Department of Clinical Psychology, Leiden University, Leiden, the Netherlands.
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco.
JAMA Psychiatry. 2021 Jun 1;78(6):659-666. doi: 10.1001/jamapsychiatry.2021.0150.
Little is known about the association between mild cognitive impairment (MCI) and suicide. Most studies have focused on dementia and suicidal behavior, with inconsistent results.
To examine the association between diagnoses of MCI and dementia and suicide attempt and explore potential psychiatric moderators and to assess whether the association differs based on recency of diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study integrated 5 national databases from the Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services and included all VA medical centers in the US. US veterans 50 years or older with MCI diagnoses at baseline (October 1, 2011, to September 30, 2013) or earlier (October 1, 2007, to September 30, 2011) were propensity matched 1:3 with (1) patients with dementia diagnoses and (2) patients without either diagnosis based on demographic characteristics and the Charlson Comorbidity Index. Diagnoses of MCI or dementia were defined as recent if there were no diagnosis codes before baseline. Data were analyzed from March 16, 2020, to January 15, 2021.
Information on suicide attempts through December 31, 2016, provided by the National Suicide Prevention Applications Network (nonfatal) and Mortality Data Repository (fatal).
The study population of 147 595 participants included 21 085 patients with MCI, 63 255 with dementia, and 63 255 in the propensity-matched comparison group. Participants had a mean (SD) age of 74.7 (10.3) years, 143 353 (97.1%) were men, 4242 (2.9%) were women, and 127 065 (86.1%) were non-Hispanic White. A total of 138 patients with MCI (0.7%) and 400 patients with dementia (0.6%) attempted suicide during follow-up, compared with 253 patients without MCI or dementia (0.4%). Exploratory analyses revealed that no psychiatric comorbidity moderated the association between MCI or dementia and suicide attempt. After adjustment for demographic details and medical and psychiatric comorbidities, risk of suicide attempt was consistently highest for patients with a recent MCI or dementia diagnosis, with adjusted hazard ratios (HRs) of 1.73 (95% CI, 1.34-2.22; P < .001) for recent MCI and 1.44 (95% CI, 1.17-1.77; P = .001) for recent dementia. Risk associated with prior diagnosis was not significant (HR for prior MCI, 1.03 [95% CI, 0.78-1.36; P = .84]; HR for prior dementia, 1.14 [95% CI, 0.95-1.36; P = .15]).
This study found that older adults with recent MCI or dementia diagnoses were at increased risk of attempting suicide. These findings suggest that involvement of supportive services at the time of or soon after diagnoses of MCI or dementia may help mitigate risk of suicide attempts.
对于轻度认知障碍 (MCI) 与自杀之间的关联，人们知之甚少。大多数研究都集中在痴呆症和自杀行为上，但结果并不一致。
研究 MCI 和痴呆症的诊断与自杀企图之间的关联，并探讨潜在的精神科调节因素，评估这种关联是否因诊断的近期程度而有所不同。
设计、地点和参与者：这项全国性队列研究整合了来自退伍军人事务部 (VA) 和医疗保险和医疗补助服务中心的 5 个国家数据库，包括美国所有的 VA 医疗中心。在基线（2011 年 10 月 1 日至 2013 年 9 月 30 日）或更早（2007 年 10 月 1 日至 2011 年 9 月 30 日）时患有 MCI 诊断的年龄在 50 岁或以上的美国退伍军人，与（1）患有痴呆症诊断的患者和（2）无上述两种诊断的患者根据人口统计学特征和 Charlson 合并症指数进行了倾向性匹配。如果在基线之前没有诊断代码，则将 MCI 或痴呆症的诊断定义为最近的诊断。数据于 2020 年 3 月 16 日至 2021 年 1 月 15 日进行分析。
通过国家自杀预防应用网络（非致命）和死亡率数据存储库（致命）提供的截至 2016 年 12 月 31 日的自杀企图信息。
研究人群包括 147595 名参与者，其中 21085 名患者患有 MCI，63255 名患者患有痴呆症，63255 名患者在倾向性匹配的对照组中。参与者的平均（SD）年龄为 74.7（10.3）岁，143353 名（97.1%）为男性，4242 名（2.9%）为女性，127065 名（86.1%）为非西班牙裔白人。在随访期间，共有 138 名 MCI 患者（0.7%）和 400 名痴呆症患者（0.6%）企图自杀，而在无 MCI 或痴呆症的患者中，有 253 名（0.4%）企图自杀。探索性分析显示，没有任何精神科合并症调节了 MCI 或痴呆症与自杀企图之间的关联。在调整人口统计学细节以及医疗和精神科合并症后，近期 MCI 或痴呆症诊断的患者自杀风险始终最高，调整后的危险比（HR）分别为 1.73（95%CI，1.34-2.22；P < 0.001）和 1.44（95%CI，1.17-1.77；P = 0.001）。先前诊断的风险并不显著（先前 MCI 的 HR，1.03 [95%CI，0.78-1.36；P = 0.84]；先前痴呆症的 HR，1.14 [95%CI，0.95-1.36；P = 0.15]）。
这项研究发现，最近诊断为 MCI 或痴呆症的老年患者自杀企图的风险增加。这些发现表明，在 MCI 或痴呆症诊断时或之后不久，提供支持性服务可能有助于降低自杀企图的风险。
