Hedna Khedidja, Sigström Robert, Johnell Kristina, Waern Margda
AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden.
Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Int Psychogeriatr. 2024 May;36(5):415-426. doi: 10.1017/S1041610223000583. Epub 2023 Aug 29.
To examine predictors of suicidal behavior (SB) in adults aged 75 years and above with dementia.
Longitudinal national register-based study.
Swedish residents aged ≥75 years with dementia identified in the Swedish Dementia Registry (SveDem) between 1 January 2007 and 31 December 2017 ( = 59 042) and followed until 31 December 2018. Data were linked with numerous national registers using personal identity numbers.
Outcomes were nonfatal self-harm and suicide. Fine and Gray regression models were used to investigate demographics, comorbidities, and psychoactive medications associated with fatal and nonfatal SB.
Suicidal behavior was observed in 160 persons after dementia diagnosis; 29 of these died by suicide. Adjusted sub-hazard ratio (aSHRs) for SB was increased in those who had a previous episode of self-harm (aSHR = 14.42; 95% confidence interval [CI] = 7.06-29.46), those with serious depression (aSHR = 4.33, 95%CI = 2.94-6.4), and in those born outside Sweden (aSHR = 1.53; 95% CI = 1.03-2.27). Use of hypnotics or anxiolytics was also associated with a higher risk of SB; use of antidepressants was not. Milder dementia and higher frailty score also increased risk of SB. Risk was decreased in those who received home care (aSHR = 0.52; 95%CI = 0.38-0.71) and in the oldest group (aSHR = 0.35; 95%CI = 0.25-0.49).
In addition to established targets for suicidal behavior prevention (improved identification and treatment of depression and previous self-harm), several new risk factors were suggested. There is a need for innovative public health strategies to meet the needs of older dementia patients with a foreign background. Home care may have a potential positive effect to prevent SB in people with dementia, but this needs to be further explored.
研究75岁及以上患有痴呆症的成年人自杀行为（SB）的预测因素。
基于全国纵向登记的研究。
2007年1月1日至2017年12月31日期间在瑞典痴呆症登记处（SveDem）中识别出的年龄≥75岁的瑞典痴呆症居民（n = 59042），随访至2018年12月31日。数据通过个人身份号码与众多国家登记处相链接。
结局为非致命性自我伤害和自杀。采用Fine和Gray回归模型研究与致命性和非致命性自杀行为相关的人口统计学、合并症和精神活性药物。
痴呆症诊断后有160人出现自杀行为；其中29人死于自杀。有过自我伤害史的人自杀行为的调整后亚危险比（aSHRs）升高（aSHR = 14.42；95%置信区间[CI] = 7.06 - 29.46），患有严重抑郁症的人（aSHR = 4.33，95%CI = 2.94 - 6.4），以及出生在瑞典境外的人（aSHR = 1.53；95%CI = 1.03 - 2.27）。使用催眠药或抗焦虑药也与自杀行为风险较高相关；使用抗抑郁药则不然。痴呆程度较轻和衰弱评分较高也会增加自杀行为风险。接受居家护理的人（aSHR = 0.52；95%CI = 0.38 - 0.71）和年龄最大的组（aSHR = 0.35；95%CI = 0.25 - 0.49）风险降低。
除了既定的自杀行为预防目标（改善抑郁症和既往自我伤害的识别与治疗）外，还提出了几个新的危险因素。需要创新的公共卫生策略来满足有外国背景的老年痴呆症患者的需求。居家护理可能对预防痴呆症患者的自杀行为有潜在的积极作用，但这需要进一步探索。
