Construction Of Evaluation Index System Of Inpatients Suicide Risk In General Hospital

Objectives:This study aims at exploring and establishing a suicide risk evaluation index system for inpatients in general hospitals and developing a tool for assessing inpatients suicide risk,so as to provide a reference for nursing staff.At the same time,this study will use the ROC curve to determine the critical value of the suicide risk assessment tool and conduct risk assessment from admission to discharge,predict and identify the suicide tendency as early as possible,in order to take preventive measures and reduce the risk of suicide among inpatients.Methods:1.Literature review: Through a review of relevant literatures about inpatients suicide,we combine with the present situation and epidemiological characteristics of comprehensive hospital patients,on this basis,we analyze and summarize the influencing factors of suicidal inpatients in general hospitals in China,and then form a preliminary items pool of evaluation contents.2.Focus group interview: Based on the literature review and previous review data,the index system has been formed initially by using focused group interviews.The interviews mainly focused on the current opinion and suggestions of the index system and the principles to be followed in the revision.According to the interview results,the index system was further revised and the improved Delphi method was compiled.3.Delphi experts consultation: The revised index system was made into a structured expert consultation questionnaire.The questionnaire was transmitted to experts by email,and the evaluation index system of suicide risk of inpatients in general hospitals was established according to expert opinions.4.Analytic hierarchy process:This study uses the analytic hierarchy process to determine the relative importance of the first-level indicators.Obtaining the importance assignment mean of the second-level and third-level indicators according to the saaty scale.Then the judgment matrix was constructed and the consistency of the matrix was tested.Finally,the yaahp software was used to determine the weight of the evaluation index.5.Questionnaire survey: The questionnaire was composed of two parts.The first part is a self-made questionnaire of 24 item evaluation tools.The second one is Suicide Probability Scale(SPS),which contains 36 items.The questionnaire was used to evaluate the inpatients in a comprehensive hospital and to provide basic information for the index through mathematical statistics.6.Statistical method: A statistical analysis of the data collected from expert consultations conducted by applying Excel,SPSS 19.0 and yaahp software.Results:1.Two rounds of the effectively response rate were 94.29% and 100%,and the experts’ authoritative coefficient was 0.857.In addition,the correlation coefficient of first-level was 0.243,the second-level was 0.387(p<0.05),and the variation coefficient fluctuated between 3.7 % to 18.4%.2.By two Delphi expert advice,the evaluation index system contains 3 first-level indicators,8 second-level indicators,18 three-level indicators.The weights of the three first-level indicators are 0.3278,0.4111 and 0.2611.3.On the basis of pre-survey data,the index system was tested by internal consistency analysis,content validity and construct validity.The Cronbach’s alpha of total system was 0.779,Cronbach’s alpha of each first-level indicators ranged from 0.605 to 0.743,these indicated the index system was feasible to use.The content validity index of index system was 0.92,each item ranged from 0.83 to 1.00.The construct validity of the index system was estimated by correlation analysis and factor analysis.The correlation coefficient of first-level indicators and total system ranged from 0.701 to0.912(p<0.05),correlation coefficient of second-level indicators and first-level indicators ranged from 0.467 to 0.954(p<0.05).Exploratory factor analysis were used to extract 3 factors,for which the cumulative variance contribution rate was 48.491%,the factor loads for 18 items were all greater than 0.400.These show that the index system has good structure validity.4.The critical value of suicide risk assessment tool was determined by ROC curve,the sensitivity of index system was 73.58%,specificity was 67.60% and the area under the curve was 0.748.The correlation coefficient between the self-made evaluation tool and the suicide probability scale was 0.489.The correlation coefficients between the self-made evaluation tool and SPS’s despair factor subscale and suicide ideation factor subscale were 0.561 and 0.544(p<0.05).By comparing suicide assessment tool with SPS,the results show that 53 inpatients need to be evaluated for suicidal tendency through SPS and 50 inpatients need to evaluated through suicide assessment tool.It is shown that the reference critical value of suicide assessment tool has certain rationality.Conclusions:This study established a evaluation index system of inpatients suicide in general hospital,the weight of indicators was determined,and the critical value of suicide assessment tool was defined.It can provide reference for clinical evaluation of suicide risk and intervention measures,so as to provide evidence for nursing staff’s work.