Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community?

A systematic review of psychosocial protective factors against suicide and suicidality among older adults

BACKGROUND

Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults.

METHOD

First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis.

RESULTS

A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures.

CONCLUSION

Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.

Friendly visiting by a volunteer for reducing loneliness or social isolation in older adults: A systematic review

Background

Loneliness and social isolation are currently among the most challenging social issues. Given their detrimental impact on physical and mental health, identifying feasible and sustainable interventions to alleviate them is highly important. Friendly visiting, a befriending intervention whereby older persons are matched with someone who visits them on a regular basis, seems promising. However, it is unclear if face-to-face (F2F) friendly visiting by a volunteer (FVV) is effective at reducing loneliness or social isolation, or both.

Objectives

To assess the effect of F2F FVV on feelings of loneliness, social isolation (primary outcomes) and wellbeing (i.e., life satisfaction, depressive symptom experiencing and mental health; secondary outcomes) in older adults.

Search Methods

We searched six electronic databases up until 11 August 2021. We also consulted 15 other resources, including grey literature sources and websites of organizations devoted to loneliness and ageing, between 25 October and 29 November 2021.

Selection Criteria

We included experimental and observational studies that quantitatively measured the effect of F2F FVV, compared to no friendly visiting, on at least one of following outcomes in older adults (≥60 years of age): loneliness, social isolation or wellbeing.

Data Collection and Analysis

Two reviewers independently performed study selection, data extraction and synthesis, risk of bias and GRADE assessment. If outcomes were measured multiple times, we extracted data for one short-term (≤1 month after the intervention had ended), one intermediate-term (>1 and ≤6 months), and one long-term time point (>6 months). Data from randomized controlled trials (RCTs) and non-RCTs were presented and synthesized separately. Synthesis was done using vote counting based on the direction of effect.

Main Results

Nine RCTs and four non-RCTs, conducted primarily in the United States and involving a total of 470 older adults (mean or median ages: 72-83 years), were included. All studies were limited in size (20-88 participants each). Programmes lasted 6-12 weeks and mostly involved weekly visits by undergraduate students to community-dwelling older adults. Visits consisted mainly of casual conversation, but sometimes involved gameplaying and TV-watching. All studies had major shortcomings in design and execution. The current evidence about the effect of F2F FVV on loneliness in older adults is very uncertain, both in the short (one RCT in 88, and one non-RCT in 35 participants) and intermediate term (one RCT in 86 participants) (both very low-certainty evidence). The same goes for the effects on social isolation, again both in the short (one RCT in 88, and two non-RCTs in 46 participants) and intermediate term (two non-RCTs in 99 participants) (both very low-certainty evidence). Similarly, there is a lot of uncertainty about the effect of F2F FVV on outcomes related to wellbeing (all very low-certainty evidence).

Authors’ Conclusions

Due to the very low-certainty evidence, we are unsure about the effectiveness of F2F FVV with regard to improving loneliness, social isolation, or wellbeing in older adults. Decision-makers considering implementing FVV should take into account this uncertainty. More and larger high-quality studies that are better designed and executed, and preferably conducted in various settings, are needed.

Factors associated with the perceived need for assistance from voluntary services in home-based older adults in Chinese urban areas: a cross-sectional study

BACKGROUND

With China's rapidly aging population, meeting the diverse care needs of senior citizens is becoming more challenging. Although voluntary social services have numerous advantages and are popular among older adults, there is little information on the need for assistance from volunteer-based social services, particularly those with a medical background, and influencing factors among urban home-based older adults. This study aimed to assess the need for assistance from voluntary services and related factors among urban home-based older adults in China.

METHODS

A cross-sectional study was conducted in 2022 on communities in four cities in China. The 27-item Home-Based Older Adults Assistance Need Scale was used to measure the assistance needs of 498 participants aged 60 and above. Multiple linear regression models were conducted to identify salient variables associated with the need for assistance from voluntary services.

RESULTS

The mean score of the need for assistance from voluntary services was 88.60 ± 24.37. The mean scores of the items examining four dimensions, namely, health maintenance, visiting communication, social intercourse, and daily life, were 3.64 ± 1.08, 3.49 ± 1.04, 3.33 ± 1.08, and 2.78 ± 1.08, respectively. The level of depression, willingness to assist older adults, attaching importance to health preservation, ability to self-comfort, desire to accept assistance from others, and the presence of more children or none at all were all positively correlated with the perceived need for assistance from voluntary services. In contrast, social care obtained from visiting medical institutions was negatively correlated. These seven factors explained 28.5% of the total variance.

