ImportanceSuicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies.ObjectiveTo identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts.Design, Setting, and ParticipantsThis cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023.ExposuresSuicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods.Main Outcomes and MeasuresDisclosure of recent intent, suicide note presence, and known psychotropic usage.ResultsAmong 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]).Conclusions and RelevanceThis study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.

中文翻译：

---

使用潜在类别分析解码自杀者的概况和自杀意图的迹象

重要性从 2001 年到 2021 年，美国的自杀率增加了 35.6%。鉴于大多数人在第一次尝试时就死亡，早期发现和干预至关重要。了解可改变的风险因素是有效预防策略的关键。目的识别不同的自杀概况或类别、自杀意图的相关迹象以及有针对性的预防工作的可改变风险的模式。设计、设置和参与者这项横断面研究使用了 2003 年的数据-2020 年国家暴力死亡报告系统限制访问数据库，包含 306 800 名自杀死者。统计分析于 2022 年 7 月至 2023 年 6 月进行。暴露使用自杀情况、毒理学和方法的现有数据的潜在类别分析来确定自杀死者概况。主要结果和措施披露近期意图、遗书存在和已知的精神药物用途。结果306 800 名自杀者（平均 [SD] 年龄，46.3 [18.4] 岁；239 627 名男性 [78.1%] 和 67 108 名女性 [21.9%]）确定了 5 个概况或类别。最大的班级，即 4 班（97 175 [31.7%]），主要面临身体健康挑战，其次是 5 班（58 803 [19.2%]）中的多物质问题，以及危机、酒精相关问题和亲密伴侣问题。 3（55 367 [18.0%]）、心理健康问题（2 类，53 928 [17.6%]）以及共病心理健康和物质使用障碍（1 类，41 527 [13.5%]）。 4 级的透露自杀意图（13 952 [14.4%]）和留下遗书（24 351 [25.1%]）的比率最低。调整协变量后，与 1 级相比，4 级不透露自杀意图的几率最高（比值比 [OR]，2.58；95% CI，2.51-2.66）和不留下遗书（OR，1.45；95%） CI，1.41-1.49）。在所有自杀概况中，4 级的所有已知精神疾病和精神药物的发生率也是最低的。第 4 类有更多老年人（23 794 人年龄在 55-70 岁[24.5%]；20 100 人年龄≥71 岁[20.7%]）、退伍军人（22 220 人[22.9%]）、寡妇（8633 人[8.9%]） 、高中以下教育程度的个人（15 690 [16.1%]）和农村居民（23 966 [24.7%]）。结论和相关性本研究确定了 5 种不同的自杀倾向，强调需要制定量身定制的预防策略。改善对共存心理健康状况、物质和酒精使用障碍以及身体疾病的检测和治疗至关重要。实施手段限制策略在降低大多数人群的自杀风险方面发挥着至关重要的作用，因此更加需要采取多方面的方法来预防自杀。