Suicide among older people in relation to their subjective and objective well-being in different European regions

Association of family function and suicide risk in teenagers with a history of self-harm behaviors: mediating role of subjective wellbeing and depression

Background

A history of self-harm behaviors is closely associated with subsequent suicide death. Although many factors associated with suicide have been identified, it remains unclear how these factors interact to influence suicide risk, especially among teenagers with a history of self-harm behaviors.

Methods

Data were collected from 913 teenagers with a history of self-harm behaviors through a cross-sectional study. The Family Adaptation, Partnership, Growth, Affection, and Resolve index was used to assess teenagers' family function. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 were used to evaluate depression and anxiety in teenagers and their parents, respectively. The Delighted Terrible Faces Scale was used to assess teenagers' perception of subjective wellbeing. The Suicidal Behaviors Questionnaire-Revised was used to evaluate teenagers' suicide risk. Student's t-test, one-way ANOVA, multivariate linear regression, Pearson's correlation, and a structural equation model (SEM) were applied to data analysis.

Results

Overall, 78.6% of teenagers with a history of self-harm behaviors were at risk for possible suicide. Female gender, severity of teenagers' depression, family function, and subjective wellbeing were significantly associated with suicide risk. The results of SEM suggested that there was a significant chain mediation effect of subjective wellbeing and depression between family function and suicide risk.

Conclusion

Family function was closely associated with suicide risk in teenagers with a history of self-harm behaviors, and depression and subjective wellbeing were sequential mediators in the association between family function and suicide risk.

The association between nation-level social and economic indices and suicide rates: A pilot study

Ever since the pioneering work of Emile Durkheim, it has been known that regional or national suicide rates can be influenced by a variety of social and economic factors. Recent research has found a robust association between two country-level economic indices-gross national product and unemployment rate-and suicide rates, particularly in men. However, the association between other country-level social indices-such as measures of social integration, inequality, environmental preservation and political freedom-and suicide rates has not been studied at the cross-national level. In the current study, national suicide rates for men and women were examined in relation to seven indices measuring subjective wellbeing, sustainable development, type of political regime, economic and gender inequality, and social capital. It was found that the Happy Planet Index, a composite measure of subjective wellbeing and sustainable development, was negatively associated with suicide rates independent of gender, and even after adjusting for possible confounding factors. Economic inequality was associated with suicide in men, and social capital was associated with suicide in women. Moreover, the strength and direction of the associations observed between socioeconomic indices and suicide varied across income groups. These results highlight the need for a closer evaluation of the link between large-scale ("macro") social factors and individual ("micro") psychological factors, as well as the importance of integrating these factors into suicide prevention programmes at the national level.

The relationship between physical exercise and subjective well-being in Chinese older people: The mediating role of the sense of meaning in life and self-esteem

PURPOSE

This study explores the relationship between physical exercise and older people's subjective well-being and the mediating role of a sense of meaning in life and self-esteem by using a structural equation modeling (SEM) approach, in order to provide some suggestions for improving older people's subjective well-being.

METHODS

In this study, a cross-sectional survey was conducted offline using a simple random method of collection, and the Physical Activity Rating Scale (PARS-3), the Subjective Well-being Scale (SWB), the Meaningfulness of Life Scale (MLQ), and the Self-Esteem Scale (SES) were applied to 419 older adults who participated in physical exercise from Chengdu (Qingyang District, Wuhou District, and Chenghua District), Sichuan Province, China, with the voluntary participation of the subjects. 197 males and 222 females, with a mean age of 72.49 (SD = 1.57). The study used SPSS 25.0 and Process 3.5 plug-in for statistical processing of the data, Cronbach's alpha coefficient for intra-variate consistency testing, Harman's one-way test for common method bias testing and multiple covariance diagnosis, and finally regression analysis and Bootstrap sampling test for significance of mediating effects.

