Cerebrovascular risk factors and late-life suicide

描述(申请人提供)：我们工作的长期目标是开发和测试有效率和有效用于老年人的自杀预防措施。了解使老年人面临自杀风险的因素对于我们实现这一目标是必要的。许多医学、心理和社会影响已被证明与晚年自杀有关。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)，对晚年精神障碍的影响，而后者已被证明是晚年自杀的强大危险因素。我们研究的主要目的是使用病例对照设计来检验临床和放射病理水平的CVRF是否独立地增加了晚年自杀的风险。在我们的次要目标中，我们将检查临床CVRF和放射病理学CVRF之间的相关性。此外，我们还将探讨CVRF(临床和放射病理)是否会使一些高危老年人更容易通过执行认知功能受损(ECF)而自我毁灭。 采用横断面病例对照设计。将从65岁或以上的自杀未遂者中招募100人，在30个月内连续进入三级护理环境；而从在当地老年人康乐中心居住的社区长者中招募相同数量、年龄和性别分布相似、没有终生自杀史的控制组。所有受试者将接受社会人口学背景、自杀行为特征、精神病理学、个性、身体健康状况(包括临床脑血管危险因素)和脑部磁共振血管病理、执行认知功能和整体认知功能的测量。 在控制了晚年自杀行为的其他生物、心理和社会危险因素后，将使用Logistic回归模型来检验自杀未遂者在临床/放射病理水平上是否比对照组有更大的CVRF负担。该模型还将测试冲动的个性特征和受损的ECF之间是否存在显著的交互作用，从而增加自杀行为的风险。临床和放射病理CVRF之间的相关性以及CVRF负荷与ECF受损之间的关系将通过相关统计得出。

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.