The University of Texas at Austin Steve Hicks School of Social Work,Austin,Texas,USA.
The University of Texas at Austin School of Nursing,Austin,Texas,USA.
Int Psychogeriatr. 2018 Oct;30(10):1531-1540. doi: 10.1017/S1041610218000212. Epub 2018 Mar 21.
ABSTRACTBackground:US suicide rates among older women have substantially increased over the past decade. We examined potential differences in sociodemographic and risk/precipitating factors among older female suicide decedents who died by drug overdose versus firearms, hanging/suffocation, and other means, and postmortem toxicology results by suicide means.
Data are from the 2005 to 2015 US National Violent Death Reporting System (N = 12,401 female decedents aged 50 years and over). We used three logistic regression models, with overdose versus firearms, overdose versus hanging/suffocation, and overdose versus "other" means as the dependent variables, to examine associations between suicide means and sociodemographic and risk/precipitating factors. χ2 tests were used to examine positive toxicology of prescription and illicit drugs by suicide means.
Compared to firearm users, overdose users were younger and had higher odds of having had previous suicide attempts/intent disclosures, mental disorders (e.g. depression/dysthymia: AOR = 1.18, 95% CI = 1.05-1.34), and substance abuse other than alcohol, but lower odds of having had relationship problems and any crisis. Compared to hanging/suffocation, overdose declined (AOR = 0.95, 95% CI = 0.93-0.97) during the study period and was less prevalent among Hispanic and Asian women and those with job/finance/housing problems. Toxicology reports showed that 47%, 43%, and 45% of overdose users were antidepressant, opiate, and benzodiazepine positive, respectively. Firearm users had the lowest rates of positive toxicology results for these drugs.
Suicide prevention should include limiting access to large quantities of prescription medications and firearms for those at risk of suicide. More effective mental health/substance abuse treatment and chronic illness management support are also needed.
描述：背景：过去十年，美国老年女性的自杀率大幅上升。我们研究了药物过量、枪支、绞刑/窒息和其他方式导致的老年女性自杀死亡者之间，以及按自杀方式进行死后毒理学检查的潜在社会人口学和风险/促成因素差异。
数据来自 2005 年至 2015 年美国国家暴力死亡报告系统（N=12401 名年龄在 50 岁及以上的女性死者）。我们使用了三个逻辑回归模型，以药物过量与枪支、药物过量与绞刑/窒息以及药物过量与“其他”方式作为因变量，研究自杀方式与社会人口学和风险/促成因素之间的关联。使用卡方检验比较不同自杀方式下处方和非法药物的阳性毒理学结果。
与枪支使用者相比，药物过量使用者更年轻，且既往自杀企图/意图披露、精神障碍（例如抑郁/心境恶劣：OR=1.18，95%CI=1.05-1.34）和除酒精以外的物质滥用的可能性更高，但人际关系问题和任何危机的可能性更低。与绞刑/窒息相比，药物过量在研究期间下降（OR=0.95，95%CI=0.93-0.97），且在西班牙裔和亚裔女性以及有工作/财务/住房问题的女性中发生率较低。毒理学报告显示，47%、43%和 45%的药物过量使用者分别为抗抑郁药、阿片类药物和苯二氮䓬类阳性。枪支使用者这些药物的阳性毒理学结果发生率最低。
预防自杀应包括限制有自杀风险者获取大量处方药物和枪支。还需要更有效的心理健康/物质滥用治疗和慢性疾病管理支持。
