O'Rourke Norm, Heisel Marnin J, Canham Sarah L, Sixsmith Andrew
Department of Public Health and Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
Department of Psychiatry University of Western Ontario and Lawson Health Research Institute, London, Ontario, Canada.
PLoS One. 2017 Nov 16;12(11):e0187632. doi: 10.1371/journal.pone.0187632. eCollection 2017.
Bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions as 25%-50% of those with BD will make one or more suicide attempt, and about 15% will intentionally end their lives. Among young adults with BD, substance misuse, medication non-adherence, age at onset, and comorbid psychiatric conditions each predict self-harm. It is currently unclear if these same factors or others predict suicide ideation among older adults with BD.
We recruited a global sample of 220 older adults with BD over 19 days using socio-demographically targeted, social media advertising and online data collection (Mean = 58.50, SD = 5.42; range 50 to 81 years). Path analyses allowed us to identify direct and indirect predictors of suicide ideation among older adults with BD.
Cognitive failures (perception, memory, and motor function), depressive symptoms, alcohol misuse, and dissatisfaction with life as direct predictors of suicide ideation; duration of BD symptoms and medication non-adherence emerged as indirect predictors. Of note, the significant impact of sleep on suicide ideation is indirect via depressive symptoms, cognitive failures, medication non-adherence and life dissatisfaction.
As with young adults with BD, alcohol misuse and medication non-adherence emerged as significant predictors of suicide ideation. In addition, cognitive failures directly and indirectly predict suicide ideation in this sample of older adults with BD. Population aging and treatment efficacy are leading to ever growing numbers of older adults with BD. Both direct and indirect predictors of suicide ideation need to be considered in future BD research and treatment planning.
双相情感障碍（BD）在所有精神疾病中自杀死亡风险最高，因为25%-50%的双相情感障碍患者会有一次或多次自杀企图，约15%会故意结束自己的生命。在患有双相情感障碍的年轻人中，药物滥用、不坚持服药、发病年龄和共病精神疾病均能预测自我伤害行为。目前尚不清楚这些相同因素或其他因素是否能预测老年双相情感障碍患者的自杀意念。
我们通过社会人口统计学定向的社交媒体广告和在线数据收集，在19天内招募了220名老年双相情感障碍患者的全球样本（平均年龄=58.50，标准差=5.42；年龄范围50至81岁）。路径分析使我们能够确定老年双相情感障碍患者自杀意念的直接和间接预测因素。
认知失误（感知、记忆和运动功能）、抑郁症状、酒精滥用和对生活的不满是自杀意念的直接预测因素；双相情感障碍症状持续时间和不坚持服药是间接预测因素。值得注意的是，睡眠对自杀意念的显著影响是通过抑郁症状、认知失误、不坚持服药和生活不满间接产生的。
与患有双相情感障碍的年轻人一样，酒精滥用和不坚持服药是自杀意念的重要预测因素。此外，在这个老年双相情感障碍患者样本中，认知失误直接和间接预测自杀意念。人口老龄化和治疗效果导致患有双相情感障碍的老年人数量不断增加。在未来的双相情感障碍研究和治疗规划中，需要考虑自杀意念的直接和间接预测因素。
