Pfaff Jon J, Almeida Osvaldo P
School of Psychiatry and Clinical Neurosciences, University of Western Australia, RPH Ainslie House-M573, Nedlands, WA 6009, Australia.
J Affect Disord. 2004 Nov 15;83(1):73-7. doi: 10.1016/j.jad.2004.03.006.
Up to 70% of older people who commit suicide consult a general practitioner (GP) in the month prior to their death. The purpose of this study was to identify the clinical and demographic characteristics of older adults who are contemplating suicide and are in contact with a GP.
We utilised a cross-sectional study to investigate the association between suicidal ideation and clinical/demographic variables of 504 consecutive patients aged 60 years or over, attending 1 of 54 randomly selected Western Australian GPs. Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about suicidal ideation (Depressive Symptom Inventory-Suicidality Subscale, DSI-SS), demographic factors, lifestyle factors, physical health and mental health, including depression (Center for Epidemiologic Studies-Depression Scale, CES-D).
Within our sample of older patients, 6.3% acknowledged current suicidal ideation. Multivariate analyses indicated that current suicidal ideation was strongly associated with being depressed at least occasionally during the previous week (OR=7.3, 95% CI=2.3-23.0), CES-D scores of 16 points or greater (OR=3.6, 95% CI=1.0-12.1), and a prior history of attempted suicide (OR=15.5, 95% CI=4.0-60.6).
Our results and conclusions are limited to suicidal ideation, and may not apply to suicidal behaviour.
Depressive symptomatology is strongly associated with suicidal ideation in later life. Strategies that enhance GPs' identification and treatment of affective illness in older patients should have the greatest impact on suicide rates within this age group.
高达70%的自杀老年人在死前一个月曾咨询过全科医生（GP）。本研究的目的是确定那些有自杀念头且与全科医生有接触的老年人的临床和人口统计学特征。
我们采用横断面研究来调查504名连续就诊的60岁及以上患者的自杀意念与临床/人口统计学变量之间的关联，这些患者来自西澳大利亚随机选取的54家全科诊所中的1家。在就诊前，患者完成一份自我报告问卷，其中包括有关自杀意念的问题（抑郁症状量表-自杀亚量表，DSI-SS）、人口统计学因素、生活方式因素、身体健康和心理健康，包括抑郁（流行病学研究中心抑郁量表，CES-D）。
在我们的老年患者样本中，6.3%的人承认目前有自杀意念。多变量分析表明，目前的自杀意念与在前一周至少偶尔感到抑郁（比值比=7.3，95%置信区间=2.3-23.0）、CES-D得分16分或更高（比值比=3.6，95%置信区间=1.0-12.1）以及既往自杀未遂史（比值比=15.5，95%置信区间=4.0-60.6）密切相关。
我们的结果和结论仅限于自杀意念，可能不适用于自杀行为。
抑郁症状与晚年的自杀意念密切相关。加强全科医生对老年患者情感疾病的识别和治疗的策略，应对该年龄组的自杀率产生最大影响。
