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Comorbidity Profiles Identified in Older Primary Care Patients Who Attempt Suicide
Author(s) -
Morin Ruth T.,
Li Yixia,
Mackin R. Scott,
Whooley Mary A.,
Conwell Yeates,
Byers Amy L.
Publication year - 2019
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16126
Subject(s) - comorbidity , medicine , depression (economics) , veterans affairs , psychiatry , poison control , medical diagnosis , suicide prevention , medical record , suicide attempt , cohort , national comorbidity survey , injury prevention , medical emergency , pathology , economics , macroeconomics
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