Completed suicide among older patients in primary care practices: A controlled study
Completed suicide among older patients in primary care practices: A controlled study
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DOI：
10.1111/j.1532-5415.2000.tb03024.x
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发表时间：
2000-01-01
影响因子：
6.3
通讯作者：
Caine, ED
中科院分区：
文献类型：
--
作者：
Conwell, Y;Lyness, JM;Caine, ED
目的：为了确定是否身体和精神疾病，功能状态和治疗史区分老年初级保健患者谁自杀从那些谁没有。设计：一个病例对照研究，使用收集的数据，心理尸检的自杀和前瞻性病人访谈的控制。设置：初级保健的做法，在门罗县，纽约州。参与者：42名年龄在60岁及以上的自杀者在死亡后30天内拜访了初级保健提供者，196名年龄在60岁及以上的患者来自普通内科（n = 115）或家庭医学（n = 81）的团体实践。精神病诊断;抑郁症状严重程度;身体健康和功能;精神病治疗史。研究结果：自杀完成者比对照组有更多的抑郁症（P = 0.001），身体疾病负担（P = 0.0002）和功能限制（P = 0.0001），更可能被处方抗抑郁药（P = 0.004），抗焦虑药（P = 0.0001）和麻醉性镇痛药（P = 0.022）。在抑郁症患者中，情感症状严重程度（P < .0001）和情感功能障碍（P < .0001）区分自杀完成者。然而，身体健康，整体功能，并接受治疗组之间没有显着差异。结论：初级保健设置是一个重要的场所，晚年自杀预防。初级保健提供者应该做好充分准备，诊断和治疗老年患者的抑郁症。需要更多的研究，关于身体健康，功能状态和抑郁症状在确定自杀风险的相互作用。
OBJECTIVE: To determine whether physical and psychiatric illness, functional status, and treatment history distinguish older primary care patients who committed suicide from those who did not.DESIGN: A case-control study using data collected by psychological autopsies of suicides and prospective patient interviews for controls.SETTING: Primary care practices in Monroe County, NY.PARTICIPANTS: Forty-two suicides aged 60 years and older who visited a primary care provider within 30 days of death and 196 patients aged 60 years and older from a group practice of general internal medicine (n = 115) or family medicine (n = 81).MEASUREMENTS: Psychiatric diagnosis; depressive symptom severity; physical health and function; psychiatric treatment history. RESULTS: Completed suicides had more depressive illness (P = .001), physical illness burden (P = .0002), and functional limitations (P = .0001) than controls and were more likely to be prescribed antidepressants (P = .004), anxiolytic agents (P = .0001), and narcotic analgesics (P = .022). Among depressed subjects, affective symptom severity (P < .0001) and emotional dysfunction (P < .0001) distinguished suicide completers. However, physical health, overall function, and treatments received did not differ between groups.CONCLUSIONS: The primary care setting is an important venue for late life suicide prevention. Primary care providers should be well prepared to diagnose and treat depression in their older patients. Additional research is needed concerning the interactions of physical health, functional status, and depressive symptoms in determining suicide risk.