精神科住院治疗与精神障碍急诊科患者自杀行为之间的关系

IF 3.2 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research Pub Date : 2025-09-26 DOI:10.1016/j.jpsychires.2025.09.051

Jessica S. Enns , Natalie P. Mota , James M. Bolton , Okechukwu Ekuma , Dan Chateau , Harpreet Chahal , Jitender Sareen , Laurence Y. Katz

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引用次数: 0

摘要

目的：确定在急诊科和住院寻求帮助的精神障碍患者与未住院患者的自杀行为风险。方法：使用管理数据确定2009年至2016年期间在加拿大马尼托巴省急诊科（ED）就诊的9606名患有精神障碍的成年人，以及1794名特别表现出自杀企图的个体。他们的自杀死亡和自杀企图的结果被跟踪到2018年，比较住院和出院的患者。在Cox比例风险模型中应用治疗权重的反概率（IPTW）来调整混杂变量，包括：性别、地区、年龄、收入五分位数、司法参与、收入援助、寄养参与、分配的精神药物、高中完成情况、身体合并症和自杀企图。结果：调整后，住院的个体与出院的个体相比，未来因自杀企图住院的可能性更大，在以精神障碍就诊的患者中（风险比（HR） 3.09，置信区间（CI）[2.70-3.54]）和以自杀企图就诊的患者（HR 2.66, CI[2.20-3.20]）。然而，与那些因精神障碍或自杀未遂而出院的患者相比，住院患者的自杀死亡率在统计上没有显著差异。结论：本研究观察到，与出院患者相比，在急诊就诊后首次住院的精神障碍患者在再次住院随访时自杀未遂的风险更高。这些研究结果表明，住院治疗与自杀风险无关。进一步的研究对于开发干预措施以降低在急诊科寻求帮助的个人的自杀风险至关重要。

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Association between psychiatric hospitalization and suicidal behavior among people presenting to the emergency department with mental disorders

Objective

To determine the risk of suicidal behaviors at follow-up among patients with mental disorders seeking help in the emergency department and hospitalized versus those not hospitalized.

Methods

Administrative data was used to identify 9606 adults, who presented to the Emergency Department (ED) in Manitoba, Canada between 2009 and 2016 with a mental disorder and a subgroup of 1794 individuals who presented specifically with a suicide attempt. They were followed until 2018 on outcomes of suicide deaths and suicide attempts, comparing those who were hospitalized versus discharged from the ED. Inverse probability of treatment weights (IPTW) were applied in Cox proportional hazards models to adjust for confounding variables including: sex, region, age, income quintile, justice involvement, income assistance, foster care involvement, dispensed psychotropic medications, high school completion, physical comorbidities and suicide attempts.

Results

After adjustment, future hospitalizations for suicide attempts were more likely among individuals who were hospitalized compared to those who were discharged, among both those who presented to the ED with a mental disorder (Hazard Ratio (HR) 3.09, Confidence Interval (CI) [2.70–3.54]) and those who presented specifically with a suicide attempt (HR 2.66, CI [2.20–3.20]). However, there was no statistically significant difference in suicide death rate among those who were hospitalized compared to those who were discharged after presenting with a mental disorder, or suicide attempt specifically.

Conclusions

This study observed a higher risk of suicide attempts with re-hospitalization at follow-up among patients with mental disorders who were initially hospitalized after an emergency department presentation compared to those discharged. These study findings suggest that hospitalization was not associated with risk of suicide. Further research is critical to develop interventions to reduce suicide risk among individuals seeking help in the ED.

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来源期刊

Journal of psychiatric research 医学-精神病学

CiteScore

7.30

自引率

2.10%

发文量

622

审稿时长

130 days

期刊介绍： Founded in 1961 to report on the latest work in psychiatry and cognate disciplines, the Journal of Psychiatric Research is dedicated to innovative and timely studies of four important areas of research: (1) clinical studies of all disciplines relating to psychiatric illness, as well as normal human behaviour, including biochemical, physiological, genetic, environmental, social, psychological and epidemiological factors; (2) basic studies pertaining to psychiatry in such fields as neuropsychopharmacology, neuroendocrinology, electrophysiology, genetics, experimental psychology and epidemiology; (3) the growing application of clinical laboratory techniques in psychiatry, including imagery and spectroscopy of the brain, molecular biology and computer sciences;