以学校为基础的自杀高危青少年针对性预防研究

A school-based indicated prevention study for suicide in adolescents with high risk

目的对有自杀风险的高危青少年进行针对性干预,评估干预方案的效果。方法选取上海市浦东新区2所初中的初一和初二年级、2所高中的高一和高二年级,以班级为单位随机分为干预班级和对照班级。通过问卷筛查出有自杀风险的高危青少年210人,研究组101人,对照组109人。研究设计为add-on。研究组高危青少年除接受学校常规心理课程以外,另外接受20节团体认知行为课程,其父母接受青少年自杀预防宣教;对照组只接受学校常规心理课程,其父母不干预。在干预前和干预结束后6个月进行问卷调查,评估自杀行为和相关因素的变化。结果干预前除研究组的敢于自表因子分高于对照组外(P=0.012),两组其他评估指标无统计学差异(P>0.05)。干预后,研究组的自杀行为(P值分别为0.000、0.000、0.006)、最近1周和最严重时的BSI-CV(Beck自杀意念量表中文版)得分(P值分别为0.000、0.003)、BDI(Beck抑郁量表)得分(P=0.000)、BHS(Beck绝望量表)总分及对未来感觉和动力丧失因子分(P值分别为0.015、0.040、0.020)均显著低于干预前,SSRS(社会支持评定量表)总分及主观和客观支持因子分(P值均为0.000)、ESAP(情绪智力技能问卷)的敢于自表(P=0.017)和压力管理因子分(P=0.042)均显著高于干预前;干预后对照组的自杀行为(P值分别为0.000、0.002、0.008)、BDI得分(P=0.000)均显著低于干预前,SSRS总分(P=0.042)及主观支持因子分(P=0.001)、SCSQ(简易应对方式问卷)的积极应对因子分(P=0.009)均显著高于干预前;除研究组的客观支持因子分(P=0.013)和敢于自表得分显著高于对照组(P=0.004),最近1周的自杀意念显著低于对照组(P=0.048)外,上述其他指标在两组间无统计学差异。结论干预方案能够改善自杀高危青少年的部分自杀行为和相关因素。目前干预结果提示我们应延长随访时间以便能够观察到最大化的干预效果。

Objective To evaluate the effectiveness of an indicated suicide prevention program on suicide behaviors and related factors in high suicide risk students.Methods A total of 210 students were screened as high suicide risk students in grade 7,8,10,11 in Pudong district,Shanghai.All students were randomly assigned into the study group or control group by class level.A suicide prevention program was conducted in study group.Both the study group and control group completed the self-administered questionnaires before and 6 months after the intervention.Results No significant difference was found in suicide behaviors and related factors in the pre-intervention test between two groups(P>0.05)except the score of self-expression(P=0.012).In the follow-up of 6 months in the end of intervention,in the study group suicide behaviors(P=0.000,0.000,0.006),BSI-CV score in the recent week and in the worst(P=0.000,0.003),BDI score(P=0.000),BHS total score and its factors score of future feeling and loss of motivation(P=0.015,0.040,0.020)were significant lower in the 6 months than in the pre-intervention;however,SSRS score and factor scores of subjective and objective support(P=0.000),self-expression score(P=0.017)and stress management score(P=0.042)in ESAP were significant higher.In the control group suicide behaviors(P=0.000,0.002,0.008)and BDI score(P=0.000)were significant lower,but SSRS score(P=0.042)and factor score of subjective support(P=0.001),positive coping score in SCSQ(P=0.009)were significant higher in the 6 months than in the pre-intervention.No significant difference was found between two groups in the above mentioned variables except that the score of objective support of SSRS and score of self-expression were higher in the study group than in the control group,BSI-CV score in the recent week was lower in the study group than in the control group at the 6-month follow-up.Conclusions In the current follow-up time,our intervention can only improve parts of suicide behaviors and their related risk factors in the students with high suicide risk.It may implicate that we prolong follow-up to maximum the effectiveness of intervention program.