Observation of Suicide Prevention in Hospitalized Patients with Depression Based on Taihe Emotion-distress Index

Jian ZHU

OT Department, Shiyan Taihe Hospital (Affiliated Hospital of Hubei University of Medicine), Shiyan 442000, China

Abstract [Objectives] To reduce suicidal ideation and suicidal behavior through initial screening of patients with suicidal tendencies and implementing suicide prevention interventions during their hospitalization. [Methods] The Taihe Emotion-distress Index (THEI) was used to conduct pre-admission and post-discharge tests to explore the effects of suicide prevention measures during hospitalization on the alleviation of the disease and the reduction of suicidal behaviors. The study selected patients who were diagnosed with depression in the psychological outpatient department of Taihe Hospital from April 2019 to September 2019 and had to be hospitalized, including patients with moderate depressive episodes, severe depressive episodes with or without psychotic symptoms, and patients with suicidal thoughts and self-harming behaviors. [Results] The pre-admission and post-discharge test data of hospitalized patients were analyzed, and the non-parametric paired sample T test was carried out, and the result was P<0.05, showing that there are significant differences between the pre-admission and post-discharge test data. [Conclusions] The measures of suicide prevention intervention are effective to a certain extent.

Key words Depression, Suicide, Taihe Emotion-distress Index (THEI), Non-parametric paired sample T test

1 Introduction

Suicide is a kind of behavior triggered by psychological conflict, and an individual voluntarily and actively takes action to end his life. Suicide is a stress response caused by maladaptation to the environment, and it is one of the extreme ways to relieve psychological stress. For a long time, hospitalized patients with chronic physical diseases (such as tumor diseases, cardiovascular diseases, diabetes,etc.) were considered to be highly susceptible to commit suicide. However, due to various factors, physicians and nursing staff in general hospitals have low rates of recognition of patients with suicidal intent. In general hospitals, patients with physical diseases often commit suicide. It not only causes immeasurable psychological and economic losses to the family of the dead, but it may also lead to medical disputes, affect the normal medical order and cause adverse consequences. The occurrence of suicidal behavior is divided into three stages: generating suicidal ideation, making suicidal plans, and implementing suicidal behaviors. Suicidal ideation is the early stage of suicide attempts, suicide plans, and suicide deaths, and has attracted the attention of many related professionals. At the same time, suicidal ideation is one of the most important assessment indicators in the recognized suicide risk assessment system. Suicidal ideation is the external behavior of wanting to end one’s own life, but not yet doing so. It is characterized by concealment, contingency, extensiveness and individual differences. At present, suicide is considered to be an important public health and social issue both at home and abroad[1]. According to relevant data, in 2012, about 803 900 people suicided in the world, of which 120 700 people in China committed suicide, accounting for 15% of the global suicide deaths, and the suicide rate per 100 000 people was 8.7%[2-4].

2 Research methods

2.1 Research subjectsWe selected 77 patients who were treated in the psychological outpatient department of Taihe Hospital from April 2020 to September 2020 and were admitted to the hospital. The subjects were patients diagnosed with depression who required hospitalization, including: moderate depressive episodes, severe depressive episodes, patients with or without psychotic symptoms, suicidal thoughts and self-harming behaviors. Among them, 31 were male and 46 were female. Patients generally stayed in hospital for 2 weeks.

2.2 Research toolsThe scale used in this study was based on the Taihe Emotion-distress Index (THEI), a national-level technical invention patent independently developed by Taihe Psychological Clinic. THEI is a clinical application tool for rapid screening of common psychological problems in hospitalized patients. Through identifying suicidal ideation in hospitalized patients early, and providing appropriate targeted interventions at the individual level of patients, medical staff, and hospital organization and management, it is possible to form a practical early warning mechanism for inpatient suicidal ideation, establish a three-level prevention and control team of clinical psychologists, improve the hierarchical handling process of suicide crisis intervention, and realize the "120" (emergency rescue) of hospital suicide prevention and first aid. The scale is a 5-level scoring scale, "Not at all -0 point", "Occasionally -1 point", "Sometimes -2 points", "Most of the time -4 points" and "All the time -5 points". The scale includes 11 items and has a total score of 44 points. Patients with a score of 0-10 points require routine observation. Patients with a score of 11-15 points have mild mental health problems, and psychological support of the medical team is needed. Patients with a score of 16-20 points have moderate mental health problems. For these level of patients, the medical team should communicate with doctors to clarify the patient’s mental health problems and possible risks (suicide, self-harm), and family members of high-risk groups should accompany the patients around the clock. Patients with scores greater than 21 points have serious mental health problems and are at risk of suicide. Family members or escorts must always pay attention to these patients, and the medical team should provide psychological counseling to them[5].

