Abstract
Suicides among older women have received little research attention. In this study based on the 2017–2019 National Violent Death Reporting System data, we examined prevalence of depression in older female suicide decedents (N=3,061), associations between depression and other suicide precipitants, and the associations between suicide methods and depression. Descriptive statistics and generalized linear models (GLM) for a Poisson distribution with a log link were used to examine the research questions. Of the decedents, 15.0% had depressed mood without a reported diagnosis and 41.8% had a depression diagnosis. Nearly one half of the decedents with reported depression were receiving mental health/substance use treatment at the time of injury. The likelihood of depression was lower among those who were age 85 and older compared to those were age 65–74, but higher among those who had anxiety disorder (IRR=1.50, 95% CI=1.33–1.69), history of suicidal ideation (IRR=1.22, 95% CI=1.10–1.35), history of suicide attempt (IRR=1.27, 95% CI=1.14–1.41), and bereavement problems (IRR=1.45, 95% CI=1.27–1.65). Those who had depression were less likely to have used firearms (IRR=0.85, 95% CI=0.75–0.97) but more likely to have used hanging/suffocation (IRR=1.37, 95% CI=1.13–1.67). The findings show that gun ownership was likely an important factor for firearm use. The high prevalence of depressed mood and/or depression diagnosis among older female suicide decedents at the time of their fatal injury underscores the importance of assessing depression and providing evidence-based depression treatment as an essential suicide prevention approach.
Keywords: Suicide, Depression, Anxiety disorder, Suicide attempt, Firearms, Poisoning
INTRODUCTION
Depression and Suicidality
Other Suicide Precipitants and Contributors in Late Life
Research Questions
Dalam makalah ini, dengan menggunakan data perempuan yang meninggal karena bunuh diri berusia 65 tahun ke atas, kami memeriksa: (1) prevalensi depresi (suasana hati yang tertekan sebelum melakukan bunuh diri dan/atau diagnosis depresi) pada berbagai kelompok umur dari perempuan yang meninggal lebih tua; (2) apakah mereka yang mengalami depresi berbeda dengan mereka yang tidak mengalami depresi dalam hal faktor demografi lainnya, gangguan mental, masalah penggunaan narkoba, riwayat ide dan percobaan bunuh diri, dan pemicu bunuh diri termasuk masalah kesehatan fisik, keuangan/perumahan, hubungan, dan duka; dan (3) hubungan antara metode bunuh diri yang digunakan wanita lanjut usia dengan depresi dan karakteristik lainnya.
METHODS
Data Source
NVDRS 2017–2019 menyediakan data tentang total 94.457 (74.042 laki-laki, 20.412 perempuan, dan 3 jenis kelamin tidak diketahui) orang yang meninggal karena bunuh diri, berusia 18–105 tahun pada saat kematiannya. Dari jumlah tersebut, 17.917 berusia 65 tahun ke atas (14.856 [82,9%] laki-laki, 3.061 [17,1%] perempuan). 3.061 perempuan yang meninggal lebih tua menjadi fokus penelitian ini. Penelitian ini, berdasarkan data yang tidak teridentifikasi pada individu yang meninggal, dikecualikan dari tinjauan dewan peninjau kelembagaan penulis.
Measures
Demographic variables:
Data mengenai usia saat meninggal, jenis kelamin, ras/etnis, status perkawinan, dan tingkat pendidikan diperoleh dari akta kematian dan laporan CME/LE. Dalam penelitian ini, orang yang meninggal dikategorikan ke dalam kelompok usia 65–74, 75–84, dan 85+ untuk menguji perbedaan kelompok usia, dan kelompok usia 65–74 tahun digunakan sebagai kategori referensi dalam model multivariabel. Kami juga memasukkan wilayah tempat tinggal orang yang meninggal (Timur Laut, Barat Tengah, Selatan, Barat, Puerto Riko, atau hilang) untuk mengendalikan kemungkinan perbedaan geografis dalam metode bunuh diri.