RESULTS

Physical exercise was able to have a positive effect on the level of subjective well-being of older adults (β = 0.0305; 95% confidence interval (CI): 0.0226, 0.0384; p < 0.05), and a mediation analysis of sense of meaning in life and self-esteem revealed that they were able to have independent and chained mediation effects, with four pathways: first, physical exercise directly affected subjective well-being of older adults (β = 0.0149; 95% CI: 0.0072, 0.0226; p < 0.05; β = 0.0149; 95% CI: 0.0072, 0.0226; p < 0.05); secondly, sense of meaning in life mediated the relationship between physical exercise and subjective well-being of older adults (β = 0.0075; 95% CI: 0.0041, 0.0115; p < 0.05); thirdly, self-esteem mediated the relationship between physical exercise and subjective well-being of older adults (β = 0.0075; 95% CI: 0.0041, 0.0115; p < 0.05). (β = 0.0061; 95% CI: 0.0034, 0.0094; p < 0.05); fourth, a chain mediating effect of sense of meaning in life and self-esteem in the relationship between physical exercise and subjective well-being in older adults (β = 0.0021; 95% CI: 0.0010, 0.0035; p < 0.05).

CONCLUSION AND PROSPECTS

As indicated by the results, physical exercise can enhance the subjective well-being of older adults through sense of meaning in life and self-esteem, therefore, in order to be able to enhance the subjective well-being of older adults, enhancing the level of sense of meaning in life and self-esteem of older adults is an effective means.

Suicide among Older People in Different European Welfare Regimes: Does Economic (in)Security Have Implications for Suicide Prevention?

Older adult suicide rates vary widely within Europe, and differential welfare policies might contribute to this. We studied variations in economic indicators and suicide rates of people 65+ across 28 European countries and examined the effects of these indicators on suicide rates, grouping countries according to their socio-political systems and welfare regimes. Suicide data was obtained from the WHO European Mortality Database. The European Union Statistics on Income and Living Conditions and the European Union Labour Force Survey provided data on economic indicators. Linear mixed models were applied. Suicide rates ranged from 4.22/100,000 (Cyprus) to 36.37/100,000 (Hungary). Material deprivation was related to elevated suicide rates in both genders in the pooled data set and in men but not women in the Continental and Island countries. Higher ratio of median income (65+/under 65) was associated with lower likelihood of suicide in women in the South-Eastern European countries. In the Nordic region, the 65+ employment rate was associated with a decreased likelihood of suicide in men. These factors to some extent show economic insecurity against older people, which influences the likelihood of suicide. Active labor market policies and inclusive social environment may contribute to suicide prevention in this age group.

Exploring life and help-seeking experiences regarding suicidal ideations among nursing home residents

Globally, older adults, especially nursing home residents, are at a higher risk of suicide. This study examined the life of nursing home residents with suicidal ideations and their help-seeking experiences. A qualitative analysis of 19 semi-structured interviews was conducted. Results indicate that suicidal ideations among nursing home residents correlates with their negative life experiences, both personally and institutionally. In terms of their life experiences, themes included the desire for death, emotional loneliness, a state of discomfort arising from incapacity, feeling like a burden on children, and dealing with the low-quality service. Older adults' negative attitudes toward seeking assistance as well as limited resort resources and ineffective help-seeking hinder them from finding more support or treatment. This study adds to a growing body of research on late-life suicide in institutional settings, and relevant findings can serve as references in improving nursing home residents' life quality and developing suicide-prevention strategies.

Sildenafil and suicide in Sweden

Much theory asserts that sexual intimacy sustains mental health. Experimental tests of such theory remain rare and have not provided compelling evidence because ethical, practical, and cultural constraints bias samples and results. An epidemiologic approach would, therefore, seem indicated given the rigor the discipline brings to quasi-experimental research. For reasons that remain unclear, however, epidemiologist have largely ignored such theory despite the plausibility of the processes implicated, which engender, for example, happiness, feelings of belonging and self-worth, and protection against depression. We use an intent-to-treat design, implemented via interrupted time-series methods, to test the hypothesis that the monthly incidence of suicide, a societally important distal measure of mental health in a population, decreased among Swedish men aged 50–59 after July 2013 when patent rights to sildenafil (i.e., Viagra) ceased, prices fell, and its use increased dramatically. The test uses 102 pre, and 18 post, price-drop months. 65 fewer suicides than expected occurred among men aged 50–59 over test months following the lowering of sildenafil prices. Our findings could not arise from shared trends or seasonality, biased samples, or reverse causation. Our results would appear by chance fewer than once in 10,000 experiments. Our findings align with theory indicating that sexual intimacy reinforces mental health. Using suicide as our distal measure of mental health further implies that public health programming intended to address the drivers of self-destructive behavior should reduce barriers to intimacy in the middle-aged populations.

