Cattell H, Jolley D J
Department of Old Age Psychiatry, Wrexham Maelor Hospital, Clwyd.
Br J Psychiatry. 1995 Apr;166(4):451-7. doi: 10.1192/bjp.166.4.451.
The White Paper The Health of the Nation targets a reduction in suicide rates. Preventive strategies must be guided by an understanding of the demography and antecedents of suicide. These issues are examined in relation to suicide by old people in Manchester.
One hundred consecutive coroners' inquisitions on people aged over 65 occurring between 1980 and 1991 in which the verdict was suicide were scrutinised and related to Health Service notes.
Suicides were rare, numbers ranging from 0 to seven per annum per Health District. Rates did not vary between district but did within smaller sub-populations. Most individuals died at home; 65% were physically ill, of whom 23% had been hospitalised within the previous year. At least 60% were clinically depressed, with 25% being prescribed antidepressants. A total of 43% had seen their general practitioner in the previous month but only 14% were in contact with psychiatric services.
Many elderly people who commit suicide are not in close contact with primary care services; those who are may not be prescribed appropriate treatment, and few are referred for specialist care. Specialist services will fail to reduce suicide rates unless they embark upon programmes to increase public awareness of therapeutic possibilities and work more closely with primary care agencies to realise these possibilities.
《国家健康白皮书》旨在降低自杀率。预防策略必须以对自杀的人口统计学特征和自杀前情况的了解为指导。本文针对曼彻斯特老年人的自杀情况对这些问题进行了研究。
对1980年至1991年间连续100例65岁以上人群的死因裁判庭调查进行审查，这些调查的裁决为自杀，并与卫生服务记录相关联。
自杀情况较为罕见，每个卫生区每年的自杀人数在0至7人之间。各区之间的自杀率没有差异，但在较小的亚人群中存在差异。大多数人在家中死亡；65%的人身体患病，其中23%的人在前一年曾住院治疗。至少60%的人临床诊断为抑郁症，25%的人正在服用抗抑郁药。共有43%的人在上个月看过全科医生，但只有14%的人与精神科服务机构有接触。
许多自杀的老年人与初级保健服务机构没有密切联系；那些有联系的人可能没有得到适当的治疗，很少有人被转诊接受专科护理。除非专科服务机构开展提高公众对治疗可能性认识的项目，并与初级保健机构更密切合作以实现这些可能性，否则它们将无法降低自杀率。