Depression:
Other mental disorders and substance use problems:
Gangguan dan sindrom mental lain yang didiagnosis yang tercantum dalam DSM-5 pada saat kematian yang diperiksa dalam penelitian ini termasuk gangguan kecemasan dan bipolar. Karena angkanya yang rendah, gangguan mental lainnya (skizofrenia, gangguan stres pasca trauma, dan demensia) tidak dimasukkan dalam penelitian ini. NVDRS juga mencatat persepsi diri sendiri atau orang lain mengenai masalah/kecanduan alkohol dan penyalahgunaan/kecanduan zat lain (misalnya, penyalahgunaan obat resep, penggunaan ganja kronis/pelecehan/bermasalah, penggunaan obat-obatan terlarang atau inhalansia lainnya), tanpa mensyaratkan bahwa masalah alkohol atau obat-obatan tersebut berkontribusi langsung terhadap kematian. Kami memasukkan pengobatan kesehatan mental atau penggunaan narkoba dalam dua bulan sebelumnya dan riwayat pengobatan tersebut hanya untuk tujuan deskriptif.
History of suicidal thoughts/plans and attempts:
In NVDRS, history of suicidal thoughts was coded “Yes,” if the decedent had at any time in her life expressed suicidal thoughts or plans. History of suicide attempts refers to any previous suicide attempts before the fatal incident, regardless of the severity and injury status.
Suicide precipitants:
Dalam NVDRS, hal ini termasuk masalah kesehatan fisik, masalah hubungan, bunuh diri/kematian keluarga/teman, dan masalah pekerjaan/keuangan/perumahan yang secara langsung berkontribusi terhadap cedera fatal. Masalah kesehatan fisik dicatat “Ya” hanya jika ada masalah kesehatan fisik yang didiagnosis atau dirasakan (misalnya, penyakit mematikan, kondisi yang melemahkan, nyeri kronis) yang relevan dengan kematian (misalnya, “putus asa atas diagnosis kanker baru-baru ini” atau “mengeluh bahwa ia tidak dapat hidup dengan rasa sakit yang terkait dengan suatu kondisi” meskipun kondisi tersebut mungkin tidak terdiagnosis atau tidak ada). Masalah hubungan mengacu pada konflik dengan pasangan intim dan/atau anggota keluarga lainnya, pertengkaran, pemicu stres keluarga lainnya, beban pengasuh, atau pelecehan yang dilakukan oleh pengasuh. Masalah duka diberi kode “Ya” jika orang yang meninggal merasa putus asa atau bereaksi terhadap tindakan bunuh diri atau kematian pasangan, anggota keluarga atau teman atau terhadap peringatan kematian/bunuh diri. Masalah pekerjaan mengacu pada kehilangan pekerjaan (dipecat atau diberhentikan) dan/atau kesulitan mencari/mempertahankan pekerjaan atau kesulitan penurunan pangkat atau konflik/stres serius di tempat kerja. Masalah keuangan mengacu pada kesulitan keuangan, misalnya kebangkrutan, hutang yang sangat besar, atau penyitaan rumah atau bisnis. Masalah perumahan mengacu pada penggusuran atau hilangnya tempat tinggal korban baru-baru ini, atau ancaman terhadap rumah tersebut. Meskipun NVDRS mengkodekan masalah pekerjaan, keuangan, dan perumahan secara terpisah, kami menggabungkannya ke dalam satu kategori (ya=1; tidak/tidak tersedia/tidak diketahui=0) dalam penelitian ini mengingat bahwa masalah-masalah ini cenderung terjadi secara berurutan (yaitu, kehilangan pekerjaan yang menyebabkan masalah keuangan dan akhirnya, hilangnya tempat tinggal).
Suicide methods:
Dalam NVDRS, metode bunuh diri diidentifikasi dari Klasifikasi Penyakit Internasional, Revisi ke-10 (ICD-10), kode untuk menyakiti diri sendiri dengan sengaja (X60-X84) untuk penyebab kematian dalam sertifikat kematian dan/atau dari deskripsi penyebab utama dalam laporan CME. Barang-barang tersebut antara lain: senjata api; gantung diri/mati lemas; keracunan obat (termasuk segala jenis overdosis obat/obat/alkohol/bahan kimia); keracunan gas (misalnya karbon monoksida, nitrogen); laserasi/alat tajam; benda tumpul; melompat dari ketinggian; kontak dengan benda bergerak (kereta api/kendaraan lain); tenggelam; dan lainnya (kebakaran, hipotermia, sengatan listrik, kelaparan, dehidrasi, tidak mematuhi atau menolak perawatan medis, atau sebab yang tidak diketahui). Kami mengklasifikasikan mereka ke dalam empat kategori dalam penelitian ini: senjata api, keracunan obat, gantung diri/mati lemas, dan segala cara lainnya.
