脸书及其它社群媒体有助于预防自杀


  【24drs.com】新研究显示,脸书和其它社群媒体可提供重要的额外信息,而帮助医师进行(患者的)自杀评估。
  
  费城Drexel大学医学院精神科住院医师训练计画主任R. Bryan Chambliss医师指出,试图自杀者更可能告诉亲友而非医师,获得在线资源的更多资料会很有帮助。
  
  自杀依旧是个严重问题,美国每年超过36,000例自杀死亡,自杀是25-34岁者的第二大死因。
  
  Chambliss医师和Amir Ahuja医师、Krystine Biesaga医师等人在美国精神科协会2012年会中发表的墙报中,描述如何运用脸书获得一名无忧郁病史之27岁黑人男性冲动试图自杀的全貌。
  
  这名男性曾就读医学院,但是因为压力恶化大肠激躁症(IBS)而中断住院医师训练,他后来变得忧郁。
  
  Biesaga医师表示,他曾试图回去住院训练,不幸的是他没有成功;在他试图服过量药物自杀前,他以脸书上的秘密讯息方式告诉朋友他想要自杀。基本上,他希望他的朋友好好过生活,将他家中的一些东西送给朋友,最重要的是,他写电子邮件给他的女朋友,让她知道他做些什么。
  
  在病患同意下,研究者使用脸书上发布的讯息重建企图自杀的动机与事件时间序,这个案例中,他的朋友在几则令人担心的讯息后即积极地连络通知紧急医疗服务。
  
  Biesaga医师表示,看他的脸书网页并获得这些资料,实际上帮助我们了解病患并帮助他了解自己的状况,他想尝试做的事情有多严重,因为在当时,他并不知道这些讯息透露了什么,他并未真正认为自己忧郁或需要帮助。
  
  作者们指出,回顾病患的讯息最后帮助他接受药物与治疗,获得更好的结果。
  
  Ahuja医师表示,我们知道他后来出院了,有开立药物并转诊给精神科医师进行门诊治疗。
  
  研究者指出,在精神科,病人报告事件的准确性有时是可疑的,只使用病患的主观资料会使医师判断事实的能力受限制。
  
  社群媒体、部落格、其它网络讯息都可以用做更客观的来源,发布讯息的日期与时间,重现帐户的所有通信。
  
  Chambliss医师表示,另外很重要的是,这名男性有一个朋友上线发表一首相当神秘的诗后自杀,透过网络而传染自杀之观念是个相当相当热门的议题。
  
  2011年,脸书启动「通报自杀内容」工具,使用者可以在朋友发布自杀讯息或其它令人担心的内容后用这个工具通报,这个工具让使用者直接连上全国自杀防治生命线的在线谘商聊天室。
  
  Drexel大学的研究团队指出,2011年底时,脸书已经有多达8亿4500万名使用者,其中4亿8300万人每天登入使用,推特(Twitter)也有上亿名会员。
  
  他们指出,可能可以使用社群媒体筛检忧郁和自杀。某些病患宁愿将敏感事务发泄给计算机,也不愿面对面访谈,所以这些筛检可以比临床评估更准确。
  
  可以透过电子邮件直接联系有风险者,电子邮件是多数社群媒体加入时必须登载的项目,邀请患者进行在线或面对面治疗与评估。在HIV门诊和大范围校园筛检中,也运用了类似的策略。
  
  作者们写道,许多公司已经致力于大范围网络自杀筛检,例如Screening for Mental Health公司以及Jed Foundation这两家公司,他们使用PHQ-9忧郁问卷评估自杀。
  
  Chambliss医师指出,这些研究清楚指出,当提供在线介入、在线治疗给人们时,效果不错,网络在这方面确实可提供帮助。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6811&x_classno=0&x_chkdelpoint=Y
  

Facebook, Other Social Media May Help Prevent Suicide

By Megan Brooks
Medscape Medical News

May 5, 2012 (Philadelphia, Pennsylvania) — Facebook and other social media can provide a useful tool to help psychiatrists with suicide assessment by providing an important source of additional information, new research shows.

