The Mediating Role of Depressive Symptoms, Hopelessness, and Perceived Burden on the Association Between Pain Intensity and Late-Life Suicide in Rural China: A Case–Control Psychological Autopsy Study

Background: Few studies have investigated the roles of psychosocial factors such as depressive symptoms and hopelessness on the relationship between pain and suicide with inconsistent results. The study aimed to analyze the impact of pain intensity on suicide death and to estimate the degree to which depressive symptoms, hopelessness, and perceived burden may explain the association in Chinese rural elderly.Methods: Using a 1:1 matched case–control design, we collected data from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including sociodemographic characteristics, pain intensity, depression, hopelessness, perceived burden, physical diseases, and social support. Conditional logistic regression was employed to assess the association between pain intensity and completed suicide. Mediation analysis using the KHB method was applied to explore the mediation effects from depressive symptoms, hopelessness, and perceived burden.Results: The result of multivariable logistic regression showed that unemployment [odds ratio (OR) = 5.06, 95% confidence interval (CI): 1.76–14.49], higher levels of hopelessness (OR = 7.72, 95% CI: 3.49–17.10), depressive symptom (OR = 15.82, 95% CI: 4.53–55.25), and severe pain (OR = 3.46, 95% CI: 1.31–9.13) were significantly associated with elevated suicide risk in older adults in rural China. Depressive symptoms, hopelessness, and perceived burden significantly mediated 43.71% of the pain–suicide association (p = 0.020), with 17.39% due to depressive symptoms, 17.63% due to hopelessness, and 8.69% due to perceived burden.Conclusions: Regular screening of pain, depressive symptoms, hopelessness, and perceived burden using simple but sensitive questions or scales for older adults with pain is vital for the prevention and early detection of suicide risk in Chinese rural areas. Moreover, the importance of pain management and psychological interventions targeted on depressive symptoms and hopelessness should be emphasized.

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The Mediating Role of Depressive Symptoms, Hopelessness, and Perceived Burden on the Association Between Pain Intensity and Late-Life Suicide in Rural China: A Case–Control Psychological Autopsy Study

10.21203/rs.3.rs-56436/v1 ◽

2020 ◽

Author(s):

Jiali Wang ◽

Zhenyu Ma ◽

Cunxian Jia ◽

Guojun Wang ◽

Liang Zhou

Keyword(s):

Logistic Regression ◽

Depressive Symptoms ◽

Pain Intensity ◽

Suicide Risk ◽

Rural China ◽

Case Control ◽

Psychological Autopsy ◽

Mediation Effects ◽

Perceived Burden ◽

The Impact

Abstract Background: Few studies have investigated the roles of psychosocial factors such as depressive symptoms and hopelessness on the relationship between pain and suicide with inconsistent results. The study aimed to analyze the impact of pain intensity on suicide death and to estimate the degree to which depressive symptoms, hopelessness, and perceived burden may explain the association in Chinese rural elderly. Methods: Using a 1: 1 matched case-control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, pain intensity, depression, hopelessness, perceived burden, physical diseases, and social support. Conditional logistic regression was used to assess the association between pain intensity and completed suicide. Mediation analysis using the KHB method was applied to explore the mediation effects from depressive symptoms, hopelessness, and perceived burden. Results: The result of multivariable logistic regression showed that unemployment (odds ratio (OR) =5.06, 95% confidential interval (CI): 1.76- 14.49), higher levels of hopelessness (OR=7.72, 95% CI: 3.49- 17.10), depressive symptom (OR=15.82, 95% CI: 4.53- 55.25), and severe pain (OR=3.46, 95% CI: 1.31- 9.13) were significantly associated with elevated suicide risk in older people in rural China. Depressive symptoms, hopelessness, and perceived burden significantly mediated 43.71% of the pain-suicide association ( P = 0.020), with 17.39% due to depressive symptoms, 17.63% due to hopelessness, and 8.69% due to perceived burden. Conclusions: Regular screening of pain, depressive symptoms, hopelessness, and perceived burden using simple but sensitive questions or scales for older adults with pain are vital for the prevention and early detection of suicide risk in Chinese rural areas. Moreover, the importance of pain management and psychological interventions targeted on depressive symptoms and hopelessness should be emphasized.