CONCLUSIONS

Urban home-based older adults in China were found to have significant requirements for assistance from volunteer services, and several complex factors were associated with more significant assistance needs. These findings may encourage the extremely limited numbers of social volunteers, particularly those with a medical background, to identify priorities in providing assistance services to the large numbers of urban home-based older adults and thus improve service delivery.

Peer-based interventions targeting suicide prevention: A scoping review

Peers of individuals at risk for suicide may be able to play important roles in suicide prevention. The aim of the current study is to conduct a scoping review to characterize the breadth of peer-delivered suicide prevention services and their outcomes to inform future service delivery and research. Articles were selected based on search terms related to peers, suicide, or crisis. After reviews of identified abstracts (N = 2681), selected full-text articles (N = 286), and additional references (N = 62), a total of 84 articles were retained for the final review sample. Types of suicide prevention services delivered by peers included being a gatekeeper, on-demand crisis support, crisis support in acute care settings, and crisis or relapse prevention. Peer relationships employed in suicide prevention services included fellow laypersons; members of the same sociodemographic subgroup (e.g., racial minority), workplace, or institution (e.g., university, correctional facility); and the shared experience of having a mental condition. The majority of published studies were program descriptions or uncontrolled trials, with only three of 84 articles qualifying as randomized controlled trials. Despite a lack of methodological rigor in identified studies, peer support interventions for suicide prevention have been implemented utilizing a diverse range of peer provider types and functions. New and existing peer-delivered suicide prevention services should incorporate more rigorous evaluation methods regarding acceptability and effectiveness.

The applicability of the interpersonal-psychological theory of suicide among community-dwelling older persons

INTRODUCTION

This study examined the application of the interpersonal-psychological theory of suicide to community-dwelling older persons in South Korea.

METHODS

A cross-sectional study design was used. The data were collected by surveying 200 older persons (117 female, 83 male) aged over 65 years at welfare centers for older persons. The Interpersonal Needs Questionnaire, the Suicidal Ideation Scale, and the Acquired Capability for Suicide Scale were used to assess participants' thwarted belongingness, perceived burdensomeness, suicidal ideation, attempts, and the capability for suicide. Structural equation modeling was used to examine the fitness of a model based on the interpersonal-psychological theory of suicide. This theory described that perceived burdensomeness and thwarted belongingness lead to suicidal ideation, which is transformed into suicide attempts through an acquired capability for suicide.

RESULTS

Perceived burdensomeness was significantly associated with suicidal ideation among older persons, whereas thwarted belongingness was not. Furthermore, suicidal ideation influenced suicide attempts. The acquired capability for suicide moderated the relationship between suicidal ideation and suicide attempts.

CONCLUSIONS

To prevent suicidal ideation and suicide attempts among older persons, it is important to prevent them from feeling that they are a burden.

Risk factors for suicidal ideation among the older people living alone in rural region of China: A path analysis

In China, suicide accounts for twenty-six percent of all suicides worldwide; however, researches on the suicidal ideation among older people living alone in the rural region are few. We performed a cross-sectional study to explore the prevalence and influence factors of suicidal ideation, and provide a theoretical basis for suicide prevention among older people living alone in rural region.695 older people living alone in rural region were selected by using stratified cluster sampling. Chi-square for categorical variables, T-test for continuous variables, and path analysis were conducted to statistical analysis.The prevalence of suicidal ideation among the elderly living alone in rural China was 23.6%. Path analyses showed that depression had the most substantial influence on suicidal ideation among the elderly living alone, it was also as a mediator between physical, economic status, social support, anxiety, and suicidal ideation; anxiety and social support had both direct and indirect influence on suicidal ideation; physical status and economic status had indirection impact.The incidence of suicidal ideation among the elderly living alone was high in Dangtu county. Psychological disorders (anxiety and depression) had the strongest impact on suicidal ideation. Strategies and measures targeting these relevant factors (economic status, physical status, and social support) should be taken to reduce the burdens of suicidal ideation among the elderly living alone in China.

