Conwell Y, Lyness J M, Duberstein P, Cox C, Seidlitz L, DiGiorgio A, Caine E D
University of Rochester School of Medicine, Department of Psychiatry, University of Rochester Center for the Study and Prevention of Suicide, New York 14642, USA.
J Am Geriatr Soc. 2000 Jan;48(1):23-9. doi: 10.1111/j.1532-5415.2000.tb03024.x.
To determine whether physical and psychiatric illness, functional status, and treatment history distinguish older primary care patients who committed suicide from those who did not.
A case-control study using data collected by psychological autopsies of suicides and prospective patient interviews for controls.
Primary care practices in Monroe County, NY.
Forty-two suicides aged 60 years and older who visited a primary care provider within 30 days of death and 196 patients aged 60 years and older from a group practice of general internal medicine (n = 115) or family medicine (n = 81).
Psychiatric diagnosis; depressive symptom severity; physical health and function; psychiatric treatment history.
Completed suicides had more depressive illness (P = .001), physical illness burden (P = .0002), and functional limitations (P = .0001) than controls and were more likely to be prescribed antidepressants (P = .004), anxiolytic agents (P = .0001), and narcotic analgesics (P = .022). Among depressed subjects, affective symptom severity (P< .0001) and emotional dysfunction (P<.0001) distinguished suicide completers. However, physical health, overall function, and treatments received did not differ between groups.
The primary care setting is an important venue for late life suicide prevention. Primary care providers should be well prepared to diagnose and treat depression in their older patients. Additional research is needed concerning the interactions of physical health, functional status, and depressive symptoms in determining suicide risk.
确定身体和精神疾病、功能状态及治疗史能否区分老年初级保健自杀患者与非自杀患者。
一项病例对照研究，采用自杀心理解剖收集的数据及对对照进行的前瞻性患者访谈。
纽约州门罗县的初级保健机构。
42名60岁及以上在死亡前30天内就诊于初级保健提供者的自杀患者，以及196名来自普通内科（n = 115）或家庭医学（n = 81）团体诊所的60岁及以上患者。
精神科诊断；抑郁症状严重程度；身体健康与功能；精神科治疗史。
与对照组相比，自杀完成者有更多的抑郁疾病（P = 0.001）、身体疾病负担（P = 0.0002）和功能受限（P = 0.0001），且更有可能被开具抗抑郁药（P = 0.004）、抗焦虑药（P = 0.0001）和麻醉性镇痛药（P = 0.022）。在抑郁患者中，情感症状严重程度（P < 0.0001）和情绪功能障碍（P < 0.0001）可区分出自杀完成者。然而，两组之间的身体健康、整体功能及接受的治疗并无差异。
初级保健机构是预防老年人自杀的重要场所。初级保健提供者应做好充分准备，诊断和治疗老年患者的抑郁症。在确定自杀风险方面，关于身体健康、功能状态和抑郁症状之间的相互作用，还需要更多研究。
