Person-centered approaches for understanding suicidal ideation and behaviors among nursing home residents

项目摘要/摘要 国家零自杀倡议认为，医疗保健环境中的所有自杀死亡都是可以预防的。 鉴于居民自杀风险的增加，对养老院自杀的研究是必要的，日益增长的 随着人口老龄化，这一背景的重要性，以及对这一主题缺乏研究。我们建议 利用我们集成的疗养院最低数据集(MDS)3.0数据库、联邦医疗保险资格和 索赔(A、B和D部分)和认证和检验提供者改进的报告制度，以审查 养老院居民的自杀意念和自杀企图。这样做将提供一个难得的机会 居民和设施层面的数据，以检查自杀风险和保护因素的跨诊断模式- 在弱势群体中的相关结果。还没有全国性的研究试图刻画模式 养老院居民自杀意念和自杀企图的风险和保护因素。这个 具体目标是：1)评估疗养院住宿期间的构思和尝试的流行率；2) 识别与构思和尝试相关的居民和设施特征；3)识别和描述 疗养院居民入院时潜在自杀风险的不同亚组；4)检查 疗养院住院期间居民潜在的自杀风险；以及5)确定自杀变化的预测因素 在养老院住宿的整个过程中都存在风险。多水平潜变量模型将使我们能够识别 自杀风险，并表征自杀风险因素的模式和结果的轨迹 养老院住宿。这项拟议的研究响应了对自杀风险轨迹进行研究的呼吁 告知如何和何时进行干预(NIMH战略优先事项2)以及全国自杀行动联盟 预防研究优先工作组呼吁使用现有的数据源，如MDS 3.0 了解医疗保健环境中的自杀风险。拟议的工作将提供必要的知识 最终帮助改进工作，以识别疗养院居民的自杀高危人群，并向 在医疗保健环境中预防自杀的努力。这一结果也将为未来的研究工作提供参考 改进在护理机构逗留期间了解个人自杀风险的方法。

PROJECT SUMMARY/ABSTRACT The national Zero Suicide initiative considers all suicide deaths in healthcare settings to be preventable. Research about suicide in nursing homes is necessary given residents’ elevated risk for suicide, the growing importance of this setting as the population ages, and the lack of research on this topic. We propose leveraging our integrated nursing home database of the Minimum Data Set (MDS) 3.0, Medicare eligibility and claims (Part A, B & D) and the Certification and Survey Provider Enhanced Reporting system to examine suicidal ideation and attempts among nursing home residents. Doing so will provide a rare opportunity to use resident- and facility-level data to examine transdiagnostic patterns of risk and protective factors for suicide- related outcomes among a vulnerable population. No national studies have attempted to characterize patterns of risk and protective factors for suicidal ideation and suicide attempts among nursing home residents. The specific aims are to: 1) estimate the prevalence of ideation and attempts during the nursing home stay; 2) identify resident and facility characteristics associated with ideation and attempts; 3) identify and describe distinct subgroups of latent suicide risk among nursing home residents at admission; 4) examine changes in residents’ latent suicide risk throughout the nursing home stay; and 5) identify predictors of change in suicide risk throughout the nursing home stay. Multilevel latent variable models will allow us to identify subgroups of suicide risk and characterize the trajectories of patterns of suicide risk factors and outcomes throughout the nursing home stay. The proposed research responds to the call for research on trajectories of suicide risk to inform how and when to intervene (NIMH Strategic Priority 2) as well as the National Action Alliance for Suicide Prevention Research Prioritization Task Force call for the use of existing data sources such as MDS 3.0 to understand suicide risk in healthcare settings. The proposed work will provide knowledge necessary to ultimately help improve efforts to identify nursing home residents at high risk for suicide and inform tailored suicide prevention efforts in this healthcare setting. The results will also inform future research efforts aimed at improving methods of understanding individuals’ suicide risk throughout lengths of stays in nursing facilities.