躯体多病共存与农村老年人群终生自杀意念和计划：心理困扰的中介作用。
Physical multimorbidity and lifetime suicidal ideation and plans among rural older adults: the mediating role of psychological distress.
机构信息
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, Shandong, China.
NHC Key Lab of Health Economics and Policy Research, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, Shandong, China.
出版信息
BMC Psychiatry. 2021 Feb 6;21(1):78. doi: 10.1186/s12888-021-03087-4.
BACKGROUND
Previous studies have revealed that single physical chronic condition was associated with suicidal ideation/plans, but few studies have examined the relationship between multimorbidity and suicidal ideation/plans, and no studies have explored the underlying potential mechanism on this relationship in China. This study aimed to explore association between physical multimorbidity and suicidal ideation as well as plans, and further examine the mediating role of psychological distress (PD) on this relationship.
METHODS
This study was based on the data from a survey about the health service of rural elderly household in Shandong, China. A total of 3242 adults aged 60 years and older were included in this study. PD was measured by Kessler Psychological Distress Scale (K10). Ordinal and binary logistic regression analyses were employed to explore the association between physical multimorbidity, PD and suicide ideation/plans. Bootstrapping analysis was further used to examine the mediation effect of PD on the association of multimorbidity and suicidal ideations/plans.
RESULTS
The prevalence of multimorbidity, lifetime suicidal ideation, and suicidal plan in rural older adults was 35.2, 10.6 and 2.2%, respectively. Older adults living in rural areas with two or more chronic physical conditions experienced significantly higher risk of suicidal ideation and suicidal plans. The association between multimorbidity and suicidal ideations/plans was partially mediated by PD, of which, the mediating effect of PD accounted for 31.7 and 25.5% of the total effect, respectively.
CONCLUSION
This study demonstrated the associations between physical multimorbidity and suicidal ideation/plans, and the mediating role of PD on this relationship among Chinese rural elderly. Healthcare providers in rural community should provide regular surveillance for the mental health status among the rural elderly with multimorbidity, and carry out various effective intervention measures to improve the mental health status, so as to reduce the risk of suicide.
背景
先前的研究表明，单一的身体慢性疾病与自杀意念/计划有关，但很少有研究探讨多种疾病与自杀意念/计划之间的关系，也没有研究探讨中国在这种关系中的潜在潜在机制。本研究旨在探讨身体多种疾病与自杀意念以及计划之间的关系，并进一步探讨心理困扰（PD）对这种关系的中介作用。
方法
本研究基于中国山东农村老年家庭健康服务调查数据。共纳入 3242 名 60 岁及以上成年人。PD 采用 Kessler 心理困扰量表（K10）进行测量。采用有序和二元逻辑回归分析探讨身体多种疾病、PD 与自杀意念/计划之间的关系。采用自举分析进一步检验 PD 在多种疾病与自杀意念/计划关联中的中介效应。
结果
农村老年人的多种疾病、终生自杀意念和自杀计划的患病率分别为 35.2%、10.6%和 2.2%。生活在农村地区有两种或两种以上慢性身体疾病的老年人自杀意念和自杀计划的风险明显更高。多种疾病与自杀意念/计划之间的关联部分由 PD 介导，其中 PD 的中介效应分别占总效应的 31.7%和 25.5%。
结论
本研究表明，身体多种疾病与自杀意念/计划之间存在关联，以及 PD 在这种关系中的中介作用在中国农村老年人中。农村社区的医疗保健提供者应为患有多种疾病的农村老年人提供定期的心理健康监测，并开展各种有效的干预措施，以改善心理健康状况，从而降低自杀风险。
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