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Yıl:2019; Cilt: 22; Sayı: 2>> Özet
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Klinik Psikiyatri Dergisi; 2019;22(2):193-205
Hastaneye yatış gerekliliğini yordamada özkıyım riskini değerlendirme araçlarının etkililiği
İ Güneysu, S Batmaz, EA Aslan, E Songur, S Koyuncu
Tokat Gaziosmanpaşa Üniversitesi, Tokat
Amaç: Bu çalışmada birinci basamak sağlık hizmetlerinde acil servise özkıyım girişimi sonrasında başvuran erişkinlerin bazı özkıyım riskini değerlendirme araçları ile değerlendirilmesinden sonra hastaneye yatış gerekliliği olduğu düşünülenlerin bu araçlarla saptanmasının etkililiği araştırılmıştır. Yöntem: Çalışmaya 60 katılımcı alındı. Psikiyatri uzmanının özkıyım riskini değerlendirerek yatış gerekliliğine karar vermesinin altın standart olduğu değerlendirme ile kullanılan araçlardan (Modifiye “SAD PERSONS” Ölçeği, California Özkıyım Riskisi Tahmin Etme Aracı, İntihar Riskini Değerlendirme Aracı) elde edilen puanlar arasındaki tutarlılık işlem karakteristik eğrileri (ROC) ile incelendi. Her bir araç için hastaneye yatış gerekliliğini en iyi yordayan kesme puanları, duyarlılık ve özgüllükleri hesaplandı. Kesme puanları ve klinik görüşmeye dayalı olarak hastaneye yatışı gereken ve gerekmeyen katılımcıların ayırt edilip edilemediğine bağımsız gruplar t testi ile bakıldı. Klinik görüşme ve değerlendirme araçları arasındaki ilişki Pearson korrelasyon analizleri ile incelendi. Bulgular: Değerlendirme araçlarının yatış gerekliliğini saptamadaki duyarlılıkları %44.4-72.2 arasında, özgüllükleri ise %81.0-95.2 arasında değişiyordu. Çizilen ROC’ların birbirlerinden farklı olup olmadığını anlamak için yapılan ikili karşılaştırmalarda bir fark saptanmadı. Değerlendirme araçları kesme puanları esas alındığında yatış gerektiren hastaları ayırt edebildi. Sonuç: Özkıyım girişimi sonrası acil servise başvuran erişkinler için uzmanın yaptığı klinik risk değerlendirmesinin yerini tutmasa da acil servis çalışanlarının olguları daha net şekilde değerlendirebilmeleri için kimi değerlendirme araçlarına başvurması yardımcı olabilir.
The effectiveness of suicide risk assessment tools in predicting the need for hospitalization
Objective: In this study, adults presenting to the emergency room after a suicide attempt were evaluated by means of some suicide risk assessment tools, and the effectiveness of these tools in identifying those who needed to be hospitalized was investigated. Method: A total of 60 participants were included in the study. The clinical risk assessment of a psychiatrist was considered to be the gold standard for evaluation, and the consistency of the scores obtained by the tools used in the study (Modified “SAD PERSONS” Scale, California Suicide Risk Estimator, Suicide Risk Assessment Tool) were compared with this gold standard by receiver operating curves (ROC). For each tool, the optimal cut-off score, and its sensitivity and specificity at this value, which identified those who needed to be hospitalized were calculated. Independent samples’ t test was used to demonstrate whether the clinical assessment and the cut-off scores of the tools were able to differentiate the groups who needed to be hospitalized or not. The relationship between the clinical assessment and the tools was investigated by Pearson correlation analyses. Results: The sensitivity of the assessment tools for the need for hospitalization ranged from 44.4% to 72.2%, and their specificity ranged from 81.0% to 95.2%. No differences were found between the ROCs of the assessment tools when they were compared with each other. The cut-off scores of the assessment tools managed to differentiate those who needed to be hospitalized. Discussion: Although the assessment tools may not replace the clinical risk assessment of a psychiatrist, some of them may be helpful for the emergency room healthcare staff in identifying the adults who need to be hospitalized after an attempted suicide.

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