A Cross-Sectional Study of the Prevalence of and Risk Factors for Suicidal Ideation Among the Elderly in Nursing Homes in Hunan Province, China

Our study aims to explore the risk factors for suicidal ideation and their interaction among the elderly in nursing homes in Hunan province, China. A cross-sectional study was conducted among the elderly in nursing homes in Hunan Province. Twenty-four nursing homes were selected by multistage cluster random sampling, and 817 elderly residents were investigated using a set of structured questionnaires. The main outcome measures included general information, suicidal ideation, depression symptoms, social support, activities of daily living (ADL), stressful life events, and sleep quality. Multivariate binary logistic regression was performed to explore the risk factors for suicidal ideation among the elderly in nursing homes, and additive interaction was used to analyze the interaction between risk factors. The prevalence of suicidal ideation among the elderly in nursing homes in Hunan province was 17.9% (95% confidence interval(CI): 15.2%, 20.6%). Living in a rural area (odds ratio(OR)=1.88, 95% CI: 1.03, 3.44), infrequent visits from relatives (OR=2.61, 95% CI: 1.42, 4.78), history of chronic disease (OR=2.34, 95% CI: 1.09, 5.01), depression symptoms (OR=8.11, 95% CI: 4.52, 14.54), lower social support (OR=3.85, 95% CI: 1.94, 7.61), and ADL disability status (OR=4.38, 95% CI: 2.10, 9.14) increased the risk of suicidal ideation. Additive interactions were detected between depression symptoms and ADL status, with a relative excess risk due to interaction (RERI) of 8.73 (95% CI: 2.04, 15.43), and between depression symptoms and social support, with an RERI of 5.98 (95% CI: 0.86, 11.10). The prevalence of suicidal ideation among the elderly in nursing homes is relatively high. Both physical conditions and psychosocial factors were associated with suicidal ideation among the elderly. These findings have significant implications for the prediction and prevention of suicidal behaviors.

The association between emotional and instrumental social support and risk of suicide death: A population-based cohort study

Suicide is an important public health issue and previous studies have suggested that social support can one preventive factor. However, the association between emotional and instrumental social support and suicide death has not been investigated in detail. The purpose of this study was to investigate the association between each type of social support and suicide death based on a population-based cohort study. We analyzed follow-up data for 47,223 subjects (aged ≥40 y) participating in a community-based, prospective cohort study. At the baseline, the subjects were asked five questions about social support. The end point of the study was suicide mortality, based on data from the National Vital Statistics. The Cox model was used to estimate the multivariate-adjusted hazard ratios of suicide death. In addition, stratified analysis was conducted to test the interaction of each type of social support with gender (male/female) and age (<65/≥65 y) separately. Among 320,880 person-years of follow-up, 90 cases of suicide death were documented. There were significant association between instrumental social support and lower risk of suicide death, and the hazard ratio was 0.60 (95% CI: 0.38-0.94). Emotional social support was also associated with a lower risk of suicide death, but not to a significant degree, and the hazard ratio was 0.70 (95% CI: 0.42-1.17). It is suggested that instrumental social support was significantly associated with a lower risk of suicide death, and emotional social support tended to be associated with a lower risk of suicide death.

Impact of support agreement between municipalities and convenience store chain companies on store staff's support activities for older adults

In the continuously aging society, private sectors are expected to play a role in older adult care. Implementing an agreement between municipalities and private sectors is one of the key mechanisms for encouraging private sectors to participate in supporting older adults. The study's aim was to evaluate whether the support agreement has promoted support activities by convenience store staff for older adults. A retrospective observational study was conducted between 2013 and 2016 using data from a nationwide survey of convenience stores. The municipality-level matching produced 168 municipality pairs, with 2242 convenience stores that entered into a support agreement with municipalities from 2014 to 2015, and 2141 stores without such an agreement. Convenience store-level logistic regression analysis evaluated the impact of the agreement on staff activities. The analysis showed that some staff activities increased significantly with the support agreement, such as corresponding or collaborating with community support centers (AOR = 3.40; 95% CI: 2.22 to 5.26), participating in role-playing programs for older adult care (AOR = 2.05; 95% CI: 1.01 to 4.26), and attending dementia support lectures (AOR = 18.21; 95% CI: 8.27 to 45.34). Emergency protection for older adults did not increase with the support agreement. The results suggest that the support agreement positively influenced some convenience store staff's support activities for older adults.

