Aging, Major Life Transitions, and Suicide Risk

总结 自杀是美国第十大死亡原因，每年有超过42，000例。迫切需要 确定可改变的风险因素，为公共卫生预防战略提供信息。这项拟议的研究 寻求利用和整合多个现有数据集来支持旨在实现以下目标的新型二次分析 从生命历程的方法中识别自杀风险的预测因子、调节因子和缓解因子。这项建议会 (1)研究四个领域的主要生活转变（例如，社会关系、健康、工作/学校，以及 居住/移动）与生命周期中的自杀风险行为和自杀死亡率有关;以及（2）检查 个人级别的主持人（例如，年龄、性别、人种/种族、精神健康史和医学合并症） 主要的人生转变和自杀风险之间的关系;（3）研究如何 上下文特征（例如，邻里社会经济地位，居住隔离，指标 社会资本）调节主要生命转变与自杀风险之间的关系。这 拟议的研究将使用两个正在进行的，具有全国代表性的纵向研究，共同涵盖 成年：美国人的生活变化（ACL，年龄25岁以上，自1986年以来调查了六次）和健康和 退休研究（HRS，自1992年以来每两年对51岁以上的人进行调查）。ACL和HRS具有多个测量值 自杀风险行为的数据，并与国家死亡指数（NDI）相关联，以确定自杀死亡。的 ACL和HRS与多个外部数据集有现有的链接，这些数据集索引宏观层面的背景 特色此外，我们将利用国家暴力死亡报告中的限制访问数据， 系统（NVDRS），美国最全面的自杀死亡登记（n~ 250，000例自杀死亡， 2003-2018年所有年龄段），其中载有关于2003-2018年期间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 数据集来表征自杀死亡率的宏观层面背景调节因素。影响：实证研究 复杂的，交叉的和时变的因素，导致自杀风险的长期影响， 和亚群之间的差异。该项目将通过提供科学知识来解决这一差距。 一套创新的综合分析，旨在全面研究生活转变的方式 与个人和宏观层面的特征相交，以塑造一生中的自杀风险。发现将 检查理论化但研究不足的风险因素，澄清潜在的接触点，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.