TY - JOUR AU - O'Callaghan, Erin AU - Mahrer, Nicole AU - Belanger, Heather G AU - Sullivan, Scott AU - Lee, Christine AU - Gupta, Carina T AU - Winsberg, Mirène PY - 2022 DA - 2022/9/30 TI -远程健康支持的自杀想法决策精神护理:纵向观察研究JO - JMIR形式Res SP - e37746 VL - 6 IS - 9kw -远程医疗KW -远程医疗KW -精神病学KW -精神健康KW -自杀意念KW -抑郁KW -焦虑KW -自杀KW -抑郁症KW -数字健康KW -电子健康KW -精神药物KW -人口统计学KW -精神护理KW -决策KW -决策支持AB -背景:自杀是美国人死亡的主要原因，而自杀意念(SI)是自杀的一个重要前兆和危险因素。目的:本研究旨在探讨远程精神科护理平台对SI随时间变化和缓解的影响，并探讨各种人口和医学因素对SI和SI缓解的关系。方法:参与者包括8581名美国成年人(治疗组8366名，对照组215名)，寻求抑郁症、焦虑或两者兼有的治疗。治疗组包括完成了至少12周治疗的患者，并且在研究期间接受了至少一种精神药物的处方。提供者在第一次治疗期间为每位患者开精神病药物，并定期收到参与者的数据。他们还通过数字平台在治疗开始时获得决策支持，该平台利用了基于经验得出的专有精确处方算法，为提供者提供实时护理指南。对照组的参与者由完成初始登记数据并在基线和12周完成调查的个人组成，但没有接受护理。结果:在基线时，更强烈的绝望感、快感缺乏和自我感觉不好与SI最显著相关(r=0.24-0.37)。 Sleep issues and feeling tired or having low energy, although significant, had lower correlations with SI (r=0.13-0.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r=−0.16) and 12 weeks (r=−0.10) but less improvement over time (r=−0.12 and −0.11, respectively). Although not different at baseline, the SI expression was evident in 34.4% (74/215) of the participants in the control group and 12.32% (1031/8366) of the participants in the treatment group at 12 weeks. Although the participants in the treatment group improved over time regardless of various demographic variables, participants in the control group with less education worsened over time, after controlling for age and depression severity. A model incorporating the treatment group, age, sex, and 8-item Patient Health Questionnaire scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely (odds ratio 4.31, 95% CI 2.88-6.44) to have complete SI remission than those in the control group. Female participants and those with advanced education beyond high school were approximately 1.4 times more likely (odds ratio 1.38, 95% CI 1.18-1.62) to remit than their counterparts. Conclusions: The results highlight the efficacy of an antidepressant intervention in reducing SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trials, are needed. SN - 2561-326X UR - https://formative.www.mybigtv.com/2022/9/e37746 UR - https://doi.org/10.2196/37746 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178727 DO - 10.2196/37746 ID - info:doi/10.2196/37746 ER -