Cerebrovascular risk factors and late-life suicide

描述（由申请人提供）：我们工作的长期目标是开发和测试自杀预防措施，有效和有效地用于老年人。要达到这个目标，我们必须了解导致长者自杀的因素。许多医学，心理和社会影响已被证明是晚年自杀的相关因素。新的证据正在出现，以证实特定领域的医学因素，即脑血管风险因素（CVRF），对晚年精神疾病的影响，这反过来又被证明是晚年自杀的强大风险因素。本研究的主要目的是使用病例对照设计，检查临床和放射病理学水平的CVRF是否独立增加晚年自杀的风险。在我们的次要目的中，我们将检查临床CVRF和放射病理学CVRF之间的相关性。此外，我们将探讨CVRF（临床和放射病理学）是否会使一些高危老年人更容易通过执行认知功能（ECF）受损而自我毁灭。 将采用横断面病例对照设计。100例病例将从65岁或以上的自杀者中招募，这些自杀者在30个月内连续到三级护理机构就诊;而相同数量的对照组，年龄和性别分布相似，没有自杀的终身史，将从参加当地老年人娱乐中心的社区居住老人中招募。将对所有受试者进行社会人口统计学背景、自杀行为特征、精神病理学、人格、身体健康特征（包括临床脑血管风险因素（CVRF）和脑MRI中的血管病理学）、执行认知功能和整体认知功能的测量。 在控制晚年自杀行为的其他生物心理社会风险因素后，将使用逻辑回归模型检验自杀未遂者在临床/放射病理学水平上的CVRF负担是否大于对照组。该模型还将测试冲动的人格特质和受损的ECF在增加自杀行为风险方面是否存在任何显着的相互作用。将通过相关性统计分析得出临床和放射病理学CVRF之间的相关性以及CVRF负荷和受损ECF之间的关系。

DESCRIPTION (provided by applicant): The long-term goal of our work is to develop and test suicide prevention measures that are efficient and effective for use in the elderly. Knowledge of the factors that place elders at risk for suicide is necessary for us to reach that goal. A number of medical, psychological and social influences have been shown to be correlates of suicide in late-life. New evidence is emerging to substantiate the effect of a specific domain of medical factors, i.e. cerebrovascular risk factors (CVRFs), on late-life psychiatric disorders, which in turn have already been shown to be robust risk factors for late-life suicide. The primary objective of our study is to examine using a case-control design whether CVRFs at clinical and radiopathological levels independently increase risk of late-life suicide. In our secondary objectives, we will examine the correlation between clinical CVRFs and radiopathological CVRFs. Also, we Will explore whether CVRFs (both clinical and radiopathological) render some at-risk older adults even more vulnerable to self-destruction by way of impaired executive cognitive function (ECF). Cross-sectional case-control design will be employed. 100 cases will be recruited from suicide attempters, ages 65 or over presenting consecutively to a tertiary care setting over a 30-month period; while the same number of controls, of comparable age and sex distribution, without life-time history of suicide, will be recruited from community dwelling elders who attend local elderly recreational centres. Measures of sociodemographic background, suicide behavior profile, psychopathology, personality, physical health profile including clinical cerebrovascular risk factor (CVRFs) and vascular pathologies in MRI of Brain, executive cognitve function and global cognitive function will be administered to all subjects. Logistic regression model will be used to test if there is greater burden of CVRFs at clinical/ radiopathological levels in suicide attempters over controls, after controlling for other biopsychosocial risk factors of late-life suicidal behavior. The model will also test if there is any significant interaction between personality trait of impulsiveness and impaired ECF in increasing risk of suicidal behavior. The correlation between clinical and radiopathological CVRFs as well as the relationship between burden of CVRFs and impaired ECFs will be worked out by correlation statistics.