Suicidal Behavior and Suicide in Older Veterans

 描述（由申请人提供）： 对老年退伍军人的自杀和与自杀有关的行为（即，意念、计划和企图），这是实际自杀的强烈风险因素，也是极端情绪和精神痛苦的强烈指标。退伍军人事务部自杀预防计划最近的监测数据表明，老年退伍军人最有可能自杀，需要大量的护理。来自VA心理健康服务自杀预防计划的2012年自杀数据报告记录了近70%的退伍军人自杀事件发生在老年退伍军人中（即，50岁或以上），在使用退伍军人健康管理局（VHA）服务的退伍军人中，这一比例接近80%。此外，最近的研究表明，自杀的VHA患者中只有不到一半的人有精神疾病诊断;这表明其他潜在的风险因素可能是突出的，例如医疗和共病状况，这在老年人中特别普遍。此外，50岁及以上的退伍军人占退伍军人人口的比例最大（> 70%），老年退伍军人是增长最快的亚组，2010年65岁及以上的退伍军人约占退伍军人的40%，2020年约占退伍军人的50%。然而，令人惊讶的是，在这个自杀风险高的老年退伍军人快速老龄化的人群中，人们对自杀知之甚少，对自杀行为的了解更少。退伍军人事务部实施的许多预防方案受到对年轻军事人员和从战斗中返回的退伍军人的研究的影响。发生这种情况的部分原因是，全国范围内老年退伍军人自杀和自杀相关行为的患病率和预测因素尚未得到很好的表征;然而，老年人占退伍军人事务部人口的大多数。为此，我们研究的主要目标是使用四个国家数据库，自杀预防和应用网络（SPAN）数据库，退伍军人自杀档案数据，国家患者护理数据库（NPCD）和医疗保险和医疗补助服务中心（CMS）数据库，确定老年退伍军人自杀相关行为和自杀的患病率和关键预测因素。SPAN和退伍军人自杀档案数据将提供关于经历过自杀相关行为和完成自杀的退伍军人的信息，而NPCD和CMS数据提供关于医疗和精神病诊断的住院和门诊信息。该项目建议创新地利用综合数据，并研究一个大型的、以全国为基础的50岁及以上退伍军人队列。在一个非常具有成本效益的方法，这个项目将是第一个 对老年退伍军人自杀和自杀相关行为的患病率和预测因素进行全面的纵向研究。将确定关键预测因素，包括社会人口统计学变量、精神疾病、慢性疾病和与自杀和自杀行为相关的合并症（目标1），以及动态风险因素（目标2）-评估总体和年龄、性别和种族/民族的关联差异（目标3），并评估最重要的预测因素和风险因素组合（即，最高风险亚组）与老年退伍军人长期发展自杀行为和完成自杀相关（目标4）。从这个项目产生的信息将是重要的，以确定那些老年退伍军人最有自杀的风险，并与护理的巨大需求，帮助确定国家的优先事项，为所有退伍军人的长期自杀预防。

 DESCRIPTION (provided by applicant): Little is known about suicide in older Veterans, and suicide-related behaviors (i.e., ideation, plans, and attempts), which are strong risk factors for actual suicide and strong indicators of extreme emotional and mental distress. Recent surveillance data from the Department of Veterans Affairs Suicide Prevention Program suggests that older Veterans are most at risk of committing suicide and require great need of care. The 2012 Suicide Data Report from the VA Mental Health Services Suicide Prevention Program documented that nearly 70% of Veteran suicides are in older Veterans (i.e., 50 years or older), and in Veterans using Veterans Health Administration (VHA) services it is nearly 80%. Furthermore, recent research has shown that less than half of VHA patients who killed themselves had a psychiatric disorder diagnosis; suggesting that other potential risk factors may be salient, such as medical and comorbid conditions, which are particularly pervasive in aging adults. In addition, Veterans 50 years and older are the largest proportion (> 70%) of the Veteran population and elderly Veterans are the fastest growing subgroup, with those aged 65 years and older comprising about 40% of Veterans in 2010 and almost 50% of Veterans in 2020. Yet, surprisingly, in this rapidly aging population of older Veterans at high risk of suicide, little is known about suicide, and even less s known about suicidal behavior. The implementation of many of the prevention programs by the VA are influenced by studies of younger military personnel and Veterans returning from combat. This has occurred, in part, because the prevalence and predictors of suicide and suicide-related behaviors among older Veterans nationwide have not been well characterized; yet, older adults compose the majority of the VA population. To this end, the primary goal of our study is to determine the prevalence and key predictors of suicide-related behaviors and suicide in older Veterans using four national databases, the Suicide Prevention and Application Network (SPAN) database, the Veteran Suicide Archive data, the National Patient Care Database (NPCD), and the Centers for Medicare and Medicaid Services (CMS) database. The SPAN and the Veteran Suicide Archive data will provide information on Veterans who have experienced suicide-related behaviors and completed suicide, while the NPCD and CMS data provide inpatient and outpatient information on medical and psychiatric diagnoses. The project proposes to make innovative use of the combined data and examine a large, nationally-based cohort of Veterans aged 50 years and older. In a very cost-efficient approach, this project will be the first comprehensive longitudinal examination of the prevalence and predictors of suicide and suicide-related behaviors in older Veterans. Key predictors, including sociodemographic variables, psychiatric disorders, chronic medical conditions, and comorbidity associated with suicide and suicidal behaviors will be determined (Aim 1), as well as dynamic risk factors (Aim 2)-assessing differences of associations overall and by age, gender, and race/ethnicity (Aim 3), and assessing the most important predictors and combinations of risk factors (i.e., highest risk subgroups) associated with developing suicidal behavior and completing suicide over the long term in older Veterans (Aim 4). Information stemming from this project will be important for identifying those older Veterans most at risk of suicide and with great need of care-helping to define national priorities for suicide prevention over the long term for all Veterans.