PDF(Pubmed)
Abstract：
BACKGROUND: A few previous cross-sectional studies investigated correlated factors of suicidal ideation or suicide attempts among suicide prevention hotline callers; however, scarcely any evidence was from a longitudinal study. In addition, it is still unclear whether improvements in some suicide risk factors could reduce the occurrence of subsequent suicidal acts. This longitudinal study focusing on the risk factors for subsequent suicidal acts among adolescent and young adult callers with high suicide risk aims to fill this gap.
METHODS: This study recruited 12-25-year-old high-risk callers to a China nationwide suicide prevention hotline. Potential risk factors, including hopefulness, psychological distress, depression, history of suicide attempts, alcohol or substance misuse, and acute life events, were examined during the index calls, and improvements in hopefulness, psychological distress, and suicide intent were assessed before ending the index calls. The recruited callers were followed up 12 months after their index calls. The primary outcome was the occurrence of suicidal acts (suicide attempts or suicide death) during follow-up. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards model were used.
RESULTS: During the follow-up period, 271 of 1656 high-risk adolescent and young adult callers attempted suicide, and seven callers died by suicide. After adjusting for demographic variables, low hopefulness (Hazard Ratio [HR] = 2.03, 95% Confidence Interval [CI]=[1.47, 2.80]) at the beginning of the index call was associated with a higher risk for subsequent suicidal acts, whereas improvements in psychological distress (HR = 0.61, 95%CI [0.41, 0.89]) and suicidal intent (HR = 0.56, 95%CI [0.38, 0.84]) during the index call reduced the risk of subsequent suicidal acts. In addition, alcohol or substance misuse (Model 2, HR = 1.65, 95%CI [1.11, 2.46]) and suicide attempt history(Model 1: one episode, HR = 1.96, 95%CI=[1.05, 3.66]; two or more episodes, HR = 2.81, 95%CI [1.59, 4.96]. Model 2: one episode, HR = 2.26, 95%CI [1.06, 4.82]; two or more episodes: HR = 3.28, 95%CI [1.63, 6.60]) were risk factors for subsequent suicidal acts.
CONCLUSIONS: While suicide prevention hotline operators deliver brief psychological interventions to high-risk adolescent and young adult callers, priority should be given to callers with low hopefulness and to the alleviation of callers\' high psychological distress and suicide intent.
METHODS: This study recruited 12-25-year-old high-risk callers to a China nationwide suicide prevention hotline. Potential risk factors, including hopefulness, psychological distress, depression, history of suicide attempts, alcohol or substance misuse, and acute life events, were examined during the index calls, and improvements in hopefulness, psychological distress, and suicide intent were assessed before ending the index calls. The recruited callers were followed up 12 months after their index calls. The primary outcome was the occurrence of suicidal acts (suicide attempts or suicide death) during follow-up. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards model were used.
RESULTS: During the follow-up period, 271 of 1656 high-risk adolescent and young adult callers attempted suicide, and seven callers died by suicide. After adjusting for demographic variables, low hopefulness (Hazard Ratio [HR] = 2.03, 95% Confidence Interval [CI]=[1.47, 2.80]) at the beginning of the index call was associated with a higher risk for subsequent suicidal acts, whereas improvements in psychological distress (HR = 0.61, 95%CI [0.41, 0.89]) and suicidal intent (HR = 0.56, 95%CI [0.38, 0.84]) during the index call reduced the risk of subsequent suicidal acts. In addition, alcohol or substance misuse (Model 2, HR = 1.65, 95%CI [1.11, 2.46]) and suicide attempt history(Model 1: one episode, HR = 1.96, 95%CI=[1.05, 3.66]; two or more episodes, HR = 2.81, 95%CI [1.59, 4.96]. Model 2: one episode, HR = 2.26, 95%CI [1.06, 4.82]; two or more episodes: HR = 3.28, 95%CI [1.63, 6.60]) were risk factors for subsequent suicidal acts.
