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JAMA Psychiatry:网络的认知行为疗法可有效预防实习医生自杀念头的出现

2015-11-20 MedSci MedSci原创

JAMA Psychiatry:网络的认知行为疗法可有效预防实习医生自杀念头的出现在美国每天约有一名医生死于自杀。尤其是实习医生,自杀的风险很高,在他们进入医院实习的前3个月,自杀的风险可提高4倍多。尽管知道他们自杀的风险已经升高,但是目前鲜有用于预防实习医生自杀风险升高的措施。本研究旨在评估实习医生进入医院实习前一年使用基于网络的认知行为疗法(wCBT)干预治疗对其自杀念头出现的预防效果。该随机

在美国每天约有一名医生死于自杀。尤其是实习医生,自杀的风险很高,在他们进入医院实习的前3个月,自杀的风险可提高4倍多。尽管知道他们自杀的风险已经升高,但是目前鲜有用于预防实习医生自杀风险升高的措施。

本研究旨在评估实习医生进入医院实习前一年使用基于网络的认知行为疗法(wCBT)干预治疗对其自杀念头出现的预防效果。

该随机临床试验共纳入了两所大学医院的199名不同专业的实习医生。将其随机分为两组:wCBT治疗组(100名)和注意控制组(99名),所有的研究对象在实习前4周里每周接受一次30分钟的干预治疗。wCBT组受试者在线完成了CBT模块, ACG组受试者则是阅读关于抑郁症、自杀想法以及当地精神卫生专业人员的一般信息的邮件。


实习开始前以及实习期间每隔3个月,采用患者健康问卷-9(PHQ-9)对受试者的自杀观念进行了评估。使用意向治疗原则分析数据。

结果发现,wCBT组受试者在实习过程至少一个评估点出现自杀念头的比例为12%,而ACG组中则为21.2%。校正可升高自杀风险的变量后,wCBT组受试者在实习期间出现自杀念头的风险显著低于ACG组。

该研究表明,免费而简便的wCBT项目可显著降低实习医生出现自杀念头的风险。具有这些的特征预防项目或很容易地在全国的培训项目中开展。

原始出处:

Constance Guille, Zhuo Zhao et al.. Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns A Randomized Clinical Trial.JAMA Psychiatry. Published online November 04, 2015. doi:10.1001/jamapsychiatry.2015.1880

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为了研究非致命性故意自我伤害后短期内的自杀风险,以及其与并存精神疾病和自我伤害方式的关系。根据瑞典国家登记记录设计一项34219名患者的群体研究,其中,女性占59%。这些患者在2000-2005年间因故意自我伤害入院(根据ICD-10定义)。跟踪随访3-9年。患者自杀,随访结束。应用Cox回归模型分析自杀风险的HR值。应用kaplan-meier生存曲线标记时间模式,分别计算每种精神疾病以及先前自

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