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Abstract
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INTRODUCTION: Suicide is the second leading cause of death in young adults. Suicide attempts by violent methods predict later completed suicide and premature mortality. Suicide prevention is a major public health issue in this specific population. The French Student Health Foundation (FSEF) developed a psychiatric ward that includes psychiatric and somatic approaches. This transdisciplinary unit provides mixed psychiatric and rehabilitation treatments for those persons who have attempted suicide and have severe somatic injuries.
METHODS: We conducted a retrospective study including all subjects admitted into the transdisciplinary unit from 1st January 2011 to 31 December 2017, after a suicide attempt by jumping from a height, in front of a moving object, or by crashing of a motor vehicle. Data was obtained from the medical and administrative records of the clinic.
RESULTS: In total, 215 persons were admitted into the transdisciplinary unit after a suicide attempt by a violent mean. Among them, 91.6% had jumped from a height, 7.4% had jumped in front of a train or a metro and 0.9% had crashed a motor vehicle. They were on average 25.5years old and 50.2% were men. 45.1% had a diagnosis of schizophrenic disorders and 34.4% of mood disorders. A total of 35.6% presented at least one previous suicide attempt, and among them 40.3% had previously attempted suicide with a violent mean. Substance abuse, mostly alcohol and/or cannabis, featured in 40.8% of subject history. The subjects hospitalised in the transdisciplinary unit had multiple, severe injuries: 78.1% had spine fractures, 69.8% had lower limb fractures, 47.9% had pelvic fractures and 43.3% had upper limb fractures. Moreover, 25.5% of them had sacral root damages. The length of stay averaged 184days and varied in a large range (less than a month to more than two years). The Activities of Daily Living scores were higher than 3 (out of a maximum score of 4) reflecting an important need of assistance. These scores decreased significantly during the hospitalisation for dressing, feeding, continence and locomotion but remained high for comportment and communication. At discharge, the physical sequelae were still important: 61% of people hospitalised had pain that required step 2 or 3 analgesics, 44% had analgesics for neuropathic pain, 80% had lower limb impairments, most often with walking limitation, and 26% had continence disorders. The psychotropic treatments at discharge were related to the psychiatric disorders observed and included 42% antidepressants, 63% neuroleptics and 16% mood stabilizers.
CONCLUSION: This study highlights the severity of the somatic and psychiatric disorders affecting people who are admitted into this transdisciplinary unit. These subjects who have attempted suicide require particular care with multidisciplinary management in order to promote their rehabilitation, reintegration and prevent a suicide reattempt.
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Objectifs
Décrire un service transdisciplinaire de psychiatrie intégrant une équipe de médecine physique et réadaptation dédiée aux personnes hospitalisées dans les suites de tentatives de suicide ayant entraîné des traumatismes multiples ; ainsi que la population qui y est accueillie et son évolution au cours de la prise en charge.
Méthodes
Étude rétrospective réalisée à partir des dossiers médicaux des personnes hospitalisées entre 2011 et 2017 ainsi que des diagnostics et des scores de dépendance extraits du PMSI.
Résultats
Parmi les 215 sujets hospitalisés, 91,6 % l'étaient dans les suites d'une tentative de suicide par précipitation et 7,4 % après un saut devant un train ou un métro. Ils étaient pour moitié (50,2 %) des hommes, âgés de 25,5 ans en moyenne. Sur le plan psychiatrique, 45,1 % souffraient de troubles schizophréniques, 34,4 % de troubles de l'humeur ; 40,8 % présentaient un abus de substances et 35,6 % avaient déjà fait au moins une tentative de suicide. Les conséquences somatiques de la tentative de suicide étaient multiples : 78,1 % de fractures vertébrales, 69,8 % de fractures des membres inférieurs, 47,9 % de fractures du bassin et 25,5 % d'atteinte des racines sacrées. La durée d'hospitalisation était de 184 jours en moyenne. La cotation des dépendances montrait une amélioration significative sur le plan somatique à la sortie du service.
Conclusion
Cette étude met en évidence la sévérité des tableaux cliniques somatique et psychiatrique des personnes accueillies en unité transdisciplinaire, notamment l'importance des séquelles invalidantes et des troubles psychiatriques justifiant une prise en charge spécifique lors de l'hospitalisation et au-delà.
Language: fr |