Repetición de conductas suicidas en urgencias psiquiátricas en pacientes sin intentos previos, index y repetidores: un estudio prospectivo / Suicidal behaviour recurrence in psychiatric emergency departments of patients without a prior suicide attempt, index and reattempters: a prospective study

INTRODUCCIÓN: La incidencia de la repetición de conductas suicidas no ha variado en los últimos años. Es necesario aportar evidencias sobre la incidencia de la conducta suicida en población psiquiátrica y su seguimiento. MATERIAL Y MÉTODO: Estudio multicéntrico caso-control, prospectivo. La muestra se compuso de 440 pacientes atendidos en los servicios de urgencias de psiquiatría. Se aplicó la Escala de acontecimientos vitales adversos de Brugha y la Escala Columbia de cribado del riesgo suicida. La muestra se dividió en tres grupos: pacientes sin intentos de suicidio previos, pacientes index y pacientes con más de un intento. A los dos años se revisaron las historias clínicas de dichos pacientes analizando la presencia de conducta suicida. RESULTADOS: El 49,1% (n=216) repitieron atención en urgencias de psiquiatría en el periodo de seguimiento. El 2,7% fallecieron por suicidio. Se ha encontrado un perfil diferencial entre los tres grupos estudiados. El grupo de los repetidores fue el que más atenciones recibió con relación a conductas suicidas (11,0%; χ2=30,3; g.l.=2; p < 0,001). El 6,1% (n=10) de los pacientes que nunca habían tenido un intento realizaron su primer intento, y el 21,7% (n=60) del resto de la muestra lo repitieron. El mayor riesgo de intento fue en los 30días siguientes a la atención en urgencias. Pasado ese tiempo, la distribución del riesgo varía en cada grupo. Tres ítems de la Escala Columbia predicen las conductas suicidas. CONCLUSIONES: Es necesario valorar el riesgo de conductas suicidas en todos los pacientes que acuden a urgencias de psiquiatría y durante su seguimiento. Este debería ser más intenso en los primeros meses para quienes no tienen intentos previos, y a más largo plazo para quienes ya lo han intentado

INTRODUCTION: There has been little change in the incidence of suicidal behaviour and reattempts in recent years. Evidence is needed on the incidence of suicidal behaviour in the psychiatric population and its follow-up. MATERIAL AND METHOD: A prospective multi-centre case-control study. The sample covered the cases of 440 patients seen as psychiatric emergencies. For this purpose, we used the Vital Adverse Event Scale by Brugha and screening with the Columbia Scale. The sample was divided into three groups: patients without prior suicide attempts, patients with an index attempt and patients with more than one attempt. At two years, the clinical histories of these patients were reviewed, assessing for suicidal behaviour. RESULTS: A total of 49.1% (n=216) of the patients required urgent psychiatric care during the follow-up period, and 2.7% eventually committed suicide. The data shows a differential profile between the three groups analysed. Among them, the group of reattempters required the highest number of interventions regarding suicide behaviour (11.0%; χ2=30.3; d.f.=2; P<.001). Eventually, 6.1% of the patients without prior suicide attempts tried to commit suicide for the first time, and 21.7% (n=60) of the remaining sample repeated their prior attempts. The highest risk of attempt was in the thirty days following the urgent intervention. After this period, risk distribution varied for each group. Three items from the Columbia Scale predict suicide behaviour. CONCLUSIONS: The results show the need for assessing suicidal behaviour for all patients who receive psychiatric urgent care, including during the follow-up period. A more thorough control should be performed during the first months for patients without prior suicide attempts, and longer periods for those patients who have already tried to commit suicide

Suicidal behaviour recurrence in psychiatric emergency departments of patients without a prior suicide attempt, index and reattempters: A prospective study. / Repetición de conductas suicidas en urgencias psiquiátricas en pacientes sin intentos previos, index y repetidores: un estudio prospectivo.

INTRODUCTION: There has been little change in the incidence of suicidal behaviour and reattempts in recent years. Evidence is needed on the incidence of suicidal behaviour in the psychiatric population and its follow-up. MATERIAL AND METHOD: A prospective multi-centre case-control study. The sample covered the cases of 440 patients seen as psychiatric emergencies. For this purpose, we used the Vital Adverse Event Scale by Brugha and screening with the Columbia Scale. The sample was divided into three groups: patients without prior suicide attempts, patients with an index attempt and patients with more than one attempt. At two years, the clinical histories of these patients were reviewed, assessing for suicidal behaviour. RESULTS: A total of 49.1% (n=216) of the patients required urgent psychiatric care during the follow-up period, and 2.7% eventually committed suicide. The data shows a differential profile between the three groups analysed. Among them, the group of reattempters required the highest number of interventions regarding suicide behaviour (11.0%; χ2=30.3; d.f.=2; P<.001). Eventually, 6.1% of the patients without prior suicide attempts tried to commit suicide for the first time, and 21.7% (n=60) of the remaining sample repeated their prior attempts. The highest risk of attempt was in the thirty days following the urgent intervention. After this period, risk distribution varied for each group. Three items from the Columbia Scale predict suicide behaviour. CONCLUSIONS: The results show the need for assessing suicidal behaviour for all patients who receive psychiatric urgent care, including during the follow-up period. A more thorough control should be performed during the first months for patients without prior suicide attempts, and longer periods for those patients who have already tried to commit suicide.