Salib Emad
Honorary Senior Lecturer, Liverpool University, UK.
Int J Geriatr Psychiatry. 2005 Feb;20(2):175-81. doi: 10.1002/gps.1211.
Suicide by drowning increases with age but its rates vary between countries and among communities. Drowning suicide rates in some of the available studies may have been over reported or under reported because of misclassification.
This study presents data on the time trends, age/sex mortality rates from death by drowning in the elderly in England and Wales between 1979 and 2001. All coroners' verdicts in death by drowning; suicide, deaths undetermined whether accidentally or purposely inflicted were examined.
Counts of suicide due to drowning and submersion [ICD 9 codes; E954] and undetermined injury deaths [E984] (WHO, 1977), reported in England and Wales between 1979 and 2001 were obtained from National Statistics (ONS).
There has been a gradual reduction in suicide by drowning in men and women by more than a third the observed count in 1979 (p < 0.01). However, this decline was less evident in the elderly particularly those over the age of 75. Elderly drownings appear to attract more verdicts of suicide compared to younger age groups (Odds Ratio 4.3 95% CI 2.3-8.3). Women, particularly elderly, are more likely to have a suicide verdict returned in drowning compared to men (Odds Ratio 1.5 95% CI 1.1-1.6).
The high rate of open verdicts in elderly drowning over the study period and compared to any other method of fatal self harm in England and Wales confirms the difficulties in reaching a firm conclusion in drowning death. Therefore combining suicide and all undetermined deaths in drowning as a matter of course, in nationally collected statistics, may result in grossly exaggerated rates and misleading trends in suicidal drowning. Suicide by drowning is probably not amenable to prevention and although the elderly are often thought to benefit more from suicide prevention than younger adults, the study findings seem to suggest that this is not likely to be the case in drowning.
溺水自杀率随年龄增长而上升，但其发生率在不同国家和社区之间存在差异。由于分类错误，一些现有研究中的溺水自杀率可能被高估或低估。
本研究呈现了1979年至2001年间英格兰和威尔士老年人溺水死亡的时间趋势、年龄/性别死亡率的数据。对所有死因裁判中溺水死亡情况进行了研究，包括自杀、死因未确定（意外或故意）的死亡。
从英国国家统计局（ONS）获取1979年至2001年间英格兰和威尔士报告的因溺水和浸没导致的自杀数[国际疾病分类第九版编码；E954]以及死因未确定的伤害死亡数[E984]（世界卫生组织，1977年）。
男性和女性溺水自杀率逐渐下降，降幅超过1979年观察到的计数的三分之一（p < 0.01）。然而，这种下降在老年人中不太明显，尤其是75岁以上的老人。与年轻年龄组相比，老年人溺水似乎更常被判定为自杀（优势比4.3，95%置信区间2.3 - 8.3）。与男性相比，女性，尤其是老年女性，在溺水死亡中更有可能被判定为自杀（优势比1.5，95%置信区间1.1 - 1.6）。
在研究期间，与英格兰和威尔士其他任何致命自残方式相比，老年人溺水死因不明的比例很高，这证实了在溺水死亡中得出确切结论存在困难。因此，在国家收集的统计数据中，将溺水自杀和所有死因未确定的溺水死亡理所当然地合并在一起，可能会导致自杀性溺水率被严重夸大和趋势产生误导。溺水自杀可能无法预防，尽管人们通常认为老年人比年轻人更能从自杀预防中受益，但研究结果似乎表明溺水情况并非如此。
