Clinicians should take care to evaluate the presence and/or history of drug dependence among patients seeking treatment for smoking cessation. These data suggest that a history of substance dependence predicts increased vulnerability to persistent ND.
Objective:In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA.Methods: Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 (n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates.Results: NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI.Conclusions: NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles. Résultats : L'AMNS était associée de façon plus marquée avec le sexe féminin, les mauvais traitements dans l'enfance, les troubles anxieux, le trouble dépressif majeur W W W Corrélats de l'automutilation non suicidaire et des tentatives de suicide chez les patients des soins tertiaires et des services d'urgence
It is important for physicians to exercise vigilance while prescribing medication, including being aware of other medications their patients have access to.
Objective: Established risk assessment tools are often inaccurate at predicting future suicide risk. We therefore investigated whether clinicians are able to predict individuals' suicide risk with greater accuracy. Method: We used the SAFE Database, which included consecutive adult (age 18 years) presentations (N ¼ 3818) over a 22-month period to the 2 tertiary care hospitals in Manitoba, Canada. Medical professionals assessed each individual and recorded his or her predicted risk for future suicide attempt (SA) on a 0-10 scale-the clinician prediction scale. The SAD PERSONS scale was completed as a comparison. SAs within 6 months, assessed using the Columbia Classification Algorithm for Suicide Assessment, were the primary outcome measure. Receiver operating characteristic curve and logistic regression analyses were conducted to determine the accuracy of both scales to predict SAs, and the scales were compared with z scores. Clinician prediction scale performance was stratified based on level of training. Results: Clinicians were able to predict future SAs with significantly greater accuracy (area under the curve [AUC] ¼ 0.73; 95% CI, 0.68 to 0.77; P < 0.001) compared with the SAD PERSONS scale (z ¼ 3.79, P < 0.001). Both scales nonetheless showed positive predictive value of less than 7%. Analyses by level of training showed that junior psychiatric residents and non-psychiatric residents did not accurately predict SAs, whereas senior psychiatric residents and staff psychiatrists demonstrated greater accuracy (AUC ¼ 0.76 and 0.78, respectively). Conclusions: Clinicians are able to predict future attempts with fewer false positives than a conventional risk assessment scale, and this skill appears related to training level. Predicting future suicidal behaviour remains very challenging. Abré géObjectif : Les instruments établis d'évaluation du risque sont souvent inexacts pour prédire le risque des futurs suicides. Nous avons donc cherché à savoir si les cliniciens sont en mesure de prédire le risque de suicide chez les personnes avec plus d'exactitude.Mé thode : Nous avons utilisé la base de données SAFE, qui comportait des présentations (N ¼ 3818) consécutives d'adultes (18 ans et þ) sur une période de 22 mois dans deux hô pitaux de soins tertiaires du Manitoba, Canada. Des professionnels de la santé ont évalué chaque personne et enregistré leur risque prédit de future tentative de suicide (TS) sur une échelle de 0 à 10-l'échelle de prédiction clinicienne. L'échelle SAD PERSONS a été administrée à titre de comparaison. Les TS sur 6 mois,
Assessment of the patient's reaction to survival, regardless of method of attempt, is important to identify risk of repeat attempts.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.