Epidemiology of Suicidal Behavior in Racially/Ethnically Diverse Older Americans

项目摘要/摘要 此应用程序是对RFA-MD-12-001：NIMHD健康差异研究的响应。其中一个优先事项 这种RFA的领域是对与显著死亡率相关的健康状况的研究 在健康差距人群中未得到充分研究。在美国老年人中，自杀率比美国高30% 总人口中，85岁或以上的非西班牙裔白人男性的比例是全国的五倍 随着年龄的增长，自杀率继续增长，种族/民族多样化，自杀率也将上升。然而，人们对此知之甚少。 老年人中与自杀相关的行为(即，想法、计划和企图)，这些行为是自杀的强烈危险因素 实际自杀和极度情绪和精神痛苦的强烈迹象。更重要的是， 几乎没有按种族/民族对自杀行为进行调查，因为大多数研究都来自不同种族。 临床样本。此外，我们所知道的大多数关于精神健康服务的使用与自杀风险有关 年长的美国人来自自杀完成者的小样本，没有多样性。然而，理解 心理健康服务的使用和使用中的种族差异是重要的，因为所有有情感和心理障碍的老年人 与自杀想法和行为相关的精神痛苦可以从服务使用和治疗中受益。这个 拟议的项目将调查自杀意念和相关行为的流行率和预测因素。 不同种族和民族的老年人的一生，也就是捕捉从想法到计划的转变 以及尝试和检查晚年生活和当前自杀行为的风险。它还将调查精神健康状况 这些服务适用于自杀风险较高的人。这些目标将通过研究三个国家的 具有代表性的聚合数据集：1)全国共病调查复制(NCS-R)，概率 美国总体样本；2)美国全国生活调查(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美国人；以及3)全国拉丁裔和亚裔美国人 研究(NLAAS)，拉美裔和亚裔美国人的概率样本。该项目建议使 创新性地使用组合数据，并对全国范围内的3600多名受访者进行调查 现年55岁及以上。以非常经济高效的方式，这个项目将是第一个全面检查 美国老年人自杀相关行为和心理健康服务使用的流行率及其预测因素。 关键预测因素，包括社会人口学变量、精神障碍和慢性疾病 将确定与自杀行为有关的问题(目标1和2)--评估不同的联系 总体上，按种族/民族，即在老年非西班牙裔白人、非西班牙裔黑人、西班牙裔美国人和 亚洲人。此外，将分别评估男性和女性的种族差异(目标3)，关键是 将全面并按种族/族裔审查精神卫生服务使用的预测因素(目标4)。信息 来自该项目的数据将对识别最有自杀风险的老年人和 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.