老年人自杀:公共卫生和从业者的视角。
Suicide in later life: public health and practitioner perspectives.
机构信息
Social Care Workforce Research Unit, King's College London, UK.
出版信息
Int J Geriatr Psychiatry. 2010 Dec;25(12):1230-8. doi: 10.1002/gps.2473.
OBJECTIVES
Suicide in later life is a public health concern. Given the need for practical guidance and policy implementation, this paper aims to provide a critical interpretive synthesis approach to prioritize the likely relevance of publications and the contribution that they make to understanding of the problem.
METHODS
A selective review of the English language literature focusing on the epidemiology of suicide among older people was conducted; the search strategy built on that of a previous review. Papers were selected for their ability to shed light on the potential for prevention and practice from public health perspectives.
RESULTS
Whilst the majority of older people who commit suicide have major depression, suicide seems to be due to a combination of personality factors and co-morbidities, including chronic pain and disablement. Complex multi-component public health studies are underway and are likely to provide useful knowledge to guide practice more precisely, but there is remarkably little information about the involvement of older people in risk reduction or about harm minimization approaches at patient and public participation levels.
CONCLUSIONS
For lack of sufficient evidence from intervention trials that are specific to older people, practitioners need to extrapolate from studies of younger adults and be aware of risk factors for suicide in later life. Public health approaches combined with practitioners' experiences of older people at risk may help minimize the risks of suicide in later life. These are fruitful areas for collaborative practice development, service initiatives, evaluation, and research.
目的
老年人自杀是一个公共卫生关注点。鉴于需要实际指导和政策实施,本文旨在提供一种批判性解释性综合方法,以优先考虑出版物的可能相关性及其对理解该问题的贡献。
方法
对老年人自杀的流行病学进行了选择性的英文文献回顾;该搜索策略建立在前一次综述的基础上。选择这些论文是为了从公共卫生的角度来看,它们能够阐明预防和实践的潜力。
结果
虽然大多数自杀的老年人都患有重度抑郁症,但自杀似乎是由于人格因素和合并症的综合作用,包括慢性疼痛和残疾。正在进行复杂的多组分公共卫生研究,这些研究很可能提供有用的知识,更准确地指导实践,但关于老年人在减少风险或在患者和公众参与层面上采取减少伤害方法方面的参与情况的信息却少得惊人。
结论
由于缺乏针对老年人的具体干预试验的充分证据,从业者需要从对年轻人的研究中推断,并意识到老年人自杀的风险因素。将公共卫生方法与从业者对处于风险中的老年人的经验相结合,可能有助于最大限度地降低老年人自杀的风险。这些是合作实践发展、服务倡议、评估和研究的富有成效的领域。