Epidemiology of Suicidal Behavior in Racially/Ethnically Diverse Older Americans

描述（由申请人提供）：本申请是对RFA-MD-12-001: NIMHD健康差异研究的回应。这一区域资源评估的优先领域之一是研究在健康差异人群中未得到充分研究的与显著死亡率相关的健康状况。美国老年人的自杀率比一般人群高30%，85岁以上非西班牙裔白人男性的自杀率比一般人群高5倍。随着美国人口持续增长，种族/民族也随着年龄的增长而多样化，自杀率也会随之上升。然而，我们对老年人的自杀相关行为（即意念、计划和企图）知之甚少，这些行为是实际自杀的强烈风险因素，也是极端情绪和精神痛苦的强烈指标。更重要的是，种族/民族自杀行为的差异几乎没有被调查过，因为大多数研究都来自非多样化的临床样本。此外，我们所知道的与美国老年人自杀风险相关的心理健康服务使用情况，大部分来自自杀完成者的小样本。然而，了解心理健康服务的使用和使用中的种族差异是很重要的，因为所有与自杀念头和行为有关的情绪和精神困扰的老年人都可能从服务的使用和治疗中受益。该项目将调查不同种族和民族的老年人一生中自杀意念和相关行为的患病率和预测因素，也就是说，捕捉从意念到计划和尝试的转变，并检查晚年和当前自杀行为的风险。它还将调查那些自杀风险增加的人使用心理健康服务的情况。研究目标将通过研究三个具有全国代表性的汇总数据集来解决：1)全国共发病调查复制（NCS-R），美国一般的概率样本；2)美国生活全国调查（NSAL），非裔美国人、非裔加勒比人和非西班牙裔美国白人的概率样本；3)全国拉丁裔和亚裔美国人研究（NLAAS），拉丁裔和亚裔美国人的概率样本。该项目建议创新性地使用综合数据，并对全国范围内超过3600名年龄在55岁及以上的受访者进行调查。以一种非常具有成本效益的方法，这个项目将是美国老年人自杀相关行为和心理健康服务使用的流行程度和预测因素的第一次全面检查。关键的预测因素，包括社会人口学变量、精神疾病和与自杀行为相关的慢性疾病（目标1和目标2）——评估总体和种族/民族（即老年非西班牙裔白人、非西班牙裔黑人、西班牙裔和亚洲人）的关联差异。此外，将分别评估男性和女性的种族差异（目标3），并将按种族/族裔整体审查心理健康服务使用情况的关键预测因素（目标4）。来自这个项目的信息对于识别那些最有自杀风险和最需要护理的老年人将是重要的，这有助于为所有美国人确定预防晚年自杀的国家优先事项。

DESCRIPTION (provided by applicant): This application is in response to RFA-MD-12-001: NIMHD Health Disparities Research. One of the priority areas of this RFA is the study of health conditions associated with significant mortality that have been understudied in health disparity populations. In older Americans, suicide rates are 30% higher than in the general population, and five times higher in non-Hispanic white men age 85 years or older-as the nation continues to grow and racially/ethnically diversify with age so will the rates of suicide. Yet, little is knon about suicide-related behaviors (i.e., ideation, plans, and attempts) in older adults, which are strong risk factors for actual suicide and strong indicators of extreme emotional and mental distress. Even more so, differences in suicidal behavior by race/ethnicity have hardly been investigated at all, as most studies are from non-diverse clinic samples. Moreover, most of what we know about mental health services use related to suicide risk in older Americans comes from small non-diverse samples of suicide completers. However, understanding mental health services use and racial disparities in use is important, as all aging adults with emotional and mental distress related to suicidal thoughts and behaviors may benefit from service use and treatment. The proposed project will investigate the prevalence and predictors of suicidal ideation and related behaviors over the lifetime of older racially and ethnically diverse adults, that is, capturing transitions from ideation to plans and attempts and examining risk of late life and current suicidal behavior. It will also investigate mental health services use in those at increased risk of suicide. The aims will be addressed by studying three nationally representative aggregated data sets: 1) the National Co-morbidity Survey Replication (NCS-R), a probability sample of the general U.S.; 2) the National Survey of American Life (NSAL), a probability sample of African- American, Afro-Caribbean, and non-Hispanic White Americans; and 3) the National Latino and Asian American Study (NLAAS), a probability sample of Latinos and Asian Americans. The project proposes to make innovative use of the combined data and examine a large, nationally-based cohort of over 3,600 respondents aged 55 and older. In a very cost-efficient approach, this project will be the first comprehensive examination of the prevalence and predictors of suicide-related behaviors and mental health services use in older Americans. Key predictors, including sociodemographic variables, psychiatric disorders, and chronic medical conditions associated with suicidal behavior will be determined (Aims 1 and 2)-assessing differences of associations overall and by race/ethnicity, that is, in older non-Hispanic Whites, non-Hispanic Blacks, Hispanics, and Asians. In addition, racial disparities will be assessed separately for men and women (Aim 3), and key predictors of mental health services use will be examined overall and by race/ethnicity (Aim 4). Information stemming from this project will be important for identifying those older adults most at risk of suicide and with great need of care-helping to define national priorities for suicide prevention in late life for all Americans. PUBLIC HEALTH RELEVANCE: Suicidal risk profoundly impacts individuals, families, and society. Knowledge gained from this proposal will be both novel and critical for understanding the occurrence and predictors of suicide-related behaviors (i.e., ideation, planning, and attempts) in older Black, Hispanic, Asian, and White Americans, including use of mental health services in those at increased risk of suicide. Thus, this proposed project will have unique public health importance, because it will provide evidence for future psychiatric research and policy planning that will help to define national priorities for suicide prevention in late life for all Americans.