Ruth T Morin1, Yixia Li1,2, R Scott Mackin1,3, Mary A Whooley4, Yeates Conwell5, Amy L Byers1,6. 1. SFVAMC, San Francisco VA Health Care System, San Francisco, California. 2. Northern California Institute for Research and Education, San Francisco, California. 3. Department of Psychiatry, University of California, San Francisco, California. 4. Department of Medicine (Division of Internal Medicine), University of California, San Francisco, California. 5. Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, New York. 6. Department of Mental Health Service, University of California, San Francisco, California.
Abstract
OBJECTIVES: To identify comorbidity profiles of older patients last seen in primary care before a suicide attempt and assess attempt and clinical factors (eg, means and lethality of attempt) associated with these profiles. DESIGN: Cohort study and latent class analysis using Department of Veterans Affairs (VA) national data (2012-2014). SETTING: All VA medical centers in the United States. PARTICIPANTS: A total of 2131 patients 65 years and older who were last seen by a primary care provider before a first documented suicide attempt. MEASUREMENTS: Fatal suicide attempt and means were identified using the National Suicide Data Repository. Nonfatal 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 y; 98.2% male) were clustered into five 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 patients in the Minimal Comorbidity and Chronic Pain-Osteoarthritis classes were most likely to attempt fatally compared with classes with a 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 most comorbidity profiles (>50%) in primary care patients attempting suicide were 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. J Am Geriatr Soc 67:2553-2559, 2019.
OBJECTIVES: To identify comorbidity profiles of older patients last seen in primary care before a suicide attempt and assess attempt and clinical factors (eg, means and lethality of attempt) associated with these profiles. DESIGN: Cohort study and latent class analysis using Department of Veterans Affairs (VA) national data (2012-2014). SETTING: All VA medical centers in the United States. PARTICIPANTS: A total of 2131 patients 65 years and older who were last seen by a primary care provider before a first documented suicide attempt. MEASUREMENTS: Fatal suicide attempt and means were identified using the National Suicide Data Repository. Nonfatal 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 y; 98.2% male) were clustered into five 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 patients in the Minimal Comorbidity and Chronic Pain-Osteoarthritis classes were most likely to attempt fatally compared with classes with a 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 most comorbidity profiles (>50%) in primary care patients attempting suicide were 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. J Am Geriatr Soc 67:2553-2559, 2019.
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