Being left-behind, mental disorder, and elderly suicide in rural China: a case-control psychological autopsy study

Association of self-reported arthritis with depression, anxiety, and comorbid depression/anxiety among the older Chinese adults: A cross-sectional study

BACKGROUND

Arthritis is relatively common among middle-aged and older people and is a significant public health problem. However, research on the relationship between arthritis and mental health in older populations is currently limited.

METHODS

Data were obtained from the Chinese Longitudinal Healthy Longevity Survey. The 10-item Center for Epidemiologic Studies Depression Scale and 7-item Generalized Anxiety Disorder Scale were used to evaluate depressive and anxiety symptoms. Arthritis status was self-reported. Linear and logistic regression analyses were conducted to assess the impact of arthritis on depression, anxiety, and comorbid depression/anxiety symptoms.

RESULTS

A total of 11,104 participants aged ≥65 years (mean age, 83.1 ± 11.1 years) were included in the analysis. We detected positive associations of arthritis with depression symptoms (adjusted odds ratio [OR]: 1.57, 95 % confidence interval [CI] 1.33 to 1.86), anxiety symptoms (adjusted OR: 1.48, 95 % CI: 1.15 to 1.90), and comorbid depression/anxiety symptoms (adjusted OR: 1.88, 95 % CI: 1.41 to 2.5) in the older adult population. Participants with arthritis had higher anxiety (adjusted linear regression coefficient: 0.43, 95 % CI: 0.24 to 0.63) and depression (adjusted linear regression coefficient: 0.87, 95 % CI: 0.57 to 1.14) scores compared with those without arthritis. In addition, there were no significant interaction effects between arthritis and participant characteristics on depression symptoms, anxiety symptoms, or comorbid depression/anxiety symptoms.

CONCLUSIONS

Arthritis was positively associated with depression symptoms, anxiety symptoms, and comorbid depression/anxiety symptoms among older adults. Further cohort studies are needed to validate these associations.

Suicide and prevalence of mental disorders: A systematic review and meta-analysis of world data on case-control psychological autopsy studies

INTRODUCTION

Suicide is a multifaceted event precipitated by underlying biopsychosocial risk factors. Evidence for various psychiatric morbidities underlying suicidality through Psychological Autopsy (PA) is established in case-control studies. However, considering the possible geographical variations and the limited number of studies from developing countries, the estimates of such risk factors across the world could provide great insight into their comparative prevalence and assist in targeting the prevention of suicide.

METHODS

A systematic review of the literature from 1991 to 2020 in the English language was conducted with the protocol registration on PROSPERO ID (CRD 42021249216) to identify the pooled odds ratio of any psychiatric morbidity as a risk factor for suicide.

RESULTS

Out of 1144 articles, 43 studies were included in this review. The pooled odds ratio for any psychiatric morbidity measured across 31 studies was 16.71 (95% CI: 12.29 - 22.70, Tau2 = 0.58, I2 = 80.4%, Cochran's Q = 153.36, df = 30, p-value <0.001). The subgroup analysis for affective disorder, previous suicide attempt, WHO region-wise risk distribution, and publication year of study were not significant.

CONCLUSIONS

There is a sixteen-fold increased risk of suicide in persons with mental disorders compared to healthy controls, and the risk is similar across the geographical region and publication time. The international efforts to reduce the common risk factors for suicide would equally be helpful for all countries despite cultural variations. Early identification and treatment of sleep disorders, physical illnesses, anxiety, and personality disorders should be prioritized along with the established mental disorders to reduce suicide rates across the world.

Safeguarding the Right to Health of the Elderly in Rural China: A Legal Analysis

Older people in rural China enjoy the right to health under Chinese law. However, the problems of economic difficulties, the unbalanced allocation of medical resources between urban and rural areas and the weakening of the traditional function of the family as a provider of old-age care in reality make the elderly in rural areas face a higher risk of health problems. The law is an important tool to mitigate these problems. Although China has made great efforts to legally guarantee the right to health of the rural elderly, it has not yet fully implemented the requirements of Article 12 of the International Covenant on Economic, Social and Cultural Rights, Article 14 of the Madrid Political Declaration and International Plan of Action on Ageing. China needs to further improve the relevant legislation to provide adequate legal support for the exercise of the right to health of the elderly in rural areas.

Relationship between left-behind status and cognitive function in older Chinese adults: a prospective 3-year cohort study

Background

Due to the inaccuracy of the traditional geographical distance-based definition of left-behind status, data on the negative effect of left-behind status on cognitive function among older adults are controversial.

Aims

This study examined the cross-sectional and longitudinal associations of left-behind status with cognitive function in older Chinese adults. The left-behind status definition was based on the frequency of face-to-face parent-child meetings.

