Morin Ruth T, Li Yixia, Karel Michele J, Consolino Tara, Hwong Alison, Clark Ryan, Byers Amy L
San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA.
Aging Ment Health. 2024 Mar-Apr;28(3):551-556. doi: 10.1080/13607863.2023.2228228. Epub 2023 Aug 7.
Suicide in late life is a public health concern. Determining profiles of psychiatric/medical comorbidity in those who attempt while engaged in mental health services may assist with prevention. We identified comorbidity profiles and their association with utilization, means, and fatality in a national sample who attempted suicide.
Using latent class analysis, all patients aged ≥ 65 from the Department of Veterans Affairs (VA) healthcare services (2012-2018) last seen in mental health prior to suicide attempt were included. Diagnoses and attempt data were obtained from VA and Center for Medicare & Medicaid Services, VA Suicide Prevention Applications Network, and VA National Mortality Data Repository.
2,269 patients were clustered into three profiles, all with high probability of depression. Profiles included minimal comorbidity (50.4%), high medical comorbidity (28.6%), and high (psychiatric/medical) comorbidity (21.0%). Over half (61.7%) attempted suicide within one week of their visit. The class with highest comorbidity had lowest proportion of fatal attempts, while minimal comorbidity class had highest proportion.
Older patients last seen in mental health prior to suicide attempt were characterized by depression and varying additional comorbidity and attempt-related factors. Findings have implications for risk assessment and intervention in mental health settings, beyond depression.
晚年自杀是一个公共卫生问题。确定那些在接受心理健康服务期间自杀未遂者的精神/医学合并症情况可能有助于预防自杀。我们在一个全国性的自杀未遂样本中确定了合并症情况及其与医疗服务利用、自杀手段和死亡情况的关联。
采用潜在类别分析，纳入了美国退伍军人事务部（VA）医疗服务机构（2012 - 2018年）中所有年龄≥65岁、在自杀未遂前最后一次接受心理健康服务的患者。诊断和自杀未遂数据来自VA以及医疗保险和医疗补助服务中心、VA自杀预防应用网络和VA国家死亡率数据存储库。
2269名患者被聚类为三种情况，所有情况都有很高的抑郁症发病概率。这些情况包括轻度合并症（50.4%）、高度医学合并症（28.6%）和高度（精神/医学）合并症（21.0%）。超过一半（61.7%）的患者在就诊后一周内自杀未遂。合并症程度最高的类别自杀死亡未遂的比例最低，而轻度合并症类别这一比例最高。
在自杀未遂前最后一次接受心理健康服务的老年患者的特点是患有抑郁症以及存在不同程度的其他合并症和与自杀未遂相关的因素。这些发现对于心理健康环境中的风险评估和干预具有启示意义，不仅仅局限于抑郁症。
