Identifying the longitudinal outcomes of suicide loss in a population-based cohort

项目摘要 自杀的影响远远超出了个人自杀死亡的范围。对于每一例自杀死亡，估计 135人暴露在自杀损失的潜在创伤中。研究表明，接触自杀 失落会导致精神和身体健康困扰，那些经历不良后果的人被称为 “自杀遗失幸存者。”与此同时，由于缺乏适当的比较，这些文献受到了严重的限制 小组(例如，事故死亡损失)，检查有限数量的结果，而不考虑共病， 以及关注一种类型的家庭关系(例如，配偶)而忽略非家庭损失幸存者(例如， 同居者)。因此，缺乏高质量的人口水平纵向流行病学研究。 自杀遗失幸存者阻碍了我们理解自杀对健康的全面影响的能力，以及自杀造成的 自杀式公共卫生危机。该项目总目标是使用丹麦国家登记册数据来记录 接触铅的人群的身心健康结果和共病 30年内的自杀损失。丹麦拥有全民医疗体系，并得到政府支持 全国范围内的电子健康和社会登记，以及将登记和社会登记的记录链接起来的能力 使用唯一个人/家庭识别符和地址信息的个人。我们的项目将利用 直接解决自杀损失文献中的空白的登记。我们将培养一批所有一流的学生 1994至2024年间遭受自杀损失的亲属和同居者，以及两个比较队列 (1)暴露于事故损失，和(2)普通民众(目标1)。这些队列将包括所有可用的 30年随访期内的社会人口和电子病历数据。这些数据将是 用于进行自杀损失的流行病学结果分析(目标2)。我们将确认所有精神和心理上的 身体健康ICD编码的诊断结果，特定于自杀损失(与事故损失和 一般人群)，并检查结果如何变化的时间，自失去以来，关系类型和性别。这 方法将为自杀领域内的预防和干预提供新的和更准确的目标 后发制人。该队列还将用于确定最显著的诊断合并症模式， 遵循自杀损失(目标3)。无人监督的机器学习将识别自杀损失的潜在亚群 幸存者的特点是精神和身体健康共病的共同模式，目标是 告知转诊预防/治疗和产生机械假说。本研究是一项 为自杀损失的流行病学研究奠定了有效的途径。我们的研究结果将为临床医生和 政策制定者拥有设计和研究特定障碍和跨诊断所需的信息 预防和治疗自杀对遗失幸存者目前未被探索和未被探索的影响的干预措施。 该队列还可以作为未来关于自杀损失的研究的持久资源。展望未来，结果 可以在其他人群中复制(例如，较小的美国样本)，以进一步了解我们的发现。

PROJECT ABSTRACT The impact of suicide reaches well-beyond individual suicide decedents. For each suicide death, an estimated 135 people are exposed to the potential trauma of suicide loss. Research indicates that exposure to suicide loss can result in mental and physical health distress, with those experiencing adverse outcomes called “suicide loss survivors.” At the same time, the literature is severely limited by a lack of appropriate comparison groups (e.g., accident death loss), examining a limited number of outcomes without considering comorbidity, and focusing on one type of familial relation (e.g., spouses) while ignoring non-familial loss survivors (e.g., cohabitants). Consequently, the lack of high-quality population-level longitudinal epidemiologic studies of suicide loss survivors hinders our ability to understand the full health effects of suicide and the full extent of the suicide public health crisis. The overall goal of this project is to use Danish national registry data to document the mental and physical health outcomes and comorbidities among the population of individuals exposed to suicide loss over a 30-year period. Denmark has a universal healthcare system, with government supported nationwide electronic health and social registries, and the ability to link records across registries and individuals using unique personal/family identifiers and address information. Our project will leverage the registries to directly address gaps in the suicide loss literature. We will develop a cohort of all first-degree relatives and cohabitants exposed to suicide loss between 1994 and 2024, as well as two comparison cohorts (1) exposed to accident loss, and (2) from the general population (Aim 1). The cohorts will include all available socio-demographic and electronic medical record data over the 30-year follow-up period. These data will be used to conduct an epidemiologic outcome-wide analysis of suicide loss (Aim 2). We will identify all mental and physical health ICD-coded diagnostic outcomes that are specific to suicide loss (compared to accident loss and the general population), and examine how outcomes vary by time since loss, relationship type, and sex. This approach will inform novel and more precise targets for prevention and intervention within the field of suicide postvention. The cohort also will be used to identify the most salient patterns of diagnostic comorbidity that follow suicide loss (Aim 3). Unsupervised machine learning will identify latent subgroups of suicide loss survivors characterized by common patterns of mental and physical health comorbidity, with the goal of informing transdiagnostic prevention/treatment and generating mechanistic hypotheses. This study is an efficient way to lay a foundation for the epidemiology of suicide loss. Our results will provide clinicians and policymakers with the information needed to design and study both disorder-specific and transdiagnostic interventions to prevent and treat currently unexplored and underexplored effects of suicide on loss survivors. The cohort also can serve as an enduring resource for future research on suicide loss. Going forward, results can be replicated across other populations (e.g., smaller US samples) to further contextualize our findings.