Clinical determinants of suicidal ideation and behavior in geriatric depression
Clinical determinants of suicidal ideation and behavior in geriatric depression
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DOI：
10.1001/archpsyc.56.11.1048
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发表时间：
1999-11-01
影响因子：
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通讯作者：
Kakuma, T
中科院分区：
文献类型：
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作者：
Alexopoulos, GS;Bruce, ML;Kakuma, T
背景资料：方法：对354例61 ~ 93岁的老年抑郁症患者进行自杀意念、既往自杀行为、抑郁严重程度、认知功能损害、医疗负担、残疾、社会支持等方面的调查。患者每6个月进行一次面对面评估，平均1.8年（SD，2.2）进行电话评估。结果：在索引发作期间，自杀意念是由先前的自杀企图与严重意图预测（比值比[OR]。抑郁严重程度（OR，1.09; 95%CI，1.03-1.16）。社会支持差（OR，1.77; 95%CI。1.18-2.65）。在入组前一年内，重度指数发作（OR，1.05; 95% CI，1.00-1.11）、工具性日常生活活动受损（OR，0.78; 95% CI，0.67-0.93）和日常生活活动有限受损（OR，1.53; 95% CI，1.10-2.14）的患者报告了自杀企图。在最初的评估中，抑郁的严重程度，以前的尝试，以及在以前的尝试自杀意图的严重性预测自杀意念的过程（一致性相关系数，0.78）。在后续行动中，同期抑郁症的严重程度是最重要的决定因素自杀意念的色彩（一致性相关系数，0.88）。结论：老年人严重抑郁症，自杀企图的历史，严重的意图，和社会支持差是最有可能有自杀意念，并应针对性地采取适当的干预措施。抑郁的严重程度是自杀意念过程的最强预测因子。
Background: The aim of this study was to find clinical characteristics that can identify elderly patients with depression at risk for suicidal idea;ion and to determine their prognosis.Method: Suicidal ideation, past suicidal behavior, severi tv of depression, cognitive impairment, medical burden, disability, and social support were studied in 354 patients with depression aged 61 to 93 years. The patients had in-person evaluations every 6 months and telephone evaluations for a mean of 1.8 years (SD, 2.2).Results: During the index episode, suicidal ideation was predicted by previous suicide attempts with serious intent (odds ratio [OR]. 2.82; 95% confidence interval [CI], 1.37-5.80), severity of depression (OR, 1.09; 95% CI, 1.03-1.16). and poor social support (OR, 1.77; 95% CI. 1.18-2.65). Suicide attempts during the year prior to entry were reported by patients with a severe index episode (OR, 1.05; 95% CI, 1.00-1.11), impaired instrumental activities of daily living (OR, 0.78; 95% CI, 0.67-0.93), and limited impairment in activities of daily living (OR, 1.53; 95% CI, 1.10-2.14). At the initial evaluation, severity of depression, previous attempts, and seriousness of suicidal intent during previous attempts predicted the course of suicidal ideation (concordance correlation, 0.78). During follow-up, contemporaneous severity of depression was the most important determinant of suicidal ideation over tints (concordance correlation, 0.88).Conclusions: Elderly individuals with severe depression, history of suicide attempts with serious intent, and poor social support are most likely to have suicidal ideation and should be targeted for appropriate interventions. Severity of depression is the strongest predictor of the course of suicidal ideation.