A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks

One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+). China has become an ageing society, and as it continues to age it will continue to exacerbate the burden borne by current family and public healthcare systems. Major healthcare challenges involved with caring for the elderly in China include the management of chronic non-communicable diseases (CNCDs), physical frailty, neurodegenerative diseases, cardiovascular diseases, with emerging challenges such as providing sufficient dental care, combating the rising prevalence of sexually transmitted diseases among nursing home communities, providing support for increased incidences of immune diseases, and the growing necessity to provide palliative care for the elderly. At the governmental level, it is necessary to make long-term strategic plans to respond to the pressures of an ageing society, especially to establish a nationwide, affordable, annual health check system to facilitate early diagnosis and provide access to affordable treatments. China has begun work on several activities to address these issues including the recent completion of the of the Ten-year Health-Care Reform project, the implementation of the Healthy China 2030 Action Plan, and the opening of the National Clinical Research Center for Geriatric Disorders. There are also societal challenges, namely the shift from an extended family system in which the younger provide home care for their elderly family members, to the current trend in which young people are increasingly migrating towards major cities for work, increasing reliance on nursing homes to compensate, especially following the outcomes of the 'one child policy' and the 'empty-nest elderly' phenomenon. At the individual level, it is important to provide avenues for people to seek and improve their own knowledge of health and disease, to encourage them to seek medical check-ups to prevent/manage illness, and to find ways to promote modifiable health-related behaviors (social activity, exercise, healthy diets, reasonable diet supplements) to enable healthier, happier, longer, and more productive lives in the elderly. Finally, at the technological or treatment level, there is a focus on modern technologies to counteract the negative effects of ageing. Researchers are striving to produce drugs that can mimic the effects of 'exercising more, eating less', while other anti-ageing molecules from molecular gerontologists could help to improve 'healthspan' in the elderly. Machine learning, 'Big Data', and other novel technologies can also be used to monitor disease patterns at the population level and may be used to inform policy design in the future. Collectively, synergies across disciplines on policies, geriatric care, drug development, personal awareness, the use of big data, machine learning and personalized medicine will transform China into a country that enables the most for its elderly, maximizing and celebrating their longevity in the coming decades. This is the 2nd edition of the review paper (Fang EF et al., Ageing Re. Rev. 2015).

The prediction model of suicidal thoughts in Korean adults using Decision Tree Analysis: A nationwide cross-sectional study

The purpose of this retrospective decisional analysis study is to develop the prediction model of suicidal ideation. We used a Decision Tree Analysis using SPSS 23.0 program to explore predictors of suicide thoughts for 12,015 Korean adults aged 19–98 years. As a result, the most powerful predictor of suicidal ideation was the level of depression. Of people who suspected depression (CESD-11>16), 32.6% experienced suicidal ideation, which is 12 times higher than that of total subjects. The group with the highest rate of suicidal ideation was people who experienced financial difficulties in depression-suspected group and the rate of suicidal thoughts in this group was 56.7%, which was the highest rate. However, in the non-depressive group, the satisfaction of family relationship was the strongest predictor of suicidal ideation. In the non-depressive group, the rate of suicidal thoughts of people with high level of family relationship satisfaction and high level of health satisfaction was 0.6%, which was the lowest rate. The contribution of this study was that it provided the combination of variables to predict the risk groups of adult suicide. This study suggests that researchers and clinicians should consider comprehensively depressive symptoms, family relationships, economic difficulties, and health status to prevent the suicide of adults.

Associations of Suicide and Subjective Well-Being

The aim of this study is to examine relationships between suicide and subjective well-being. Correlation and regression analysis are conducted on 81 countries' aggregate data from United Nation agencies. Generally, suicide is not significantly related to life satisfaction; or negative affect, or positive social emotion, but significantly negatively related to positive self-emotion, or positive interpersonal emotion. In preventing suicide, subjective well-being's affective aspect might play a more important role than its cognitive aspect, positive affect might play a more important role than negative affect, and the personal aspect of positive affect might play a more important role than the social aspect.

Randomised controlled trial with economic and process evaluations of domiciliary welfare rights advice for socioeconomically disadvantaged older people recruited via primary health care (the Do-Well study)

Background

Welfare rights advice services are effective at maximising previously unclaimed welfare benefits, but their impact on health has not been evaluated.

Objective

To establish the acceptability, cost-effectiveness and effect on health of a domiciliary welfare rights advice service targeting older people, compared with usual practice.