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Loneliness, hopelessness and suicide in later life: a case–control psychological autopsy study in rural China

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020000335 ◽

2020 ◽

Vol 29 ◽

Cited By ~ 2

Author(s):

Lu Niu ◽

Cunxian Jia ◽

Zhenyu Ma ◽

Guojun Wang ◽

Bin Sun ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

Logistic Regression ◽

Depressive Symptoms ◽

Rural China ◽

Case Control ◽

Living Alone ◽

Psychological Autopsy ◽

Tree Model ◽

Elderly Suicide

Abstract Aims Loneliness is increasingly recognised as a serious public health issue worldwide. However, there is scarce research addressing the association between loneliness and suicide in older adults in rural China. We set out to examine loneliness and other psychosocial factors in elderly suicide cases and explore their interaction effects. Methods Using a 1 : 1 matched case–control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, loneliness, depression, hopelessness and social support. The chi-square automatic interaction detection (CHAID) tree model and multivariable logistic regression analysis were used to explore the relationships of these factors and suicide. Results The CHAID tree model showed that loneliness, hopelessness and depressive symptoms were closely associated with completed suicide and that loneliness and hopelessness interacted with each other. The result of multivariable logistic regression showed that individuals who were unemployed [odds ratio (OR) = 2.344; 95% confidence interval (CI): 1.233–4.457], living alone (OR = 2.176; 95% CI: 1.113–4.254), had lower levels of subjective social support (OR = 2.185; 95% CI: 1.243–3.843), experienced depressive symptoms (OR = 6.700; 95% CI: 3.405–13.182), showed higher levels of hopelessness (OR = 7.253; 95% CI: 3.764–13.974) and felt higher levels of hopelessness × higher levels of loneliness (OR = 2.446; 95% CI: 1.089–5.492) were significantly associated with an elevated suicide risk in older people in rural China. Conclusions Regular evaluation of loneliness, hopelessness and depression can help detect older adults who are at risk of committing suicide. Interventions should target social support systems, particularly among people living alone, to alleviate feelings of loneliness and hopelessness. Treating depression is also key to preventing suicide among elderly people in rural China.

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SEPARATED KIN: RURAL-URBAN MIGRATION AND MENTAL HEALTH TRAJECTORIES OF OLDER ADULTS LEFT BEHIND IN RURAL CHINA

Innovation in Aging ◽

10.1093/geroni/igz038.3223 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S880-S880

Author(s):

Zhiyong Lin

Keyword(s):

Mental Health ◽

Older Adults ◽

Depressive Symptoms ◽

Rural China ◽

Well Being ◽

Migrant Children ◽

Urban Migration ◽

Left Behind ◽

Rate Of Increase ◽

The Impact

Abstract As the processes of urbanization and globalization have intensified across the world, a burgeoning literature has documented the impact of emigration on the health of family members left behind in emigrant communities. Although the association between children’s migration and parental well-being is well documented, few have examined the health implications of children’s migration in the milieu of multiple children and further differentiated between children’s short-term and long-term migration. Therefore, I argue that it is not the geographic locality of a single child but the composition of all children’s location that matters. I further suggest that the impact of children’s migration on parental wellbeing is conditioned on the duration of children’s migration. Using a six waves longitudinal data (2001-2015) collected in rural China, this paper compares mental health (measured as depressive symptoms) trajectories of old adults (aged 60 and older) across different compositions of local and migrant children over a 14-year span. Results from growth curve models show that parents having more migrant children relative to local children experience a more rapid increase in depressive symptoms. In addition, older adults who have their most children migrate away for three or more waves of data have experienced the steepest rate of increase in depressive symptoms. These findings provide new evidence to support the life course processes of mental health disparities among older adults from the perspective of intergenerational proximity.

