Journal of Rafsanjan University of Medical Sciences

other آشنایی با مدل پیشگیری از خودکشی و خودآزاری Getting to Know Suicide and Self-Harm Prevention Model جراحي Surgery پژوهشي Research در سخن سردبیری شماره‌ شهریور ماه مجله‌ دانشگاه، با مدل تعیین کننده‌های گوناگون زمینه‌ای، اجتماعی، اقتصادی، جمعیت شناختی و عوامل خطر فردی که باعث به وجود آمدن خودکشی و خود آزاری می‌گردند، آشنا شدیم (1). در این سخن سردبیری قصد داریم که بر اساس این مدل، به چگونگی پیشگیری از این دو پدیده، بپردازیم. سازمان جهانی بهداشت، در کتاب خود با عنوان "پیشگیری از خودکشی: یک ضرورت جهانی" و با ارائه تصویری سعی می‌کند تا مهم‌ترین عوامل خطر خودکشی را در یک طبقه‌بندی از بالا به پایین، نشان دهد و سپس راه‌های پیشگیری از این دو پدیده را نیز در یک طبقه‌بندی از بالا به پایین دیگر، بیان کند (2) (شکل 1). همان‌طور که در شکل یک دیده می‌شود، در پنل سمت راست، برخی از مهم‌ترین تعیین کننده‌ها و عوامل خطر خودکشی و خودآزاری، از دورترین آن‌ها که به ترتیب شامل عوامل تعیین کننده‌ مربوط به نظام‌های بهداشتی، عوامل اجتماعی و عوامل مربوط به جامعه می‌گردد، تا نزدیک‌ترین عوامل که عوامل مربوط به روابط بین افراد و عوامل فردی می‌گردند، طبقه‌بندی شده است. در عوامل مربوط به نظام‌های بهداشتی، مشخصاً به موانع دسترسی به مراقبت‌های بهداشتی اشاره شده است. در حالی‌که عوامل اجتماعی، مشتمل بر دسترسی به ابزار خودکشی، گزارش غیرمسئولانه اخبار خودکشی در رسانه‌ها و انگ مرتبط با رفتار کمک جویانه می‌باشد. عوامل مربوط به جامعه نیز مشتمل بر بلایا، جنگ و درگیری‌های نظامی، استرس‌های مربوط به پذیرش فرهنگ غالب و یا جابه‌جایی‌ها، تبعیض، تروما و سوء استفاده می‌باشد. عوامل مربوط به روابط نیز، مشتمل بر حس تنهایی و فقدان حمایت‌های اجتماعی، به انضمام درگیری‌های بین فردی و از دست دادن می‌باشد. این در حالی است که عوامل فردی، شامل اقدام به خودکشی قبلی، بیماری‌های روانی، استفاده آسیب زا از الکل، از دست دادن شغل و عملکرد، نا امیدی، دردهای مزمن، سابقه خانوادگی خودکشی و عوامل ژنتیکی و زیست شناختی خودکشی، می‌باشد. <div aria-label="شکستن صفحه" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="شکستن صفحه"></div> <v:rect 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پایین، نشان دهد و سپس راه‌های پیشگیری از این دو پدیده را نیز در یک طبقه‌بندی از بالا به پایین دیگر، بیان کند (2) (شکل 1). همان‌طور که در شکل یک دیده می‌شود، در پنل سمت راست، برخی از مهم‌ترین تعیین کننده‌ها و عوامل خطر خودکشی و خودآزاری، از دورترین آن‌ها که به ترتیب شامل عوامل تعیین کننده‌ مربوط به نظام‌های بهداشتی، عوامل اجتماعی و عوامل مربوط به جامعه می‌گردد، تا نزدیک‌ترین عوامل که عوامل مربوط به روابط بین افراد و عوامل فردی می‌گردند، طبقه‌بندی شده است. در عوامل مربوط به نظام‌های بهداشتی، مشخصاً به موانع دسترسی به مراقبت‌های بهداشتی اشاره