The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital),Guangzhou,China.
Xiangya School of Public Health,Central South University,Changsha,China.
Psychol Med. 2019 Feb;49(3):458-464. doi: 10.1017/S003329171800106X. Epub 2018 Apr 25.
Suicide rate among rural elderly is the highest among all age groups in China, yet little is known about the suicide risks in this rapidly growing vulnerable population.
This matched case-control psychological autopsy study was conducted during June 2014 to September 2015. Consecutive samples of suicides aged 60 or above were identified in three provinces (Shandong, Hunan, and Guangxi) in China. Living comparisons were 1:1 matched with the suicides in age (±3 years old), gender, and living location. Risk factors included demographic characteristics, being left-behind, mental disorder, depressive symptoms, stressful life events, and social support.
A total of 242 suicides and 242 comparisons were enrolled: 135 (55.8%) were male, mean (s.d.) age was 74 (8) years. The most frequently used suicide means were pesticides (125, 51.7%) and hanging (95, 39.3%). Independent risks of suicide included unstable marital status [odds ratio (OR) 4.19, 95% confidence interval (CI) 1.61-10.92], unemployed (compared with employed, OR 4.43, 95% CI 1.09-17.95), depressive symptoms (OR 1.34, 95% CI 1.21-1.48), and mental disorder (OR 6.28, 95% CI 1.75-22.54). Structural equation model indicated that the association between being left-behind and suicide was mediated by mental disorder, depressive symptoms, stressful life events, and social support.
Unstable marital status, unemployed, depressive symptoms, and mental disorder are independent risk factors for suicide in rural elderly. Being left-behind can elevate the suicide risk through increasing life stresses, depressive symptoms, mental disorder, and decreasing social support. Elderly suicide may be prevented by restricting pesticides, training rural physicians, treating mental disorders, mitigating life stress, and enhancing social connection.
中国农村老年人的自杀率在所有年龄段中是最高的，但对于这一快速增长的弱势群体的自杀风险知之甚少。
本项匹配病例对照心理解剖研究于 2014 年 6 月至 2015 年 9 月进行。在中国三个省份（山东、湖南和广西）连续确定年龄在 60 岁及以上的自杀者样本。按照年龄（±3 岁）、性别和居住地点与自杀者进行 1:1 匹配的生存比较。危险因素包括人口统计学特征、留守、精神障碍、抑郁症状、生活压力事件和社会支持。
共纳入 242 例自杀者和 242 例对照者：135 例（55.8%）为男性，平均（标准差）年龄为 74（8）岁。最常使用的自杀手段是农药（125 例，51.7%）和上吊（95 例，39.3%）。自杀的独立风险因素包括不稳定的婚姻状况[比值比（OR）4.19，95%置信区间（CI）1.61-10.92]、失业（与就业相比，OR 4.43，95%CI 1.09-17.95）、抑郁症状（OR 1.34，95%CI 1.21-1.48）和精神障碍（OR 6.28，95%CI 1.75-22.54）。结构方程模型表明，留守与自杀之间的关联是通过精神障碍、抑郁症状、生活压力事件和社会支持来介导的。
不稳定的婚姻状况、失业、抑郁症状和精神障碍是农村老年人自杀的独立危险因素。留守可以通过增加生活压力、抑郁症状、精神障碍和减少社会支持来提高自杀风险。通过限制农药使用、培训农村医生、治疗精神障碍、减轻生活压力和加强社会联系，可以预防老年人自杀。
