Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry (HT-G, JO, YL), Rochester, NY.
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry (HT-G, JO, YL), Rochester, NY.
Am J Geriatr Psychiatry. 2020 Mar;28(3):288-298. doi: 10.1016/j.jagp.2019.12.011. Epub 2020 Jan 3.
To assess prevalence of suicidal ideation (SI) among new postacute and long-stay nursing home (NH) admissions and examine the associations with individual and NH-level factors.
SETTING/PARTICIPANTS: A total of 1,864,102 postacute and 304,106 long-stay admissions to just over 15,000 NHs between 7/1/2014 and 6/30/2015.
Using 100% of the national Minimum Data Set 3.0, we identified SI and key covariates. SI was based on responses to one item on the PHQ-9 scale. For postacute residents, SI was measured at admission and discharge. For long-stay residents, SI was assessed at admission and assessments closest to 90, 180, and 365 days thereafter. Patient sociodemographics, functional and cognitive status, comorbid conditions, and other covariates were included as independent variables, as were several NH-level factors. Logistic regression models were fit to estimate SI risk at admission and at subsequent time intervals.
Observed 2-week prevalence rates of SI were highest at admission (1.24% for postacute and 1.84% for long stays) and declined thereafter at each subsequent time interval. The odds of SI were significantly increased for residents with severe depression at admission and all subsequent intervals. Residents in for-profits had significantly lower rates of SI, compared with those in not-for-profits.
Our findings demonstrate that SI risk in NHs is highest at admission and subsequently declines. We found several potentially modifiable individual-level risk factors for SI. The identification of SI may be seriously underreported in for-profit-facilities. Future research may be needed to explore how the PHQ-9 item on SI is understood by residents and recorded by staff.
评估新入住急性后期和长期护理院（NH）患者自杀意念（SI）的患病率，并考察其与个体和 NH 层面因素的相关性。
背景/参与者：2014 年 7 月 1 日至 2015 年 6 月 30 日期间，超过 15000 家 NH 共收治了 1864102 例急性后期入住患者和 304106 例长期入住患者。
使用 100%的国家最低数据集 3.0，我们确定了 SI 和关键协变量。SI 基于 PHQ-9 量表上的一个项目的回答。对于急性后期入住患者，SI 在入院和出院时进行评估。对于长期入住患者，SI 在入院时以及此后的 90、180 和 365 天左右进行评估。患者的社会人口统计学、功能和认知状况、合并症和其他协变量被作为自变量，同时还包括了几个 NH 层面的因素。逻辑回归模型被用来估计入院时和随后各个时间间隔的 SI 风险。
入院时观察到的 2 周 SI 患病率最高（急性后期为 1.24%，长期为 1.84%），此后每个后续时间间隔均下降。入院时患有严重抑郁症以及所有后续间隔的患者，其发生 SI 的可能性显著增加。与非营利性机构相比，营利性机构的患者 SI 发生率显著降低。
我们的研究结果表明，NH 中的 SI 风险在入院时最高，随后下降。我们发现了一些可能可改变的 SI 个体层面风险因素。营利性机构中 SI 的识别可能严重漏报。未来的研究可能需要探索 SI 项目如何被居民理解以及如何被工作人员记录。
