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Comorbidity Profiles Identified in Older Primary Care Patients who Attempt Suicide
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12 2019
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Source: J Am Geriatr Soc. 67(12):2553-2559
Details:
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Alternative Title:J Am Geriatr Soc
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Personal Author:
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Description:Objectives:
To identify comorbidity profiles of older patients last seen in primary care prior to a suicide attempt, and assess attempt and clinical factors (e.g., means and lethality of attempt) associated with these profiles.
Design:
Cohort study and latent class analysis using VA national data (2012–2014).
Setting:
All Department of Veterans Affairs (VA) medical centers in the United States.
Participants:
2,131 patients 65 years and older who were last seen by a primary care provider prior to a first documented suicide attempt.
Measurements:
Fatal suicide attempt and means were identified using the National Suicide Data Repository. Non-fatal attempt was defined using the National Suicide Prevention Applications Network. Medical and psychiatric diagnoses and other variables were determined from electronic medical records.
Results:
Patients (mean age 74.4, 98.2% male) were clustered into 5 classes based on medical and psychiatric diagnoses: Minimal Comorbidity (23.2%); Chronic Pain-Osteoarthritis (30.1%); Depression-Chronic Pain (22.9%); Depression–Medical Comorbidity (16.5%); and High Comorbidity (7.3%). The Minimal Comorbidity and Chronic Pain-Osteoarthritis classes were most likely to attempt fatally compared to classes with higher burden of comorbidities. Overall, 61% of the sample attempted fatally, and 82.5% of suicide decedents used firearms.
Conclusion:
This study provides evidence that the majority of comorbidity profiles (>50%) in primary care patients attempting suicide was characterized by minimal depression diagnoses and fatal attempts, mostly with firearms. These findings suggest that more than a depression diagnosis contributes to risk and that conversations about firearm safety by medical providers may play an important role in suicide intervention and prevention.
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Source:
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Pubmed ID:31469184
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Pubmed Central ID:PMC6898743
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Funding:
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Volume:67
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Issue:12
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