Prevalence of Suicidal Ideation and Its Association with Positive Affect in Working Women: A Day Reconstruction Study

The suicide rate for females in China is the second highest worldwide, and China is the only country in the world in which the rate of suicides is higher for women than men. Affective instability has been shown to be a strong predictor of suicidal ideation, particularly among women. However, prior research has mainly focused on the impact of women's negative affect on suicidal ideation, ignoring the influence of positive affect on suicidal ideation. Studies have revealed that hopelessness, which is 1.3 times more important than depression for explaining suicidal ideation, is driven more by low levels of positive affect than by high levels of negative affect. Although positive affect has also been found to be related to suicidal ideation, and it demonstrates independent, beneficial effects on mental health, much remains to be learned about the association between positive affective instability and suicidal ideation. Therefore, we investigated the prevalence of suicidal ideation among Chinese working women and explored the differences between working women with and without suicidal ideation in the intensity and daily variability of positive affect. A total of 222 young working women of ages 22–36 years (M = 27.64, SD = 3.73) were recruited from a free weekend psychology lecture. The women subsequently completed a daily diary Day Reconstruction Method (DRM) as well as a suicidal ideation questionnaire. We used hierarchical linear modeling (HLM) to analyze the data, and the results showed that: (1) 10.81% of participates reported suicidal ideation, the intensity of positive affect (happiness, warmth/friendliness, interest and relaxation/calmness) was significantly lower for women with suicidal ideation compared to women without suicidal ideation; (2) differing diurnal patterns of positive emotions were observed between women with and without suicidal ideation; women with suicidal ideation demonstrated a significantly lower trend of growth and a higher volatility in happiness, warmth/friendliness, relaxation/calmness. Given that lower intensity of positive affect and greater affective instability significantly predicted suicidal ideation in Chinese women, researchers should pay more attention to the role of positive affect in female suicide prevention research and intervention efforts in the future.

Social Capital and Suicidal Ideation in Community-Dwelling Older Residents: A Multilevel Analysis of 10,094 Subjects in Japan

OBJECTIVE

Social capital, the collective resources of groups including perceptions of trust and reciprocity, is recognized as an important contributor to suicide. We examined the association of individual- and community-level social capital with suicidal ideation after adjusting for social support among older adults living in the community.

METHODS

In August 2010 we sent questionnaires to all residents aged 65 years and older living in 3 rural municipalities (N = 21,232) in Okayama Prefecture, Japan; 13,919 questionnaires were returned (response rate: 65.6%). The final analysis included 10,094 participants. The outcome variable was suicidal ideation. Exposure variables were individual-level mistrust and lack of reciprocity (level 1), and the aggregated responses of these variables from 35 communities in the municipalities (level 2). Covariates included age, sex, educational attainment, marital status, the number of cohabitants, years of residence, self-rated socioeconomic status, disability, social support, and psychological distress. Multilevel logistic regression analysis was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

After adjusting for social support and psychological distress, we found that mistrust and lack of reciprocity were only associated with suicidal ideation at the individual level. Stratified analysis showed that among subjects with psychological distress, mistrust was associated with suicidal ideation at individual (OR: 1.88; 95% CI: 1.42-2.51) and community levels (OR: 1.98; 95% CI: 1.02-3.81).

CONCLUSIONS

Our findings show that individual- and community-level social capital is a possible protective factor for suicidal ideation, particularly for people with psychological distress.

Home visits by commissioned welfare volunteers and psychological distress: a population-based study of 11,312 community-dwelling older people in Japan

OBJECTIVE

Novel countermeasures to increase healthcare expenditures should be explored in rapidly aging societies, including Japan. Social support is a resource for the older people that effectively reduces psychological distress, with or without specialized health service provision. This cross-sectional study was conducted to determine whether home visits by commissioned welfare volunteers (organizations of community residents assigned by national or local governments) are associated with a lower risk of psychological distress among the older people.

