Suicide among older psychiatric inpatients: An evidence-based study of a high-risk group
Suicide among older psychiatric inpatients: An evidence-based study of a high-risk group
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DOI：
10.1097/01.jgp.0000225084.16636.ec
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发表时间：
2006-09-01
影响因子：
7.2
通讯作者：
Conwell, Yeates
中科院分区：
文献类型：
--
作者：
Erlangsen, Annette;Zarit, Steven H.;Conwell, Yeates
目的：老年人的自杀率较高，尤其是在有精神疾病的情况下，但对这一高危人群的自杀预测因素知之甚少。目前的研究调查了在精神病院住院的老年人中与自杀有关的特征。方法：所有在1990-2000年期间因精神疾病住院的60岁及以上丹麦居民纳入研究。采用病例对照设计和逻辑回归分析，作者计算了与特定患者特征相关的自杀风险。结果：发现情感性障碍与精神病住院患者的自杀风险比其他类型障碍高出近两倍（95%置信区间[CI]: 1.5-2.6）。痴呆患者的风险比明显较低，为0.2 （95% CI: 0.1-0.3）。与其他类型的障碍相结合，情感性障碍被发现会增加自杀的风险。与首次因抑郁症住院的年龄（60岁之前或之后）相比，首次因抑郁症住院的年龄更能预测自杀。超过一半的自杀发生在入院或出院的第一周（chi(2) [1] = 27.70, p < 0.001）。结论：我们的研究结果强调了情感性障碍与其他类型障碍合并的重要作用。评估老年精神科住院患者的自杀风险应考虑当前或以前的情感性疾病发作，并特别注意入院和出院后不久的时间。
Objective: Older adults have elevated suicide rates, especially in the presence of a psychiatric disorder, yet not much is known about predictors for suicide within this high-risk group. The current study examines the characteristics associated with suicide among older adults who are admitted to a psychiatric hospital. Method: All persons aged 60 and older living in Denmark who were hospitalized with psychiatric disorders during 1990-2000 were included in the study. Using a case-control design and logistic regression analysis, the authors calculated the suicide risk associated with specific patient characteristics. Results: Affective disorders were found to be associated with an almost twofold higher risk of suicide among psychiatric inpatients than other types of disorders (95% confidence interval [CI]: 1.5-2.6). Patients with dementia had a significantly lower risk ratio of 0.2 (95% CI: 0.1-0.3). In combination with other types of disorder, affective disorders were found to modify an increased risk of suicide. First versus later admission for depression was a better predictor for suicide than age at first hospitalization for depression (before or after age 60 years). More than half of suicides occurred either within the first week of admission or discharge (chi(2) [1] = 27.70, p < 0.001) compared with the distribution of patient days. Conclusions: Our findings underline the important role of affective disorder in combination with other types of disorders. Assessment of suicide risk among older psychiatric inpatients should take current or previous episodes of affective illness into consideration and pay special heed to the time shortly after admission and discharge.