Methods

Data from a nationally representative sample of 8 682 older adults (60+ years) in 2015 (5 658 left behind and 3 024 non-left behind), of which 6 933 completed the follow-up in 2018, were obtained from the China Health and Retirement Longitudinal Study. Left-behind older adults were broadly defined as those aged 60+ years who had living adult children and saw their children less than once per month. The cognitive function was assessed with a composite cognitive test with higher total scores indicating better cognitive function.

Results

Left-behind older adults had significantly lower cognitive test scores than non-left-behind older adults in both 2015 (11.1 (6.0) vs 13.2 (5.9), t=15.863, p<0.001) and 2018 (10.0 (6.6) vs 12.4 (6.7), t=14.177, p<0.001). After adjusting for demographic factors, lifestyle factors, chronic medical conditions and the baseline cognitive test score (in the longitudinal analysis only), on average, the cognitive test score of left-behind older adults was 0.628 lower than their non-left-behind counterparts in 2015 (t=5.689, p<0.001). This difference in cognitive test scores attenuated to 0.322 but remained significant in 2018 (t=2.733, p=0.006).

Conclusions

Left-behind older Chinese adults have a higher risk of poor cognitive function and cognitive decline than their non-left-behind counterparts. Specific efforts targeting left-behind older adults, such as encouraging adult children to visit their parents more regularly, are warranted to maintain or delay the progression of cognitive decline.

Association of unmet long-term care needs with depression and anxiety among older adults in urban and rural China

This study examined the association of unmet long-term care (LTC) needs with depression and anxiety in older adults and explored urban-rural disparities. Cross-sectional data for 1896 respondents with a mean age of 91.58 years was from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression and anxiety were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Unmet LTC needs were self-reported by older adults with functional limitations. Research methods included regression analyses, decomposition analyses, sensitivity analyses. Results showed that unmet LTC needs, depression, anxiety were more severe in rural older adults. Unmet LTC needs were significantly and positively related to depression and anxiety, but their associations with CESD-10 scores, depressive and anxiety symptoms were stronger in urban older adults. Urban-rural disparities in unmet LTC needs explained about 20%-40% of disparities in depression and anxiety. The findings highlighted the role of meeting LTC needs in reducing depression and anxiety, and that LTC policymakers should not ignore the needs of urban older adults and focus solely on rural older adults.

Suicide among young-old and old-old adults in rural China: A case-control psychological autopsy study

OBJECTIVE

Late-life suicide is a vital public health concern. Though gerontological research suggested the young-old and old-old phases were heterogeneous, age differences in the elderly suicide have not been well studied due to the lack of comparable control groups and small samples. The study aimed to examine the age-specific suicidal characteristics and risk factors among the young-old (60-79) and old-old (over 80) elderly.

METHODS

Two hundred and forty two suicide decedents and 242 living comparisons were enrolled in a 1:1 matched case-control psychological autopsy study in rural China: 173 young-old and 69 old-old in each group. Suicidal characteristics, demographic characteristics, living arrangements, physical health, mental disorder, and psychosocial factors were collected. We used logistic regression models to assess risk factors of suicide and test for interactions between age and each risk factor.

RESULTS

Pesticide suicide was more prevalent among young-old suicides than old-old suicides (56.07% vs. 40.58%, p = 0.029). Non-currently married, unemployment, mental disorder, higher disability in physical activities of daily living, higher hopelessness and higher depressive symptom were significantly associated with suicide among older adults. The effect of poor function in physical activities of daily living on suicide was significantly greater during younger ages (p for interaction = 0.038).

CONCLUSIONS

Findings indicated that most suicidal characteristics and risk factors for completed suicide were generally similar among young-old and old-old adults. But poor function in physical activities of daily living predicted increase suicide risk only at younger ages. In addition to common risk factors, age-specific factors should also be noted in suicide prevention.

CLINICAL TRIAL REGISTRATION

According to the ICMJE, purely observational studies (those in which the assignment of the medical intervention is not at the discretion of the investigator) will not require registration. Our study was not registered because this is a case-control study. But all procedures of the study were carried out in accordance with the latest version of the Declaration of Helsinki. The study were approved by the Institutional Review Boards of the Central South University, Shandong University, and Guangxi Medical University.

Prevalence and correlates of suicidal ideation among older adults attending primary care clinics in Wuhan, China: A multicenter cross-sectional study

Background

Primary care represents an ideal setting for screening for and managing suicidal older adults but the clinical epidemiology of suicidal ideation in Chinese older primary care patients remains unclear. This study investigated the prevalence and correlates of suicidal ideation in older Chinese adults receiving primary care.

Methods

This multicenter cross-sectional survey included a total of 769 older adults (≥65 years) from seven urban and six rural primary care clinics in Wuhan, China. The presence of depressive symptoms and suicidal ideation was assessed with the Geriatric Depression Scale and a single-item question "In the past 12 months, did you think about ending your life?," respectively.