METHODS

Questionnaires were sent in August 2010 to all residents aged ≥65 years in three municipalities (n = 21,232) in Okayama Prefecture in Japan; 13,929 were returned (response rate = 65.6%). The final sample size for the analysis was 11,312 participants. Home visits, psychological distress (Kessler Psychological Distress Scale: K6 > 5), and severe psychological distress (K6 > 13) were measured by the questionnaire. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for psychological distress, adjusting for age, gender, education, marital status, and qualification for long-term care insurance.

RESULTS

The prevalence was 41.4% for psychological distress and 6.5% for severe psychological distress among all participants. Home visits were significantly associated with a lower risk of psychological distress after adjusting for the covariates (OR: 0.71, 95% CI: 0.65-0.77). These associations were comparable for men and women. The association was clearer for severe psychological distress (OR: 0.51, 95% CI: 0.43-0.61).

CONCLUSIONS

Home visits by commissioned welfare volunteers are significantly associated with a lower risk of psychological distress among older people.

Community-Level Social Capital and Psychological Distress among the Elderly in Japan: A Population-Based Study

Despite accumulating evidence, previous studies have not clearly separated the contribution of community-level social capital on mental health from that of individual-level social support. We examined the association between community-level social capital and psychological distress in a sample of older Japanese individuals, taking into account the effects of individual-level social capital and social support. We collected data via a cross-sectional survey among all residents aged ≥65 in three rural municipalities in Okayama Prefecture. We measured two components of social capital in the questionnaire: perceptions of trust and reciprocity in the community. Community-level social capital was obtained by aggregating individual responses and calculating the proportion of subjects reporting mistrust and lack of reciprocity. Psychological distress was assessed by the Kessler Psychological Distress scale. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for psychological distress using two-level Poisson regression models (9,761 individuals nested within 35 communities). The prevalence of psychological distress was 39.8%. Low community-level social capital was associated with psychological distress, even after controlling for individual-level social support, age, sex, educational attainment, frequency of alcohol consumption, smoking status, body mass index, marital status, socioeconomic status, and number of cohabiters. The adjusted RRs per 10% increase of the proportion of mistrust and lack of reciprocity in the communities were 1.23 (95% CI: 1.01–1.51) and 1.12 (95% CI: 1.02–1.24), respectively. Lower levels of community-level social capital are associated with psychological distress among the Japanese elderly population, even after adjusting for individual-level perceptions of social capital and social support.

Group involvement and self-rated health among the Japanese elderly: an examination of bonding and bridging social capital

Background

To date, only a small amount of research on bonding/bridging social capital has separately examined their effects on health though they have been thought to have differential effects on health outcomes. By using a large population-based sample of elderly Japanese people, we sought to investigate the association between bonding and bridging social capital and self-rated health for men and women separately.

Methods

In August 2010, questionnaires were sent to all residents aged ≥65 years in three municipalities in Okayama prefecture (n = 21232), and 13929 questionnaires were returned (response rate: 65.6%). Social capital was measured from survey responses to questions on participation in six different types of groups: a) the elderly club or sports/hobby/culture circle; b) alumni association; c) political campaign club; d) citizen’s group or environmental preservation activity; e) community association; and f) religious organization. Participant perception of group homogeneity (gender, age, and previous occupation) was used to divide social capital into bonding or bridging. Odds ratios (ORs) and 95% confidence intervals (CIs) for poor self-rated health were calculated.

Results

A total of 11146 subjects (4441 men and 6705 women) were available for the analysis. Among men, bonding and bridging social capital were inversely associated with poor self-rated health (high bonding social capital; OR: 0.55, 95% CI: 0.31–0.99; high bridging social capital; OR: 0.62, 95% CI: 0.48–0.81) after adjusting for age, educational attainment, smoking status, frequency of alcohol consumption, overweight, living arrangements, and type-D personality. The beneficial effect among women was more likely limited to bonding social capital (high bonding social capital; OR: 0.34, 95% CI: 0.12–1.00), and the association between bridging social capital and self-rated health was less clear (high bridging social capital; OR: 0.69, 95% CI: 0.44–1.07).

Conclusions

Bonding/bridging social capital could have differential associations with self-rated health among the Japanese elderly depending on the individual’s sex. Considering the lack of consensus on how to measure bonding and bridging social capital, however, we need to carefully assess the generalizability of our findings. Further research is warranted to identify health-relevant dimensions of social capital in different cultural or economic settings.