自伤后的急性阶段干预措施,以预防自杀和复发:系统性审查和元分析
Guilherme Pimenta Roncete1, Luis C Farhat1, Loren Beiram1,2
1Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Acta psychiatrica Scandinavica
|March 9, 2026
概括
自伤后的早期干预没有显示出重复自伤的显著减少. 然而,解决问题的治疗和简短的接触干预与中长期中低自杀死亡率有关.
科学领域:
- 精神病学是一个精神病学.
- 公共卫生 公共卫生
- 临床心理学 临床心理学
背景情况:
- 在自我伤害演示后,自杀风险显著增加.
- 在这个高风险时期进行早期干预的证据需要综合.
- 识别有效的早期干预措施对于精神病治疗和预防至关重要.
研究的目的:
- 系统地审查和元分析随机临床试验 (RCT) 的干预措施,在自我伤害呈现的一个月内开始.
- 评估早期干预措施在减少重复自我伤害和自杀死亡率方面的有效性.
- 为了确定干预效应的调节者.
主要方法:
- 系统性审查和RCT的元分析.
- 在多个数据库 (PubMed,Embase,PsycINFO,ICTRP,ClinicalTrials.gov) 进行了搜索,截至2025年4月.
- 使用Cochrane RoB 2以避免偏差风险,并使用GRADE以确保证据的确定性.
- 进行随机效应元分析和元回归.
主要成果:
- 包括60个RCT与22,654名参与者.
- 没有任何干预措施显著减少了重复的自我伤害.
- 在中期随访 (6-12个月) 时,解决问题治疗显示自杀死亡率降低.
- 在长期随访 (>12个月) 时,简短的干预和接触显示自杀死亡率降低.
结论:
- 在自我伤害表现的一个月内进行的早期干预对自我伤害的重复产生了小而无意义的影响.
- 结构化的问题解决和简短的接触干预与减少自杀死亡率有关.
- 研究结果支持可扩展的早期干预措施,并突出了未来的研究重点,以发现自杀死亡率.
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