Acil servise intihar girişimiyle başvuran hastaların değerlendirilmesinde  hastane anksiyete depresyon ölçeği'nin kullanılması /
Yazar: VOLKAN ÇELEBİ
Danışman: DOÇ. DR. MEHMET NURİ BOZDEMİR
Sağlık Bilimleri Üniversitesi / Antalya Eğitim ve Araştırma Hastanesi​ / Acil Tıp Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2017
Konu: İlk ve Acil Yardım = Emergency and First Aid
Dizin: Acil servis = Emergency service ; Anksiyete = Anxiety ; Anksiyete bozuklukları = Anxiety disorders ; Depresif bozukluk = Depressive disorder ; Depresyon = Depression ; Ölçekler = Scales ; İntihar = Suicide

Özet:
İntihar girişimi acil servislere sıkça başvuru nedenlerinden biridir. İntihar girişimiyle başvuran hastaların tanımlanması risk gruplarının belirlenmesi ve riskli hastalar için uygun önlemlerin alınması oluşabilecek yaralanmaları ve ölümü önleyebilir. 
Bu çalışmada acil servise intihar girişimiyle başvuran hastalarda hastane anksiyete depresyon ölçeğini kullandık. Hastaların intihar riskinin değerlendirilmesinde bu ölçeğin kullanılabilirliğini göstermek amaçlanmıştır.  
Çalışmaya 102 hasta dahil edildi ve 14 soruluk hastane anksiyete depresyon ölçeği hastalar tarafından dolduruldu. Anketi dolduran hastalar, 1 hafta sonra daha önceden belirlenmiş bir psikiyatri uzmanı tarafından değerlendirilmek üzere telefonla arandı ve kontrol muayenesine çağırıldı. İntihar girişimi olan hastaların intihar girişimi olmayan hastalara göre Hastane Anksiyete Depresyon Ölçeği Anksiyete (HAD-A)   Hastane Anksiyete Depresyon Ölçeği Depresyon (HAD-D) skoru ve Hastane Anksiyete Depresyon Ölçeği (HADÖ) toplam skorları açısından aralarında anlamlı bir fark olduğu tespit edildi (p=0.043,p=0.031,p=0.034, sırasıyla). İmpulsif (içgüdesel olarak verilen ani tepki) tanısı alan hastaların, diğer tanıları alan hastalarla anlamlılık düzeyine göre karşılaştırıldığında HAD-D skorları istatiksel olarak anlamlı bulundu (p=0.044).
Çalışmamızda uyguladığımız HAD ölçeği, hastaların anksiyete depresyon düzeylerini değerlendirerek risk grubundaki hastaları tanımakta yardımcı olmuştur. Özellikle hikâyesinde en az bir intihar girişimi bulunan hastaların daha riskli grupta yer 
aldıkları tespit edildi. 
Hikâyesinde en az bir intihar girişimi bulunan hastaların daha riskli grupta yer aldıkları ve psikiyatrik destek sağlanırsa hastaların intihar eğilimlerinin azaltılabileceği sonucuna vardık.
Acil servis doktorları, intihar girişimiyle başvuran hastaların sadece intihardan doğan fiziksel sorunlarını çözmeye odaklanmamalı, bu hastalara taburcu edilmeden gereken psikiyatrik desteği sağlamalıdır.

Abstract:
Suicide attempts are one of the common reasons for referral to emergency services. Identification of patients admitted by commiting suicide, identification of risk groups and taking appropriate precautions for risky patients may preventinjuries and death.
In this study, we used hospital anxiety depression scale in patients who applied with emergency service suicide attempt. The aim of this study was to show the usefulness of this scale in evaluating patient's suicide risk.
102 patients were included in the study and the 14-questions hospital anxiety depression scale was filled by the patients. The patients who completed the questionnaire was called to be evaluated by a pre-determined psychiatrist one week later and then asked for the control examination. There was a significant difference between the patients with suicide attempt and those without suicide attempt  in terms of HAD-A, HAD-D score and HAD total scores (p = 0.043, p = 0.031, p = 0.034, respectively). HAD-D scores were statistically significant (p = 0.044) when the patients diagnosed as impulsive were compared with the patients with other diagnoses according to the level of significance. 
In our study, the HAD scale helped to identify patients in the risk group by assessing the anxiety depression levels of the patients. In particular, it was noticed that the patients had at least one suicide attempt in their story were in high risky group. 
We found that patients who had at least one suicide attempt in their story were in a higher risk group and if psychiatric support was available, the suicidal tendencies of patients may be reduced.
Emergency physicians should focus not only to solve the physical problem of the patients presented suicide attempts but also provide the required psychiatric care before the dischargement .
102 patients were included in the study and the 14-questions hospital anxiety depression scale was filled by the patients. The patients who completed the questionnaire was called to be evaluated by a pre-determined psychiatrist one week later and then asked for the control examination. There was a significant difference between the patients with suicide attempt and those without suicide attempt  in terms of HAD-A, HAD-D score and HAD total scores (p = 0.043, p = 0.031, p = 0.034, respectively). HAD-D scores were statistically significant (p = 0.044) when the patients diagnosed as impulsive were compared with the patients with other diagnoses according to the level of significance. 
In our study, the HAD scale helped to identify patients in the risk group by assessing the anxiety depression levels of the patients. In particular, it was noticed that the patients had at least one suicide attempt in their story were in high risky group. 
We found that patients who had at least one suicide attempt in their story were in a higher risk group and if psychiatric support was available, the suicidal tendencies of patients may be reduced.
Emergency physicians should focus not only to solve the physical problem of the patients presented suicide attempts but also provide the required psychiatric care before the dischargement.


Key Words: Suicide, Hospital Anxiety Depression Scale, Suicide Attempt