These questions are limited, easy to administer, and include a brief time frame. The first item queries the patient's state of mind, and sets the stage for asking about current suicidal ideation and intent. Positive endorsement of the ideation item prompts an inquiry about a previous suicide attempt, the single best predictor of future suicidal behavior [3,10], but still requires a follow-up question regarding current plans to assess for hospitalization potential.
We are currently in the process of conducting a lengthy validation study on these suicide items in primary care to assess sensitivity, specificity, and predictive validity. While preliminary evidence for these items is favorable, reporting the results would be premature. We have also been using these items in our ED, and they have been well received. Many physicians and nurses report a sense of relief that patients are now being asked about suicidal thoughts and behaviors.Often, a two-tier evaluation is recommended .
The four questions described above, and detailed in Fig. 1, serve as an appropriate initial assessment that meets the demands of the ED and other acute care settings. Endorsement of either initial item requires a second-tier assessment from social work, psychiatry staff, or a crisis team. Simply stating a belief that life is not worth living places one at moderate risk but rarely leads to psychiatric hospitalization. These adolescents, however, may benefit from outpatient mental health services to prevent escalation of symptoms and subsequent suicide attempts. Adolescents who divulge that they had specific plans for suicide or a suicide attempt and a desire to kill themselves within the past week should be deemed imminent risk. Most of these adolescents will require psychiatric hospitalization to reduce the threat of serious harm to themselves.
- 1 decade agoFavorite Answer
這些問題是有限，容易執行，并且包括一個短時間框架。 第一項詢問患者的心境，并且設置階段為詢問當前自殺的觀念化和意向。 觀念化項目的正面背書提示詢問關於一個早先自殺嘗試，未來自殺的行為[3,10的]唯一最佳的預報因子，但是仍然要求關於當前計劃的後續問題為住院治療潛力估計。
我們當前是在進行關於這些自殺項目的長的檢驗研究過程中在初級護理估計敏感性、特異性和有預測性的有效性。 當初步證據為這些項目是有利時，報告結果是過早的。 我們在我們的ED也使用這些項目，并且他們深受接納。 許多醫師和護士報告患者現在被詢問自殺的想法和行為的安慰。通常，建議使用一個兩層評估。
在圖被描述上面和詳述的四個問題1，擔當適應ED和其他深刻關心設置的需要的一個適當的最初的評估。 任一個最初的項目的背書要求二排評估從社會服務、精神病學職員或者危機隊。 陳述信仰生活不值生存地方一在輕度的風險，但是很少導致精神病學的住院治療。 這些青少年，然而，也許受益於門診病人精神健康服務防止症狀的逐步升級，并且隨後自殺試圖。 洩漏的青少年他們有具體計劃為自殺或自殺嘗試和一個慾望自殺在過去星期之內應該是被視為的臨近風險。 大多這些青少年將要求精神病學的住院治療使嚴重的害處降低威脅到他們自己。