Epidemiology of Suicidal Behavior in Racially/Ethnically Diverse Older Americans

项目总结/摘要 本申请是对RFA-MD-12-001：NIMHD健康差异研究的回应。其中一个优先 该RFA的领域是研究与显著死亡率相关的健康状况， 在健康差异人群中研究不足。在美国老年人中，自杀率比老年人高出30%。 一般人口，非西班牙裔白色男性年龄在85岁或以上的五倍 随着年龄的增长和种族/民族的多样化，自杀率也将继续增长。然而，人们对 自杀相关行为（即，想法，计划和尝试），这是老年人的强烈风险因素， 实际自杀和强烈的极端情绪和精神痛苦的迹象。更重要的是， 几乎没有调查过种族/民族的自杀行为，因为大多数研究都来自非多样化的研究。 临床样本此外，我们所知道的大多数关于精神卫生服务的使用与自杀风险有关， 老年美国人来自小型非多样化自杀完成者样本。然而，理解 精神卫生服务的使用和种族差异的使用是重要的，因为所有老年人的情绪和 与自杀念头和行为有关的精神困扰可能会从服务的使用和治疗中受益。的 拟议的项目将调查自杀意念和相关行为的患病率和预测因素， 年龄较大的种族和民族多样化的成年人的一生，即捕捉从构思到计划的转变 以及尝试和检查晚年和当前自杀行为的风险。它还将调查心理健康 在自杀风险增加的人群中使用服务。这些目标将通过研究三个国家的 代表性的汇总数据集：1）全国科摩罗重复调查（NCS-R），概率 一般美国的样本; 2)美国生活全国调查（NSAL），非洲人的概率样本， 美国人、非洲裔加勒比人和非西班牙裔白色美国人;以及3）全国拉丁裔和亚裔美国人 研究（NLAAS），拉丁裔和亚裔美国人的概率样本。该项目旨在使 创新地使用综合数据，并研究了一个由3，600多名受访者组成的大型全国性队列 55岁及以上这一项目将是第一次全面审查 美国老年人自杀相关行为和精神卫生服务使用的流行率和预测因素。 关键预测因素，包括社会人口学变量、精神疾病和慢性疾病 将确定与自杀行为相关（目的1和2）-评估相关性的差异 总体和种族/民族，即在老年非西班牙裔白人，非西班牙裔黑人，西班牙裔， 亚洲人此外，将分别评估男女的种族差异（目标3）， 将对精神卫生服务使用的预测因素进行总体检查，并按种族/民族进行检查（目标4）。信息 该项目的结果对于确定那些最有自杀风险的老年人以及 非常需要护理--帮助确定所有美国人晚年预防自杀的国家优先事项。

PROJECT SUMMARY/ABSTRACT This application is in response to RFA-MD-12-001: NIMHD Health Disparities Research. One of the priority areas of this RFA is the study of health conditions associated with significant mortality that have been understudied in health disparity populations. In older Americans, suicide rates are 30% higher than in the general population, and five times higher in non-Hispanic white men age 85 years or older-as the nation continues to grow and racially/ethnically diversify with age so will the rates of suicide. Yet, little is known about suicide-related behaviors (i.e., ideation, plans, and attempts) in older adults, which are strong risk factors for actual suicide and strong indicators of extreme emotional and mental distress. Even more so, differences in suicidal behavior by race/ethnicity have hardly been investigated at all, as most studies are from non-diverse clinic samples. Moreover, most of what we know about mental health services use related to suicide risk in older Americans comes from small non-diverse samples of suicide completers. However, understanding mental health services use and racial disparities in use is important, as all aging adults with emotional and mental distress related to suicidal thoughts and behaviors may benefit from service use and treatment. The proposed project will investigate the prevalence and predictors of suicidal ideation and related behaviors over the lifetime of older racially and ethnically diverse adults, that is, capturing transitions from ideation to plans and attempts and examining risk of late life and current suicidal behavior. It will also investigate mental health services use in those at increased risk of suicide. The aims will be addressed by studying three nationally representative aggregated data sets: 1) the National Comorbidity Survey Replication (NCS-R), a probability sample of the general U.S.; 2) the National Survey of American Life (NSAL), a probability sample of African- American, Afro-Caribbean, and non-Hispanic White Americans; and 3) the National Latino and Asian American Study (NLAAS), a probability sample of Latinos and Asian Americans. The project proposes to make innovative use of the combined data and examine a large, nationally-based cohort of over 3,600 respondents aged 55 and older. In a very cost-efficient approach, this project will be the first comprehensive examination of the prevalence and predictors of suicide-related behaviors and mental health services use in older Americans. Key predictors, including sociodemographic variables, psychiatric disorders, and chronic medical conditions associated with suicidal behavior will be determined (Aims 1 and 2)-assessing differences of associations overall and by race/ethnicity, that is, in older non-Hispanic Whites, non-Hispanic Blacks, Hispanics, and Asians. In addition, racial disparities will be assessed separately for men and women (Aim 3), and key predictors of mental health services use will be examined overall and by race/ethnicity (Aim 4). Information stemming from this project will be important for identifying those older adults most at risk of suicide and with great need of care-helping to define national priorities for suicide prevention in late life for all Americans.