Byrne G J, Raphael B
Department of Psychiatry, University of Queensland, Australia.
Int Psychogeriatr. 1999 Mar;11(1):67-74. doi: 10.1017/s1041610299005591.
Older widowers have high rates of completed suicide but have rarely been the subject of systematic inquiry. We investigated the prevalence of depressive symptoms and major depressive episodes (MDEs) in recently widowed older men over the first 13 months after bereavement. We employed a matched-pair longitudinal design and recruited subjects from a suburban community population. Fifty-seven recently widowed older men were identified from official death records and 57 matched married men were identified from the electoral roll. Subjects were assessed for the presence of current DSM-III-R MDEs using the Composite International Diagnostic Interview (CIDI), a fully structured psychiatric interview. Widowers were assessed at 6 weeks after bereavement (T1) and 13 months after bereavement (T2). Married men were assessed at similar intervals. At T1, seven widowers (12.3%) and no married men were found to have CIDI cases of current MDE. At T2, one widower (1.9%) and no married men were found to have CIDI cases of current MDE. Current MDE was not predicted by a past history of dysphoria. At T1, 14.0% (8/57) of widowers reported specific suicidal thoughts or actions. At T2, 15.4% (8/52) of widowers reported suicidal thoughts or actions. We conclude that health workers should monitor closely the clinical course of MDEs in recently widowed older men. Routine inquiry about suicidal ideation should be an essential component of the clinical assessment of recently widowed older men.
老年鳏夫的自杀死亡率很高，但很少成为系统研究的对象。我们调查了新近丧偶的老年男性在丧亲后的头13个月内抑郁症状和重度抑郁发作（MDE）的患病率。我们采用了配对纵向设计，并从郊区社区人群中招募研究对象。从官方死亡记录中确定了57名新近丧偶的老年男性，从选民名单中确定了57名配对的已婚男性。使用综合国际诊断访谈（CIDI）对研究对象进行当前DSM-III-R MDE的评估，CIDI是一种完全结构化的精神科访谈。鳏夫在丧亲后6周（T1）和丧亲后13个月（T2）接受评估。已婚男性在相似的时间间隔接受评估。在T1时，发现7名鳏夫（12.3%）有当前MDE的CIDI确诊病例，而没有已婚男性被发现有此类病例。在T2时，发现1名鳏夫（1.9%）有当前MDE的CIDI确诊病例，同样没有已婚男性被发现有此类病例。当前的MDE不能通过过去的烦躁不安病史来预测。在T1时，14.0%（8/57）的鳏夫报告有特定的自杀念头或行为。在T2时，15.4%（8/52）的鳏夫报告有自杀念头或行为。我们得出结论，医护人员应密切监测新近丧偶老年男性MDE的临床病程。对自杀意念的常规询问应成为新近丧偶老年男性临床评估的重要组成部分。