CONCLUSIONS: While suicide prevention hotline operators deliver brief psychological interventions to high-risk adolescent and young adult callers, priority should be given to callers with low hopefulness and to the alleviation of callers\' high psychological distress and suicide intent.
摘要：
背景：先前的一些横断面研究调查了自杀预防热线来电者自杀意念或自杀企图的相关因素；然而，几乎没有任何证据来自纵向研究。此外,目前尚不清楚某些自杀风险因素的改善是否可以减少随后的自杀行为的发生。这项纵向研究的重点是自杀风险高的青少年和年轻成年呼叫者中随后自杀行为的危险因素，旨在填补这一空白。
方法：这项研究招募了12-25岁的高危人群到中国全国性的自杀预防热线。潜在风险因素,包括希望,心理困扰,抑郁症,自杀未遂史,酒精或物质滥用，和急性生活事件，在索引调用期间进行了检查，和希望的改善，心理困扰,在结束索引调用之前，对自杀意图进行了评估。招募的呼叫者在索引呼叫后12个月进行了随访。主要结果是在随访期间发生自杀行为（自杀未遂或自杀死亡）。Kaplan-Meier存活曲线,对数秩测试，采用Cox比例风险模型。
结果：在随访期间，1656名高危青少年和年轻成年来电者中的271人企图自杀，七个打电话的人自杀了.在调整人口统计学变量后，低希望（危险比[HR]=2.03，95％置信区间[CI]=[1.47，2.80]）在指标调用开始时与随后的自杀行为的高风险相关，而在指数呼叫期间,心理困扰(HR=0.61,95CI[0.41,0.89])和自杀意图(HR=0.56,95CI[0.38,0.84])的改善降低了后续自杀行为的风险.此外,酒精或物质滥用（模型2，HR=1.65,95CI[1.11,2.46]）和自杀未遂史（模型1：一次发作，HR=1.96，95CI=[1.05，3.66]；两次或更多次发作，HR=2.81，95CI[1.59，4.96]。模型2:一集，HR=2.26，95CI[1.06，4.82]；两次或两次以上发作：HR=3.28，95CI[1.63，6.60]）是随后自杀行为的危险因素。
结论：虽然自杀预防热线操作员对高危青少年和年轻成年来电者进行简短的心理干预，应优先考虑希望较低的来电者，并减轻来电者的高度心理困扰和自杀意图。
方法：这项研究招募了12-25岁的高危人群到中国全国性的自杀预防热线。潜在风险因素,包括希望,心理困扰,抑郁症,自杀未遂史,酒精或物质滥用，和急性生活事件，在索引调用期间进行了检查，和希望的改善，心理困扰,在结束索引调用之前，对自杀意图进行了评估。招募的呼叫者在索引呼叫后12个月进行了随访。主要结果是在随访期间发生自杀行为（自杀未遂或自杀死亡）。Kaplan-Meier存活曲线,对数秩测试，采用Cox比例风险模型。
结果：在随访期间，1656名高危青少年和年轻成年来电者中的271人企图自杀，七个打电话的人自杀了.在调整人口统计学变量后，低希望（危险比[HR]=2.03，95％置信区间[CI]=[1.47，2.80]）在指标调用开始时与随后的自杀行为的高风险相关，而在指数呼叫期间,心理困扰(HR=0.61,95CI[0.41,0.89])和自杀意图(HR=0.56,95CI[0.38,0.84])的改善降低了后续自杀行为的风险.此外,酒精或物质滥用（模型2，HR=1.65,95CI[1.11,2.46]）和自杀未遂史（模型1：一次发作，HR=1.96，95CI=[1.05，3.66]；两次或更多次发作，HR=2.81，95CI[1.59，4.96]。模型2:一集，HR=2.26，95CI[1.06，4.82]；两次或两次以上发作：HR=3.28，95CI[1.63，6.60]）是随后自杀行为的危险因素。
结论：虽然自杀预防热线操作员对高危青少年和年轻成年来电者进行简短的心理干预，应优先考虑希望较低的来电者，并减轻来电者的高度心理困扰和自杀意图。