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Gender-specific risk for late-life suicide in rural China: a case-control psychological autopsy study

Age and Ageing ◽

10.1093/ageing/afaa036 ◽

2020 ◽

Vol 49 (4) ◽

pp. 683-687

Author(s):

Lu Niu ◽

Zhenyu Ma ◽

Cunxian Jia ◽

Liang Zhou

Keyword(s):

Risk Factors ◽

Depressive Symptoms ◽

Rural Areas ◽

Rural China ◽

Univariate Analysis ◽

Late Life ◽

Case Control ◽

Psychological Autopsy ◽

Specific Risk ◽

Gender Specific

Abstract Background despite unique gender patterns of suicide among older people in rural China, research addressing this issue is scarce. This study aims to clarify the gender-specific risk factors of late-life suicide in rural China. Methods the study included 242 persons (51% male) aged 60 and above who had committed suicide between June 2014 and September 2015 in the rural areas of three provinces of China. Using 1:1 matched case-control design, 242 living controls matched in age, gender and neighbourhood were randomly selected. Psychological autopsy interviews and psychological assessments were conducted with two informants for each suicide and living control, respectively. Results men used alcohol before suicide more than women (12.6 versus 4.7%, P < 0.05). There was no gender difference in suicide method, suicide intent and previous attempts. Univariate analysis showed that married status, mental disorder, depressive symptoms, hopelessness, impulsivity, loneliness, social support, family function and quality of life were associated with suicide in both genders. For men, other risk factors were chronic physical illness and functions of daily living. Variables remaining in the multivariable model for both men and women were depressive symptoms and hopelessness. Discussion depression and hopelessness are the two major risk factors for suicide among both older men and woman in rural China. Suicide prevention programmes focusing on depression and hopelessness in this population are indicated. Also needed are continued efforts to develop and refined gender-specialised strategies to identify high-risk individuals or groups and to enhance targeted support in the rural community.

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Physical diseases and elderly suicide in rural China: A case–control psychological autopsy study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867421998804 ◽

2021 ◽

pp. 000486742199880

Author(s):

Guojun Wang ◽

Cunxian Jia ◽

Zhenyu Ma ◽

Liang Zhou

Keyword(s):

Depressive Symptoms ◽

Mental Disorders ◽

Rural China ◽

Severity Index ◽

The Elderly ◽

Case Control ◽

Psychological Autopsy ◽

Autopsy Study ◽

Physical Diseases ◽

The Relationship

Objectives: Physical diseases are well-established risk factor for suicide, particularly among older adults. However, little is known about the underlying mechanism of the association. This study aimed to describe the prevalence of physical diseases and their influences on the elderly in rural China and to examine the underlying mechanisms of the relationship between physical diseases and suicide. Methods: This matched case–control psychological autopsy study was conducted from June 2014 to September 2015. Consecutive suicide cases (242) among people aged 60 years or above were identified in three Chinese provinces. The suicide cases were 1:1 matched with living comparisons based on age, gender and residential area. Two informants for each participant were interviewed to collect data on their demographic characteristics, the severity index of physical diseases, depressive symptoms, feelings of hopelessness, mental disorders and social support. Results: A significant difference was found between suicide cases and living comparisons regarding the prevalence of physical diseases (83.5% vs 66.5%, p < 0.001) and their severity (11.3 ± 6.2 vs 6.7 ± 5.3, p < 0.001). Independent risks of suicide included the following: not currently married (OR = 2.81, 95% CI = [1.04, 7.62]), mental disorders (OR = 7.18, 95% CI = [1.83, 28.13]), depressive symptoms (OR = 1.15, 95% CI = [1.05, 1.26]) and feelings of hopelessness (OR = 1.51, 95% CI = [1.20, 1.90]). The structural equation model indicated that the relationship between the severity index of physical diseases and suicide was mediated by depressive symptoms, feelings of hopelessness and mental disorders. Conclusion: The severity and number of physical diseases were found to be correlated with suicide among the elderly in rural China, after controlling for demographic characteristics. Physical diseases elevate one’s suicide risk by increasing depressive symptoms, feelings of hopelessness and mental disorders. Efforts for suicide prevention should be integrated with strategies to treat physical diseases along with psychological interventions.