2.3 Research proceduresThe inpatients were tested on the day of consultation through the "THEI" scale for psychological assessment, and the score obtained from the scale was the pre-admission test score. Under the condition that the attending physician evaluates and agrees that the patient is discharged from the hospital, the patient will be evaluated again by THEI, and the score obtained on the scale is the post-discharge score. During the 2 weeks of the patient’s hospitalization, physicians and nurses performed daily interventions on the patient in three aspects: drug therapy, physical therapy and psychotherapy.

2.3.1Drug therapy. Physicians would give different types and doses of drugs according to the individual conditions of patients, such as escitalopram, fluoxetine, paroxetine, sertraline,etc.Physicians would also adjust the dose of the drug in time according to the changes in the patient’s condition during the hospitalization.

2.3.2Physical therapy. Inpatients would receive a variety of comprehensive treatments such as electro-acupuncture, parietal nuclear therapy, repetitive transcranial magnetic stimulation (rTMS) therapy, and intelligent psychological multi-functional decompression chamber every day. Modified electroconvulsive therapy (MECT) may also be performed according to the assessment of the condition to help patients better relieve their condition and recover from hospital discharge.

2.3.3Psychotherapy. Psychological clinics are equipped with psychotherapists to provide regular psychological counseling and treatment to inpatients.

3 Results and analysis

For the THEI test of hospitalized patients, we compared the results of pre-admission test score and post-discharge test score. The comparison results indicate that after the inpatients undergo professional psychological assessment and interventions in three aspects: drug therapy, physical therapy and psychotherapy, the conditions of patients have been significantly improved, which demonstrate that these methods can help the patients to recover to a certain extent (Table 1). The normality test results of the pre-admission test score and post-discharge test score of hospitalized patients are shown in Table 2. The non-parametric paired sampleTtest results of the pre-admission test score and post-discharge test score of hospitalized patients are shown in Table 3. Because the number of samples was only 77, we selected the Shapiro-Wilk test. From Table 2, it can be seen that thePvalues of the normality test of the pre-admission test score and post-discharge test score are both less than 0.05. Therefore, the pre-admission test data and post-discharge test data are non-normal data. Therefore, we selected the rank sum test of paired samples for difference comparison. From the result of the Wilcoxon test, we can see that thePvalue is less than 0.05 in Table 3, indicating that there is a significant difference between the pre-admission test score and the post-discharge test score of the THEI scale in the test.

Table 1 THEI scoring results of patients

Table 2 Normality test of pre-admission test and post-discharge test data

Table 3 Non-parametric paired sample T test of pre-admission test and post-discharge test data

4 Discussion

The diagnosis of depression still remains in the stage of inference of symptoms and subjective filling and screening of scales. At present, there are still no objective physical and chemical examination diagnostic indicators[6-8]. In the treatment of depression, western medicine is very effective in improving the symptoms of patients, but it cannot effectively prevent the recurrence of depression. In addition, although antidepressants are not addictive, the side effects of antidepressants are a serious concern. Almost all antidepressants have side effects. Long-term use of the drug may cause damage to the gastrointestinal tract and liver, making it difficult for patients to take the drug for a long time and influencing the patient’s ability to work and quality of life. There have been extensive reports about suicidal behavior in depression, but a complete set of research criteria has not yet been developed. Suicide is a concern of many disciplines, such as sociologists, psychologists, philosophers,etc.It needs to be studied collaboratively by researchers from various disciplines. However, at present, various disciplines conduct research in a decentralized manner, lacking a unified coordination organization. There are also shortcomings in this study. The sample size included in the trial was relatively small, so the validity of the experiment is not high. Besides, the experiment should set a control group and an experimental group, then a more significant comparison of experimental results can be seen. The within-subject design may cause a practice effect. The patient’s subjective filling in the scale cannot objectively and comprehensively judge the patient’s psychological state. As a result, the test scores of the scale may be inaccurate. As far as possible, the scale should be filled out by the physicians asking the patients.

Suicidal behavior is relatively common in depression, but suicidal or self-harming behavior can bring a double burden of psychological and financial burdens to both the patients themselves and their families[9]. Studies have shown that 3/4 of adults with depression have their first depressive episode during adolescence[10]. Depression has a great impact on quality of life and social functioning, especially in adolescents[11-12]. It is hoped that in the future, there will be better methods for treating depression, so that patients with depression can adapt to society and face life more positively and optimistically, reduce the adverse effects of depression on individuals and families, and make effort to control symptoms from the source and predict recurrence.