Increased Risk of Suicide Attempts and Unintended Death Among Those Transitioning From Prison to Community in Later Life
Increased Risk of Suicide Attempts and Unintended Death Among Those Transitioning From Prison to Community in Later Life
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DOI：
10.1016/j.jagp.2018.07.004
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发表时间：
2018-11-01
影响因子：
7.2
通讯作者：
Byers, Amy L.
中科院分区：
文献类型：
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作者：
Barry, Lisa C.;Steffens, David C.;Byers, Amy L.
目标：在晚年（年龄>= 50岁）从教养设施过渡到社区的人数正在增加。我们试图确定晚年监狱释放是否是自杀行为和意外伤害死亡的风险因素，包括药物过量。设计：回顾性队列研究。背景：美国退伍军人事务部和医疗保险医疗系统，2012-2014年。参与者：年龄>= 50岁的退伍军人从惩教机构释放（N = 7，671重返退伍军人）和那些从未被监禁（N = 7，671）。研究方法：自杀企图和原因特定死亡率的日期分别使用国家自杀预防应用网络和国家自杀数据存储库定义。结果如下：晚年监狱释放与自杀企图的风险增加有关（599.7/100，000/年vs 134.7/100，000/年;调整后的风险比[HR] 3.45; 95%置信区间[CI] 2.24-5.32; p < 0.001，Wald chi（2）= 31.58，自由度[df] = 1），药物过量死亡（121.7 vs 43.5;校正HR 3.45; 95% CI 1.37-8.73; p = 0.009，Wald chi（2）= 6.86，df = 1）和其他意外伤害（126.0 vs 39.1;校正HR 3.13; 95% CI 1.28-7.69; p = 0.013，Wald chi（2）= 6.25，df = 1），校正无家可归、创伤性脑损伤、医疗和精神状况，并考虑其他死亡的竞争风险。在重返社会的退伍军人和从未被监禁的退伍军人之间观察到的自杀死亡率无显著性差异（分别为30.4和17.4;校正HR 2.40; 95% CI 0.51-11.24; p = 0.266，Wald chi（2）= 1.23，df = 1）。结论：老年退伍军人有相当大的风险企图自杀和药物过量或其他意外伤害死亡。这项研究强调了预防和干预工作的重要性，针对晚年监狱到社区护理的过渡。
Objective: The number of individuals transitioning from correctional facilities to community in later life (age >= 50 ) is increasing. We sought to determine if later-life prison release is a risk factor for suicidal behavior and death by accidental injury, including drug overdose. Design: Retrospective cohort study. Setting: U.S. Department of Veterans Affairs and Medicare healthcare systems, 2012-2014. Participants: Veterans age >= 50 released from correctional facilities (N = 7,671 re-entry veterans) and those never incarcerated (N = 7,671). Methods: Dates of suicide attempt and cause-specific mortality defined using the National Suicide Prevention Applications Network and the National Suicide Data Repository, respectively. Results: Later-life prison release was associated with increased risk of suicide attempt (599.7 versus 134.7 per 100,000 per year; adjusted hazard ratio [HR] 3.45; 95% confidence interval [CI] 2.24-5.32; p < 0.001, Wald chi(2) = 31.58, degrees of freedom [df] = 1), death by drug overdose (121.7 versus 43.5; adjusted HR 3.45; 95% CI 1.37-8.73; p = 0.009, Wald chi(2) = 6.86, df = 1), and other accidental injury (126.0 versus 39.1; adjusted HR 3.13; 95% CI 1.28-7.69; p = 0.013, Wald chi(2) = 6.25, df = 1), adjusting for homelessness, traumatic brain injury, medical and psychiatric conditions, and accounting for competing risk of other deaths. Suicide mortality rates were observed as nonsignificant between re-entry veterans and those never incarcerated (30.4 versus 17.4, respectively; adjusted HR 2.40; 95% CI 0.51-11.24; p = 0.266, Wald chi(2) = 1.23, df = 1). Conclusion: Older re-entry veterans are at considerable risk of attempting suicide and dying by drug overdose or other accidental injury. This study highlights importance of prevention and intervention efforts targeting later-life prison-to-community care transitions.