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The Impact of Work Hours on Depressive Symptoms among Koreans Aged 45 and Over

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18030853 ◽

2021 ◽

Vol 18 (3) ◽

pp. 853

Author(s):

Juyeong Kim ◽

Eun-Cheol Park

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Social Services ◽

Depression Scale ◽

Epidemiological Studies ◽

Work Hours ◽

Middle Aged ◽

Health Studies ◽

Males And Females ◽

The Impact

Background: Given the documented importance of employment for middle-aged and older adults’ mental health, studies of the association between their number of work hours and depressive symptoms are needed. Objectives: To examine the association between the number of work hours and depressive symptoms in Korean aged 45 and over. Methods: We used data from the first wave to fourth wave of the Korea Longitudinal Study of Aging. Using the first wave at baseline, data included 9845 individuals. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale. We performed a longitudinal analysis to estimate the prevalence of depressive symptoms by work hours. Results: Both unemployed males and females aged 45–65 years were associated with higher depressive symptoms (β = 0.59, p < 0.001; β = 0.32, p < 0.001). Females working ≥ 69 h were associated with higher depressive symptoms compared to those working 41–68 h (β = 0.25, p = 0.013). Among those both middle-aged and older adults, both males and females unemployed were associated with higher depressive symptoms. Those middle-aged female working ≥69 h were associated with higher depressive symptoms. Conclusions: An increase in depressive symptoms was associated with unemployed males and females working ≥69 h compared to those working 41–68 h. Although this association was found among middle-aged individuals, a decrease in depressive symptoms in both sexes was associated with working 1–40 h. Depressive symptoms should decrease by implementing employment policies and social services to encourage employers to support middle-aged and older adults in the workforce considering their sex and age differences.

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Loving Others: The Impact of Compassionate Love on Later-Life Psychological Well-Being

Innovation in Aging ◽

10.1093/geroni/igaa057.1554 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 480-481

Author(s):

Eva Kahana ◽

Tirth Bhatta ◽

Boaz Kahana ◽

Nirmala Lekhak

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Negative Affect ◽

Positive Affect ◽

Emotional Support ◽

Later Life ◽

Well Being ◽

Psychological Well Being ◽

Compassionate Love ◽

The Impact

Abstract Existing scholarship in social gerontology has surprisingly paid little attention to broader loving emotions, such as compassionate and altruistic love, as potentially meaningful mechanisms for improving later life psychological well-being. This study examined the influence of feeling love toward other persons and experiencing love from others on later life psychological well-being. We conducted a 3-wave longitudinal study of a representative sample of 340 ethnically heterogeneous community dwelling older residents of Miami, Florida. The increase in feeling of being loved (β=-1.53, p<0.001) and love for others (β=-1.43, p<0.001) led to decline in odds of reporting greater level of depressive symptoms over time. The odds of reporting higher level of positive affect were significantly greater for older adults who reported feeling loved by others (β=1.16, p<0.001) and expressed love for other people (β=1.18, p<0.01). Older adults who felt loved had 0.92-point lower ordered log odds of reporting higher negative affect than those who reported lower level of love. The impact of compassionate love on depressive symptoms and negative affect remained statistically significant even after adjustment for altruistic attitudes and emotional support. The influence of loving emotions on positive affect was, however, explained by altruistic attitudes and emotional support. Our findings underscore the powerful influence of both receiving and giving love for the maintenance of later life psychological well-being. We offer support for the expectation that love is a significant force in the lives of older adults that transcends intimate relationships.

