技术可以帮助全球预防自杀吗?

September 10th2017年是第15位World Suicide Prevention Day. The theme of the 2017 day is ‘Take a Minute, Change a Life’ - encouraging everyone to consider those impacted by suicide and take the time to notice what’s going on with those around you, and support those who may be feeling vulnerable. Here, we discuss the contribution that eHealth interventions can play in the global public health strategy for suicide prevention

世界卫生组织估计800,000 people die by suicide each year– that is one person every 40 seconds! But for every suicide, there are many more people who attempt suicide, and many individuals who are impacted by the suicide of a loved one. Suicide is not restricted by age, gender, nationality or income; it occurs throughout the lifespan and in 2015, was the second leading cause of death among 15–29-year-olds. A prior suicide attempt is the single most important risk factor for suicide in the general population, and whilst people with mental health conditions are at higher risk of suicide, many suicides occur spontaneously in response to life events or crisis.

Suicide is a serious public health concern and is preventable. In 2014, the World Health Organization published “防止自杀:全球命令”,这是增加对自杀和自杀企图的认识,并将预防自杀预防作为全球公共卫生优先事项的第一项全球报告。自杀是一个复杂的问题,因此有效的预防自杀工作需要多个成分。预防自杀的一个关键组成部分是对有需要的人的早期识别,以确保他们获得适当的护理和支持;在这里,社区和亲人提供的社会支持对于寻求精神保健的脆弱个人至关重要。

Access to appropriate mental health care, when and where it is needed, is vital for the prevention of suicide. In some countries mental health care may be harder to access due to geographical or financial restraints. However, even in countries where access to care is ready available many who experience suicidal ideation do not seek help. A number of barriers may prevent those experiencing suicidal ideation from seeking treatment; suicide and mental illness are still heavily stigmatized in many communities, and some groups of the general population are less likely to seek help than others, including young people and men.

Johan Larsson, Flickr, CC

全球对技术的依赖增加为改善心理保健提供的机会;对于那些无法或不选择不访问传统的“面对面”医疗保健的人的潜力是可以通过数字方法获得的。迄今为止,这已经采取了多种形式 - 从通过视频通话的医生咨询到开发复杂的在线和移动电话应用程序。研究数字或eHealth干预措施对预防治疗和后续护理的有效性正在迅速扩大。

A systematic review and meta-analysis,最近出版inBMC精神病学byKatrina Witt来自澳大利亚莫纳什大学的同事研究了数字干预对自杀念头或自我伤害的自我管理的有效性。研究人员分析了14项已发表研究的数据,其中包括总共3,356名参与者。大多数研究包括评估在线干预措施,但两项检查的手机应用程序是为患有抑郁症/自杀状态的人设计的,以自我控制。研究人员发现,尽管有许多已发表的研究设计的局限性,但仍有证据表明数字干预可能与自杀念头的减少有关。

另一个系统的综述和荟萃分析,Mark Deady和colleagues from the University of New South Wales and the Black Dog Institute (Australia),最近出版inBMC精神病学,评估了eHealth干预措施预防抑郁和焦虑的有效性。研究人员分析了10项已发表的随机对照试验的数据,其中包括4,522名参与者。这些研究包括评估在线和手机应用程序,以及其他干预方法,例如使用电子邮件和/或文本消息传递提供支持的方法。审查表明,一系列的eHealth干预计划对普通人群的焦虑和抑郁症的症状减轻产生了很小但积极的影响。

在这两种评论中,干预计划都是由心理学家/精神科医生使用认知行为疗法(CBT)的方面制定的,与对照条件相比,人们发现有益。但是,应该强调的是,在所有研究中,缺乏长期的随访数据,因此尚不清楚这些干预措施是否可以转化为长期自杀企图,抑郁和焦虑的减少。两次评论中的少量研究表明,持续不断地评估eHealth干预措施的有效性;尽管旨在改善和促进心理健康的数字程序和应用程序的数量不断增加,但仍需要在以证据为基础医学的基础上(例如这里分析的研究)和那些正在分析的研究以及那些正在分析的研究,以及那些正在分析的人之间的区别不是。

eHealth和数字干预措施有可能吸引更多资源比面对面护理少的人,并且可能有助于打破一些当前的障碍,这些障碍阻止人们无法获得精神卫生保健。

如果你想了解更多关于suicide prevention please seeBMC精神病学’sdedicated section ‘Causes, treatment and prevention of suicide‘.

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