Analysis
RESULTS
Prevalence of Depression
Table 1.
Prevalence of depression among older female suicide decedents by age group, 2017–2019 (%)
Age group differences were significant: Pearson χ2 (df=2)=50.89, p<.001
Characteristics of Decedents by Depression Status
Table 2.
Decedent’s characteristics by depression status (%)
Associations of Depression with Demographic and Other Suicide Contributors: Multivariable GLM Results
Table 3.
Asosiasi depresi dengan demografi dan karakteristik lainnya: Hasil pemodelan linier umum (N=3,061)
p<.05
p<.01
p<.001
Associations of Suicide Methods with Depression: Multivariable GLM Results
Table 4.
Associations of suicidal intent disclosure and suicide methods with depression: Generalized linear modeling results (N=3,061 for each model)
p<.05
p<.01
p<.001
DISCUSSION
Penelitian ini memiliki beberapa keterbatasan karena keterbatasan data NVDRS, termasuk ketidakpastian validitas pelaporan depresi di NVDRS dan keterbatasan generalisasi temuan di negara-negara yang tidak berpartisipasi dalam NVDRS. Pencetus dan kontributor depresi dan bunuh diri di NVDRS didasarkan pada laporan dari keluarga/teman orang yang meninggal dan informan lain dan/atau catatan bunuh diri dan tidak dapat diverifikasi secara independen. Tingkat depresi sebenarnya mungkin lebih tinggi. Beberapa anggota dalam sistem informal mungkin tidak menyadari diagnosis depresi atau suasana hati yang tertekan terutama jika mereka tidak melakukan kontak dekat. Orang yang meninggal, termasuk mereka yang tidak memiliki sistem dukungan informal, dengan kondisi depresi “tidak diketahui” atau “tidak tersedia” mungkin pernah mengalami depresi namun tidak dilaporkan mengalami depresi. Meskipun 43 negara bagian, District of Columbia, dan Puerto Riko berpartisipasi dalam NVDRS 2017-2019, beberapa negara bagian tidak menyediakan data mengenai ketiga tahun observasi dan negara bagian lainnya hanya memberikan sebagian data terbatas pada beberapa negara.
Acknowledgments
The Centers for Disease Control and Prevention (CDC) administers the National Violent Death Reporting System (NVDRS) in conjunction with participating NVDRS states. CDC provided the NVDRS Restricted Access Data used in this study to the authors. Study findings and conclusions are those of the authors alone and do not necessarily represent the official position of CDC or of the participating NVDRS states.
Funding
This work was supported by the National Institute on Aging [P30AG066614], awarded to the Center on Aging and Population Sciences at The University of Texas at Austin.
Footnotes
Conflict of Interest
None for both authors.
Ethics Statement
This study based on de-identified/deceased individuals was exempt from the authors’ Institutional Review Board’s review.
Data Availability and Acknowledgments
The Centers for Disease Control and Prevention (CDC) administers the National Violent Death Reporting System (NVDRS) in conjunction with participating NVDRS states. CDC provided the NVDRS Restricted Access Data used in this study to the authors after reviewing the authors’ data request. Study findings and conclusions are those of the authors alone and do not necessarily represent the official position of CDC or of the participating NVDRS states.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Pusat Pengendalian dan Pencegahan Penyakit (CDC) mengelola Sistem Pelaporan Kematian Akibat Kekerasan Nasional (NVDRS) bersama dengan negara-negara bagian NVDRS yang berpartisipasi. CDC memberikan Data Akses Terbatas NVDRS yang digunakan dalam penelitian ini kepada penulis setelah meninjau permintaan data penulis. Temuan dan kesimpulan penelitian adalah milik penulis sendiri dan tidak mewakili posisi resmi CDC atau negara bagian NVDRS yang berpartisipasi.