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The associations between family characteristics and depressive symptoms in older adults: a community-based survey in rural China

International Psychogeriatrics ◽

10.1017/s1041610211002663 ◽

2012 ◽

Vol 24 (8) ◽

pp. 1226-1234 ◽

Cited By ~ 5

Author(s):

Yanhong Gong ◽

Xiaopiao Wen ◽

Chaoping Guan ◽

Zhiqing Wang ◽

Yuan Liang

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Life Events ◽

Rural China ◽

Economic Status ◽

Negative Life Events ◽

Family Members ◽

Family Characteristics ◽

Negative Life Event ◽

The Past

ABSTRACTBackground: The aim of the current study was to investigate the associations between family characteristics and depressive symptoms, and provide new evidence and recommendations for prevention and intervention in the depressive symptoms of older adults.Methods: The study was a cross-sectional survey conducted door-to-door, utilizing a sample of 1,317 individuals aged 60 years and above in rural China. The five family characteristic variables recorded were: living with spouse, living with descendant, support of family members, self-reported family economic status in the previous year, and family-related negative life events that occurred anytime in the past with a continuous psychological effect during the past 12 months. Gender, age, years of schooling, and self-rated physical health status were taken as potential confounders. Univariable and multivariable logistic regression models were used to examine independent effects on depressive symptoms.Results: In addition to the potential confounders, only family-related negative life events, support of family members, and self-reported family economic status had significant effects on depressive symptoms in older adults. Experiencing a family-related negative life event was the most significant variable (OR = 11.70, 95% CI: 7.72–17.73), the second was support of family members (OR = 6.93, 95% CI: 3.26–14.70), while family economic status was less important than support of family members (OR = 2.38, 95% CI: 1.08–5.25).Conclusion: This study, from the perspective of family characteristics on depressive symptoms in older adults, showed a strong correlation between being exposed to harmful family environments and depressive symptoms among the elderly. Efforts to address family risk factors and strengthen family cohesiveness deserve a higher priority, given the importance of these factors, compared with other efforts such as promoting economic development.

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Assessing the Impact of a Hilly Environment on Depressive Symptoms among Community-Dwelling Older Adults in Japan: A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094520 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4520

Author(s):

Takafumi Abe ◽

Kenta Okuyama ◽

Tsuyoshi Hamano ◽

Miwako Takeda ◽

Masayuki Yamasaki ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Depression Scale ◽

Cross Sectional Study ◽

Community Dwelling ◽

Rural Setting ◽

Sectional Study ◽

Cross Sectional ◽

The Impact ◽

Community Dwelling Older Adults

Although some neighborhood environmental factors have been found to affect depressive symptoms, few studies have focused on the impact of living in a hilly environment, i.e., land slope, on depressive symptoms among rural older adults. This cross-sectional study aimed to investigate whether a land slope is associated with depressive symptoms among older adults living in rural areas. Data were collected from 935 participants, aged 65 years and older, who lived in Shimane prefecture, Japan. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale (SDS) and defined on the basis of an SDS score ≥ 40. Land slopes within a 400 m network buffer were assessed using geographic information systems. Odds ratios (ORs) with 95% confidence intervals (CIs) of depressive symptoms were estimated using logistic regression. A total of 215 (23.0%) participants reported depressive symptoms. The land slope was positively associated with depressive symptoms (OR = 1.04; 95% CI = 1.01–1.08) after adjusting for all confounders. In a rural setting, living in a hillier environment was associated with depressive symptoms among community-dwelling older adults in Japan.

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515-P: The Impact of COVID-19 Worries on Diabetes Distress and Depressive Symptoms in Older Adults with Type 2 Diabetes

Diabetes ◽

10.2337/db21-515-p ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 515-P

Author(s):

MIN JUNG KIM ◽

CHANG G. PARK ◽

CYNTHIA FRITSCHI

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Depressive Symptoms ◽

Diabetes Distress ◽

The Impact

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