"People who attempt suicide are much more likely to tell friends and family than their doctors. Obtaining collateral data from online sources can be very helpful," R. Bryan Chambliss, MD, director of the psychiatry residency training program at Drexel University College of Medicine in Philadelphia, noted in an interview with Medscape Medical News.

Suicide remains a significant problem, with more than 36,000 deaths from suicide reported in the United States each year. Suicide is the second leading cause of death in adults aged 25 to 34 years.

A poster presented here at the American Psychiatric Association's 2012 Annual Meeting by Dr. Chambliss and coauthors Amir Ahuja, MD, and Krystine Biesaga, MD, describes how Facebook was used to obtain a clearer picture of a 27-year-old black man who was without a diagnosable history of depression and who made an impulsive suicide attempt.

The man went through medical school but had to leave residency because the stress was exacerbating his irritable bowel syndrome (IBS), and he subsequently became depressed.

"He was trying to get back into residency, and unfortunately, he didn't make it into the residency match," said Dr. Biesaga.

Before his suicide attempt by drug overdose, he told his friends through "cryptic" postings on Facebook of his intent to commit suicide.

"He was basically wishing his friends good things in their life and giving away some of his items from his home, and most importantly, he then wrote an email to his girlfriend to let her know what he was doing," Dr. Biesaga added.

With the patient's consent, Facebook postings were used to reconstruct a picture of the suicide attempt and to establish a clear timeline of events. In this case, his friends were very proactive and called Emergency Medical Services after several of the postings triggered concern.

Hot Topic

"Looking at his Facebook pages and obtaining all this collateral data really helped us understand the patient and also helped him understand his situation and how serious his attempt was, because at the time, he had very little insight into what had transpired, and he didn't really feel he was depressed or needed help," Dr. Biesaga said.

Reviewing the postings with the patient helped him finally accept treatment with medication and therapy, which led to a much better outcome, the authors note.

We know he was discharged on [medication] with a referral to a psychiatrist and agreeing to outpatient therapy," said Dr. Ahuja.

In psychiatry, the accuracy of patient reports of events is sometimes questionable, and using only subjective data from the patient limits a clinician's ability to discern the truth, the investigators note.

Social media, blogs, and other Internet postings can be used as a more objective source. Postings are dated and timed, and there is a reproducible account of all communication.

"It's also significant that this man had a friend who committed suicide who had posted a very cryptic poem online beforehand. The idea of suicide contagion via the Internet is a hot, very hot topic," said Dr. Chambliss.

In 2011, Facebook launched a "Report Suicidal Content" tool, with which users can report if their friends have posted a suicide note or other worrisome content. This tool gives users a direct link to an online chat with counselors at the National Suicide Prevention Lifeline.

Mass Screening?

The Drexel team notes that as of the end of 2011, Facebook alone had 845 million users, of whom 483 million used it daily. Twitter also has hundreds of millions of members.

It might be possible to use social media to screen for depression and suicide. Some patients would rather divulge sensitive matters to a computer than in a face-to-face interview, so these screenings could prove more accurate than clinical assessments, they note.

Individuals at risk could then be directly contacted through email, which is a requirement for joining most social media sites, and they could be invited to online or in-person therapy and evaluation. A similar strategy has been used in HIV clinics and in large-scale screenings at a college campus.

"Several companies are already working on large-scale Internet suicide screenings. They are Screening for Mental Health, Inc, and the Jed Foundation. They use a PHQ-9 Depression Questionnaire with an evaluation for suicide," the authors write.

"The studies are very clear that when people are offered online intervention, online therapy, they do well with that; that's the place where the Internet is proving helpful," Dr. Chambliss added.

The authors have disclosed no relevant financial relationships.

The American Psychiatric Association's 2012 Annual Meeting. Abstract NR1-54. Presented May 8, 2012.

    
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