Aging, Major Life Transitions, and Suicide Risk

摘要 自杀是美国第十大死因，每年超过4.2万例。有一个迫切的需要 确定可以为公共卫生预防战略提供信息的可改变的风险因素。这项拟议的研究 寻求利用和集成几个现有的数据集，以支持旨在 从生命过程的角度确定自杀风险的预测、调节和缓解因素。这项提议将 (1)研究四个领域(例如，社会关系、健康、工作/学校和 居住/搬家)与自杀危险行为和一生中的自杀死亡率有关；以及(2)检查 个人级别的主持人(例如，年龄、性别、种族/民族、精神健康史和医疗合并症) 人生重大转变与一生中自杀风险之间的关系；以及(3)研究如何 背景特征(例如，邻里社会经济状况、居住隔离、 社会资本)调节人生重大转变与终生自杀风险之间的关系。这 拟议的研究将使用两项正在进行的、具有全国代表性的纵向研究，这两项研究共同涵盖了 成年期：美国人不断变化的生活(25岁以上的ACL，自1986年以来进行了六次调查)和健康与健康 退休研究(HRS，51岁以上，自1992年以来每两年进行一次调查)。ACL和HRS有多个测量 并与国家死亡指数(NDI)挂钩，以确定自杀死亡人数。这个 ACL和HRS具有到多个外部数据集的现有链接，这些数据集索引宏观级别的上下文 特点。此外，我们将利用国家暴力死亡报告中的受限访问数据 美国最全面的自杀死亡登记系统(NVDRS)(约250,000人自杀死亡 2003年至2018年的所有年龄段)，其中包含关于中国主要生活转变的定量和定性数据 自杀死亡率的背景。我们将使用地理标识符将NVDRS数据链接到多个外部 用于表征自杀死亡率的宏观层面背景调节因素的数据集。影响：实证研究 导致自杀风险的复杂、交叉和时变因素的长期影响 而且缺乏跨亚群的。该项目将通过以下方式解决科学理解方面的差距 一组创新的综合分析，寻求全面检查生活转变的方式 与个人和宏观层面的特征交织在一起，形成一生中的自杀风险。调查结果将 检查理论上但研究不足的风险因素，澄清潜在的参与点，并告知 确定现有预防性干预措施的目标和优先次序。

SUMMARY Suicide is the 10th leading cause of death in the US, with over 42,000 cases annually. There is an urgent need to identify modifiable risk factors that can inform public health prevention strategies. This proposed research seeks to leverage and integrate several existing datasets to support novel secondary analyses aimed at identifying predictors, moderators, and mitigators of suicide risk from a life course approach. This proposal will (1) Examine how major life transitions in four domains (e.g., social relationships, health, work/school, and residence/moving) relate to suicide-risk behaviors and suicide mortality over the life span; and (2) Examine individual-level moderators (e.g., age, sex, race/ethnicity, mental health history, and medical comorbidities) of the relationship between major life transitions and suicide risk over the life span; and (3) Examine how contextual characteristics (e.g., neighborhood socioeconomic status, residential segregation, indicators of social capital) moderate the relationship between major life transitions and suicide risk over the life span. This proposed research will use two ongoing, nationally-representative longitudinal studies that collectively cover adulthood: the Americans’ Changing Lives (ACL, ages 25+, surveyed six times since 1986) and the Health and Retirement Study (HRS, ages 51+ surveyed biennially since 1992). The ACL and HRS have multiple measures of suicide-risk behaviors and are being linked to the National Death Index (NDI) to identify suicide deaths. The ACL and HRS have existing linkages to multiple external datasets which index macro-level contextual characteristics. In addition, we will leverage restricted-access data from the National Violent Death Reporting System (NVDRS), the most comprehensive registry of suicide mortality in the US (n~250,000 suicide deaths of all ages from 2003-2018), which contains both quantitative and qualitative data on major life transitions in the context of suicide mortality. We will link the NVDRS data using geographic identifiers to multiple external datasets to characterize macro-level contextual moderators of suicide mortality. Impact: Empirical research on the long-term influences of complex, intersecting and time-varying factors that contribute to suicide risk within and across subpopulations is lacking. This project will address this gap in scientific understanding by providing an innovative, integrated set of analyses that seek to comprehensively examine the ways that life transitions intersect with individual and macro-level characteristics to shape suicide risk over the life span. Findings will examine theorized but under-researched risk factors, clarify potential points of engagement, and inform targeting and prioritization of existing preventive interventions.