Szanto Katalin, Gildengers Ariel, Mulsant Benoit H, Brown Greg, Alexopoulos George S, Reynolds Charles F
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Drugs Aging. 2002;19(1):11-24. doi: 10.2165/00002512-200219010-00002.
In almost all industrialised countries, men aged 75 years and older have the highest suicide rate among all age groups. Although in younger age groups suicide attempts are often impulsive and communicative acts, suicide attempts in older people (defined as aged 65 years and older) are often long planned and involve high-lethality methods. These characteristics, in addition to the fact that elderly are more fragile and frequently live alone, more often lead to fatal outcome. In later life, in both sexes, the most common diagnosis in those who attempt or complete suicide is major depression. In contrast to other age groups, comorbidity with substance abuse and personality disorders is less frequent. Physical illness plays an important role in the suicidal behaviour of the elderly: most frequently, depression and illness co-occur; less often, the physical illness or the treating medications are causally related to the depressive symptoms. However, only 2 to 4% of terminally ill elderly commit suicide. In addition to physical illness, complicated or traumatic grief, anxiety, unremitting hopelessness after recovery from a depressive episode and history of previous suicide attempts are risk factors for suicide attempts and completed suicide. During a depressive episode, elderly patients with suicidal ideation have higher levels of anxiety and, during treatment, anxiety decreases the probability of remission and recovery. As well as overt suicide attempts, indirect self-destructive behaviours, which often lead to premature death, are common, especially in residents of nursing homes, where more immediate means to commit suicide are restricted. Although we do not have randomised trials of treatment, studies suggest that antidepressant treatment may decrease suicide risk. Prevention and treatment trials are underway to detect the effectiveness of improved treatment of depression by primary care physicians as a means of reducing the prevalence of depressive symptoms, hopelessness and suicidal ideation.
在几乎所有工业化国家，75岁及以上的男性在所有年龄组中自杀率最高。虽然在较年轻的年龄组中，自杀未遂往往是冲动和有沟通意图的行为，但老年人（定义为65岁及以上）的自杀未遂往往是经过长期计划的，且采用高致死性方法。这些特征，再加上老年人身体更脆弱且经常独居，更常导致致命后果。在晚年，无论男女，自杀未遂或自杀身亡者最常见的诊断是重度抑郁症。与其他年龄组相比，物质滥用和人格障碍的共病情况较少见。身体疾病在老年人的自杀行为中起重要作用：最常见的是，抑郁症和疾病同时出现；较少见的是，身体疾病或治疗药物与抑郁症状存在因果关系。然而，只有2%至4%的绝症老人会自杀。除了身体疾病外，复杂或创伤性悲伤、焦虑、抑郁发作康复后持续的绝望感以及既往自杀未遂史都是自杀未遂和自杀身亡的危险因素。在抑郁发作期间，有自杀意念的老年患者焦虑水平较高，而且在治疗期间，焦虑会降低缓解和康复的可能性。除了明显的自杀未遂行为外，间接的自我毁灭行为也很常见，这些行为往往导致过早死亡，尤其是在养老院居民中，因为在那里实施自杀的更直接手段受到限制。虽然我们没有治疗的随机试验，但研究表明抗抑郁治疗可能会降低自杀风险。目前正在进行预防和治疗试验，以检测初级保健医生改善抑郁症治疗作为减少抑郁症状、绝望感和自杀意念患病率的一种手段的有效性。