Design

A pragmatic, individually randomised, parallel-group, single-blinded, wait-list controlled trial, with economic and process evaluations. Data were collected by interview at baseline and 24 months, and by self-completion questionnaire at 12 months. Qualitative interviews were undertaken with purposive samples of 50 trial participants and 17 professionals to explore the intervention’s acceptability and its perceived impacts.

Setting

Participants’ homes in North East England, UK.

Participants

A total of 755 volunteers aged ≥ 60 years, living in their own homes, fluent in English and not terminally ill, recruited from the registers of 17 general practices with an Index of Multiple Deprivation within the most deprived two-fifths of the distribution for England, and with no previous access to welfare rights advice services.

Interventions

Welfare rights advice, comprising face-to-face consultations, active assistance with benefit claims and follow-up as required until no longer needed, delivered in participants’ own homes by a qualified welfare rights advisor. Control group participants received usual care until the 24-month follow-up, after which they received the intervention.

Main outcome measures

The primary outcome was health-related quality of life (HRQoL), assessed using the CASP-19 (Control, Autonomy, Self-realisation and Pleasure) score. The secondary outcomes included general health status, health behaviours, independence and hours per week of care, mortality and changes in financial status.

Results

A total of 755 out of 3912 (19%) general practice patients agreed to participate and were randomised (intervention,n = 381; control,n = 374). In the intervention group, 335 participants (88%) received the intervention. A total of 605 (80%) participants completed the 12-month follow-up and 562 (75%) completed the 24-month follow-up. Only 84 (22%) intervention group participants were awarded additional benefits. There was no significant difference in CASP-19 score between the intervention and control groups at 24 months [adjusted mean difference 0.3, 95% confidence interval (CI) –0.8 to 1.5], but a significant increase in hours of home care per week in the intervention group (adjusted difference 26.3 hours/week, 95% CI 0.8 to 56.1 hours/week). Exploratory analyses found a weak positive correlation between CASP-19 score and the amount of time since receipt of the benefit (0.39, 95% CI 0.16 to 0.58). The qualitative data suggest that the intervention was acceptable and that receipt of additional benefits was perceived by participants and professionals as having had a positive impact on health and quality of life. The mean cost was £44 per participant, the incremental mean health gain was 0.009 quality-adjusted life-years (QALYs) (95% CI –0.038 to 0.055 QALYs) and the incremental cost-effectiveness ratio was £1914 per QALY gained.

Conclusions

The trial did not provide sufficient evidence to support domiciliary welfare rights advice as a means of promoting health among older people, but it yielded qualitative findings that suggest important impacts on HRQoL. The intervention needs to be better targeted to those most likely to benefit.

Future work

Further follow-up of the trial could identify whether or not outcomes diverge among intervention and control groups over time. Research is needed to better understand how to target welfare rights advice to those most in need.

Trial registration

Current Controlled Trials ISRCTN37380518.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 3. See the NIHR Journals Library website for further project information. The authors also received a grant of £28,000 from the North East Strategic Health Authority in 2012 to cover the costs of intervention delivery and training as well as other non-research costs of the study.

Depression and associated variables in people over 50 years in Spain

INTRODUCTION

Depression is a common and disabling psychiatric disorder in adulthood and is associated with higher mortality and functional disability.

OBJECTIVES

To determine the association between clinical and sociodemographic variables with depression in a sample of people over 50 years old living in Spain, and compare the prevalence of depression with the other Survey of Health, Ageing and Retirement (SHARE) countries.

MATERIAL AND METHODS

There were 5,830 participants in the Spanish sample of the Wave 5, 2013, of SHARE. Tools used: EURO-D (Depression) and CASP-12 (Quality of Life).

STATISTICAL ANALYSIS

Bivariate, and binary logistic.

RESULTS

The variables associated with depression in the binary logistic regression (EURO-D ≥4) were poor self-perceived physical health (OR=13.34; 95% CI: 9.74-18.27), having more than 2 difficulties in Activities of Daily Living (ADL) (OR=4.46; 95% CI: 3.13-6.34) and female gender (OR=2.16; 95% CI: 1.83-2.56). Depression was more common among participants with Alzheimer (76.4%), emotional disorders (73.9%), Parkinson (57.4%), hip fracture (55.4%), and rheumatism (50.9%). Compared with other European countries, Spain had a percentage of people with depression (29.3%) that was higher than the European average (27.9%).

