridge, Michelle Maddalozzo, Samuel Ochinang, Rosemary A Jackson, Anita H Clayton
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引用次数: 0

Abstract

Objective: The goal was to promote early diagnosis and referral of patients with depressive symptomology in the primary care setting using a biopsychosocial-informed risk stratification tool to prevent suicides.

Methods: A qualitative analysis of military suicides stationed at Fort Eustis, Virginia, using demographics from Fatality Review Boards (FRBs) of 10 cases assessing shared biopsychosocial stressors was conducted. The case reviews were used to assess the failure modes and effects analyses (FMEA), prompting the development of a performance improvement (PI) plan via a risk stratification scale that recognizes opportunities for intervention in the primary care and supervisor/peer settings to improve patient outcomes.

Results: FMEA revealed the presence and interplay of multiple biopsychosocial stressors specifically impacting relationships, occupational functioning, financial status, legal issues, and undiagnosed mental health conditions across the 10 suicides reviewed. Furthermore, the severity of each stressor was best examined from a dimensional perspective to gauge the impact on or impairment of the individual in the military setting. The dimensional use of biopsychosocial stressors is congruent with our hypothesis that an increase in duration and intensity of biopsychosocial stressors increases risk of suicide.

Conclusion: This case series reveals a gap in suicide assessment and suggests the use of a dimensional approach to measure biopsychosocial stressors at the entry level, such as primary care settings, or in the case of the military, during routine counseling. Additionally, a risk stratification tool that crosses biopsychosocial domains could provide a more accurate assessment for self-harm, in turn enabling a timely referral to appropriate helping agencies, including nonclinical resources.

主要抑郁症、自杀和维度精神病学在初级保健环境中的作用:一个病例系列回顾分析。
目的:目的是使用生物-心理-社会知情风险分层工具,在初级保健环境中促进抑郁症状患者的早期诊断和转诊,以防止自杀。方法:对驻扎在弗吉尼亚州尤斯蒂斯堡的军人自杀事件进行定性分析,使用死亡审查委员会(FRB)的10例评估共同生物心理社会压力源的人口统计数据。案例审查用于评估失效模式和影响分析(FMEA),通过风险分层量表促进绩效改进(PI)计划的制定,该计划识别了在初级保健和主管/同行环境中进行干预以改善患者结果的机会。结果:FMEA揭示了多种生物-心理-社会压力源的存在及其相互作用,这些压力源特别影响了所审查的10名自杀者的关系、职业功能、经济状况、法律问题和未诊断的心理健康状况。此外,最好从维度的角度来检查每种压力源的严重程度,以衡量个人在军事环境中的影响或损害。生物心理社会应激源的维度使用与我们的假设一致,即生物心理社会压力源持续时间和强度的增加会增加自杀风险。结论:这一系列案例揭示了自杀评估中的差距,并建议在初级保健环境或军队的常规咨询过程中,使用维度方法来衡量生物心理社会压力源。此外,跨生物-心理-社会领域的风险分层工具可以为自残提供更准确的评估,从而能够及时转介到适当的帮助机构,包括非临床资源。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Innovations in clinical neuroscience
Innovations in clinical neuroscience Medicine-Psychiatry and Mental Health
CiteScore
2.10
自引率
0.00%
发文量
87
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