Pathways from social disconnection to suicidal ideation in later life

摘要 老年人的自杀死亡和社会脱节是日益严重的公共卫生问题。A‘愿望 “去死”(WTD)是一种消极自杀意念的指标，指的是一个人想到自己会死。 最好是死了，或者希望自己去死。社会脱节和自杀之间的联系是广泛的 公认的和社会脱节已被证明与WTD的可能性增加有关。 重要的是，社会脱节是一个多方面的结构，无论是数量(社会孤立)还是质量 (孤独感)人们的社会关系与自杀意念和随后的自杀密切相关 尝试。虽然这种联系已经确立，但解释这种联系的机械途径就不那么好了 明白了。提出的主要假设机制是：行为(睡眠、体力活动、吸烟、酒精 消费)、心理(抑郁、焦虑和衰老感知)和生理(神经内分泌、 免疫功能和心脏新陈代谢)。 这项研究利用爱尔兰老龄化纵向研究(Tilda)的数据来确定解释 社会脱节与消极自杀意念之间的联系。蒂尔达是一个大型的，全国性的 具有代表性的前瞻性队列研究，考察了8,500+人的社会、经济和健康状况 爱尔兰50岁及以上社区居住的成年人。自那以后，蒂尔达的数据每两年收集一次 2009年，包括调查数据(CAPI和SCQ)和以诊所为基础的全面健康评估。详细 生物标志物数据可从这些健康评估中获得，包括神经内分泌、免疫、 心脏代谢系统和副交感神经系统。 利用这些纵向数据，该研究的目的是：(1)确定谁是社会脱节和WTD的最高风险 老年人之间以及个人最危险的时候；(2)检查两者之间的联系的性质 老年人的社会脱节和WTD，包括强度、暂时性和方向性；(3)识别 解释社会脱节和WTD之间联系的机械途径。为了实现这些目标， 将对四波调查和两波生物标志物数据进行调查，并推进纵向统计 将应用技术(GLMM、潜在增长曲线、潜在班级增长分析和扫描电子显微镜通径分析)。 鉴于这项研究的复杂性，我们已经组建了一支出色的多学科临床和 在项目的每一个组成部分都有专业知识的学术研究人员。通过建立因果关系 社会脱节和WTD之间的途径，研究结果将确定重要的风险和保护因素 容易受到干预的自杀念头。在这样做的过程中，这项研究将为有效的临床和 以社区为基础的干预，通过这种干预可以阻止导致积极自杀念头的一系列想法 在个体发展到积极的构思和自杀行为之前。

ABSTRACT Suicide deaths and social disconnection among older adults are increasingly serious public health concerns. A 'Wish To Die' (WTD) is an indicator of passive suicide ideation which refers to thoughts of one’s own death, that one would be better off dead, or wishing for one’s death. The association between social disconnection and suicide is widely recognised and social disconnection has been shown to be associated with an increased likelihood of WTD. Importantly, social disconnection is a multi-faceted construct and both the quantity (social isolation) and quality (loneliness) of people’s social relationships are strongly related to both suicide ideation and subsequent suicide attempts. While this association is well-established, the mechanistic pathways to explain the association are less well understood. The main putative mechanisms proposed are: behavioral (sleep, physical activity, smoking, alcohol consumption), psychological (depression, anxiety, and ageing perceptions), and physiological (neuroendocrine, immune function, and cardiometabolic). This study leverages data from The Irish Longitudinal Study on Ageing (TILDA) to identify the pathways that explain the association between social disconnection and passive suicidal ideation. TILDA is a large, nationally representative, prospective cohort study that examines the social, economic and health circumstances of 8,500+ community-dwelling adults aged 50 years and older in Ireland. TILDA data have been collected every two years since 2009 and includes both survey data (CAPI and SCQ) and a comprehensive clinic-based health assessment. Detailed biomarker data are available from these health assessments and include markers from the neuroendocrine, immune, cardiometabolic, and parasympathetic systems. Using this longitudinal data, the study aims to: (1) Identify who is at highest risk of social disconnection and WTD among older adults as well as when individuals are most at risk; (2) Examine the nature of the associations between social disconnection and WTD, including strength, temporality, and directionality, among older adults; (3) Identify mechanistic pathways that explain the association between social disconnection and WTD. To address these aims, four waves of survey and two waves of biomarker data will be investigated and advanced longitudinal statistical techniques (GLMM, latent growth curve, latent class growth analysis, and SEM path analysis) will be applied. Given the complex nature of this study, we have assembled an outstanding multi-disciplinary team of clinical and academic researchers with expertise in each of the constituent parts of the project. By establishing the causal pathways between social disconnection and WTD, study results will identify important risk and protective factors for suicidal ideation that are amenable to intervention. In doing so, the study will inform effective clinical and community-based interventions by which the train of thoughts leading to active suicidal ideation can be stopped before individuals progress to active ideation and suicidal behavior.