CONCLUSIONS

The most important variables associated with depression were poor perceived physical health, presence of difficulties in ADL, and female gender.

Quality of life in people aged 65+ in Europe: associated factors and models of social welfare-analysis of data from the SHARE project (Wave 5)

PURPOSE

To analyse the clinical, sociodemographic and socioeconomic factors that influence perceived quality of life (QoL) in a community sample of 33,241 people aged 65+ and to examine the relationship with models of social welfare in Europe.

METHODS

This was a cross-sectional study of data from Wave 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE). The instruments used in the present study were as follows: sociodemographic data, CASP-12 (QoL), EURO-D (depression), indicators of life expectancy and suicide (WHO), and economic indicators (World Bank). Statistical analysis included bivariate and multilevel analyses.

RESULTS

In the multilevel analysis, greater satisfaction in life, less depression, sufficient income, better subjective health, physical activity, an absence of functional impairment, younger age and participation in activities were associated with better QoL in all countries. More education was only associated with higher QoL in Eastern European and Mediterranean countries, and only in the latter was caring for grandchildren also related to better QoL. Socioeconomic indicators were better and QoL scores higher (mean = 38.5 ± 5.8) in countries that had a social democratic (Nordic cluster) or corporatist model (Continental cluster) of social welfare, as compared to Eastern European and Mediterranean countries, which were characterized by poorer socioeconomic conditions, more limited social welfare provision and lower QoL scores (mean = 33.5 ± 6.4).

CONCLUSIONS

Perceived quality-of-life scores are consistent with the sociodemographic and clinical characteristics of participants, as well as with the socioeconomic indicators and models of social welfare of the countries in which they live.

Care service use in 2 years preceding suicide among older adults: comparison with those who died a natural death and those who lived longer

The aim of the study is (1) to describe and analyse health and social service use and medicine purchases in the last 2 years of life among older adults who died by suicide and (2) to compare use and purchases between three groups: those who died by suicide, died a natural death or who lived longer. Nation-wide Finnish register data were used. The data consist of 316,639 decedents who died at the age of 70 years or older in 1998-2008 and 222,967 people who lived longer. Use of hospital, long-term care and home care, and the purchase of prescribed psychotropic medications were studied for the 2-year period. Binary logistic regression analyses were applied. 1118 older adults died by suicide (0.4 % of all deaths). A majority of older adults who died by suicide had multiple somatic diseases and mental disorders, especially depression, and had contact with health and social services in the last 2 years of life. At the same level of morbidity, use of hospital and long-term care was less common among those who died by suicide than among those who died of natural causes, but more common than among those who lived longer. Those who died by suicide received less home care than those who lived longer. A high proportion of suicides occurred in the first month following hospital discharge. Health and social services should improve support for older adults with chronic diseases and depression.

Influences of population-level factors on suicides in older adults: a national ecological study from Australia

OBJECTIVE

The relationship between older adult suicide rates and population-level variables has been examined in a few studies. Therefore, the objective of the present study is to analyse the extent to which population-level factors are associated with suicide by older persons in Australia, from an ecological perspective.

METHODS

Suicide rates for older adults aged 65 years and over were calculated for 68 observation units at Statistical Areas Level 4 in Australia for 2002-2011. The 2011 Census of Population and Housing was used for population-level variables. Analysis on standardised suicide mortality ratios and Poisson regression were performed to examine geographical and gender differences.

RESULTS

Between 2002 and 2011, a total of 3133 suicides of persons aged 65 years and above (men: n = 2418, 77.1%) was identified with an average annual rate of 10.1 per 100,000 persons. Suicide rates in older adults vary widely between different geographical regions in Australia. The multivariate estimates of contextual factors showed that the risk of suicide was positively associated with the sex ratio (incidence risk ratio (IRR) = 1.053, 95%CI = 1.016-1.092), the proportion of those in tenant household (IRR = 1.120, 95%CI = 1.081-1.160) and Australian residents born in North-West Europe (IRR = 1.058, 95%CI = 1.022-1.095). Significant gender variations were found.

CONCLUSIONS

Specific factors increasing risk of suicide for older adults on SA4 level in Australia were living in areas with a higher proportion of male population, a higher proportion of tenant household dwellers and a higher proportion of immigrants from North-West Europe. The different influences of population-level factor on suicide between older men and women indicate the need for targeted suicide prevention activities.