شده است. در حالی‌که عوامل اجتماعی، مشتمل بر دسترسی به ابزار خودکشی، گزارش غیرمسئولانه اخبار خودکشی در رسانه‌ها و انگ مرتبط با رفتار کمک جویانه می‌باشد. عوامل مربوط به جامعه نیز مشتمل بر بلایا، جنگ و درگیری‌های نظامی، استرس‌های مربوط به پذیرش فرهنگ غالب و یا جابه‌جایی‌ها، تبعیض، تروما و سوء استفاده می‌باشد. عوامل مربوط به روابط نیز، مشتمل بر حس تنهایی و فقدان حمایت‌های اجتماعی، به انضمام درگیری‌های بین فردی و از دست دادن می‌باشد. این در حالی است که 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الکل، دسترسی به مراقبت‌های بهداشتی، گزارش مسئولانه اخبار خودکشی و افزایش آگاهی درباره بیماری‌های روانی، اختلالات مرتبط با مصرف مواد و خودکشی می‌باشد. در حالی که راه‌کارهای انتخابی مشتمل بر مداخله برای گروه‌های آسیب‌پذیر، آموزش دروازه‌بانان و خطوط بحران، می‌باشد. بالاخره، راه‌کارهای نشان‌داد نیز مشتمل بر پیگیری و حمایت‌های جامعه، ارزیابی و مدیریت رفتارهای خودکشی، ارزیابی و مدیریت بیماری‌های روانی و بیماری‌های مرتبط با مصرف مواد، می‌باشد. در این مدل، جهت و اندازه پیکان‌ها نشان می‌هدکه چگونه با انتخاب راه‌کارهای مناسب برای مقابله با عوامل خطر، می‌توان برنامه‌های پیشگیری از خودکشی را در سه سطح عمومی، انتخابی و نشان‌داد، سامان‌دهی کرد. برای نمونه، حجم وسیع فعالیت‌هایی که در نظام‌های بهداشتی برای بهبود دسترسی به مراقبت‌های بهداشتی به عمل می‌آید، همچنین، فعالیت‌هایی که در سطح اجتماعی برای کاهش دسترسی به ابزار خودکشی به عمل آمده یا گزارش مسئولانه اخبار خودکشی را در دستور کار قرار می‌دهند، و تمامی برنامه‌هایی که برای کاهش انگ بهره‌مندی از برنامه‌های سلامت روان به عمل می‌آیند، بیشترین تأثیر خود را در سطح عمومی بر جای خواهند گذاشت. اما در عین حال اثرات مثبت، اما با شدت کمتری را در سطوح انتخابی و نشان‌داد نیز، بر جای خواهند گذاشت. همین‌طور، حجم وسیع فعالیت‌هایی که برای مبارزه با عوامل خطر فردی به مرحله اجرا در می‌‌آیند، اثرات مثبت بالقوه‌ خود را در سطح نشان‌داد بر جای خواهند گذاشت. اما در عین حال، اثرات مثبت بالقوه کمتری را در سطح انتخابی نشان داده و کمترین اثرات مثبت خود را در سطح عمومی، ایفاء خواهند کرد. اگر چه این مدل، تمامی تعیین کننده‌ها و عوامل خطر را در برنگرفته و حتی ارتباط مابین این عوامل را از نظر هم افزایی نیز نشان نمی‌دهد، با این وجود، راهنمای خوبی برای کلیه کسانی است که در امر پیشگیری از خودکشی و خودآزاری کار می‌نمایند. چرا که به آن‌ها نشان می‌دهد، برنامه‌های پیشگیرانه برای هر عامل خطر یا تعیین کننده، در کدام سطح پیشگیری، بیشترین تأثیر را از خود بر جای خواهد گذاشت.   660 662 http://journal.rums.ac.ir/browse.php?a_code=A-10-280-163&slc_lang=other&sid=1 Mohsen Rezaeian محسن رضائیان moeygmr2@yahoo.co.uk 6900319475328460059149 6900319475328460059149 Yes دانشگاه علوم 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