Results

The 12-month prevalence of suicidal ideation in older primary care patients was 16.6%. Significant correlates of suicidal ideation were poor economic status (vs. good, OR = 2.80, P = 0.008), heart disease (OR = 2.48, P = 0.005), chronic gastric ulcer (OR = 3.55, P = 0.012), arthritis (OR = 2.10, P = 0.042), and depressive symptoms (OR = 11.29, P < 0.001).

Conclusions

Suicidal ideation is common among older adults attending Chinese primary care clinics. It is necessary to integrate psychological crisis intervention into primary care to prevent late-life suicide.

Development and Validation of the Self-Rating Suicide Risk Screening Questionnaire

Since suicide is one of the major health problems worldwide, the goal of the present study is to develop a psychometrically sound suicide risk screening tool named Suicide Screening Questionnaire- Self-Rating (SSQ-SR) to quantify the risk of suicidal behavior. The development process includes item generation, item revision and refinement, and validation. A total sample of 2,238 adults in South Korea was used for analysis. The results of factor analysis showed that the SSQ-SR, containing 25 items, supported a three-factor model: "Situational factors," "Negative self-perceptions and mental health factors," and "Suicidal thoughts and behaviors." Also, SSQ-SR showed satisfying internal consistency, concurrent validity and discriminant validity. Lastly, the results of ROC analysis showed a cut-off point of 33.5 for the low-risk group and 36.5 for the high-risk group. Considering these results, the current results demonstrate the SSQ-SR is a valid scale and therefore can contribute to future suicide-related studies and prevention.

Quality of Life, Hopelessness, Impulsivity, and Suicide in the Rural Elderly in China: A Moderated Mediation Analysis of Psychological Autopsy Data

Background

People who had died by suicide always being associated with negative emotions and even mental disorders. Understanding mechanisms underlying the association between quality of life (QOL), hopelessness, and suicide are of great significance. In this study, we aimed to test a model in which the QOL-suicide relationship was mediated by hopelessness and moderated by impulsivity.

Methods

Participants (N = 484, including 242 suicide deaths and 242 matched controls) were rural residents 60 years of age and older, randomly selected from 12 rural counties in China using a two-stage stratified cluster sampling method. Data were collected with standard psychological autopsy technique from informants (n = 968). The outcome variable was a suicide death. QOL, hopelessness, and impulsivity were assessed using validated scales. The proposed relationships were tested using mediation and moderated mediation models.

Results

Of the total sample, 55.8% were men with a median age of 75.5 years. Results from the moderated mediation analysis indicated that QOL was negatively associated with suicide (beta = −0.141, p < 0.01); this association was mediated by hopelessness (indirect effect: beta =0.578, p < 0.01), accounting for 73% of the total effect. Impulsivity significantly moderated the mediation effect from QOL to hopelessness (beta =0.005, p < 0.01).

Conclusions

Study findings have confirmed the negative association between QOL and suicide with psychological autopsy data, and demonstrated the role of hopelessness in mediating the QOL-suicide relation that is further modified by impulsiveness. These findings depend on our understanding of the suicide epidemiology among the elder in rural China and provide information much needed for suicide prevention.

Elder Abuse and Neglect in China: Prevalence, Co-occurrence, and Intergenerational Risk Factors

The prevalence and patterns of elder abuse and neglect in China have been understudied. The objectives of this study were to examine the chronicity and prevalence of different patterns of elder abuse, and the influence of individual and contextual risk factors. We used data from a sample of 7,466 adults randomly recruited from six regions in China. The participants responded to a questionnaire about their demographic characteristics, childhood abuse experiences, and instances of abuse and neglect against their elderly parents. Logistic regression analysis was performed to examine the association of elder abuse and neglect with individual and contextual factors. The results showed that one in 10 participants reported that their elderly parents had experienced abuse or neglect in the past year. The elder victims were reported to have suffered different types of abuse and neglect on multiple occasions, ranging from 3.6 to 11.82 times on average. More than 5% of participants reported that their elderly parents had suffered two or more types of abuse and neglect in the past year, accounting for 40% of the elderly victims. The co-occurrence of elder abuse within elderly couples was also high. Reports of abuse and neglect of elderly parents were related to low socioeconomic status, living in rural areas, and the experience of childhood abuse of the participants. This study supports the model of intergenerational transmission of violence in the Chinese population. The high prevalence, chronicity, and co-occurrence of elder abuse and neglect underline the importance of screening for risk factors, and have implications for preventive practice and policy.

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

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.

Association of using biomass fuel for cooking with depression and anxiety symptoms in older Chinese adults

BACKGROUNDS

Household air pollution exposure is a crucial public concern and have the potential to seriously affect human health. Using biomass fuels for cooking is the main contributor to household air pollution. However, current evidence linked between cooking with biomass fuels and mental health remains limited.

OBJECTIVES

To explore whether cooking with biomass fuels is associated with depression and anxiety symptoms among older adults in China.

METHODS

We obtained data from Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depressive and anxiety symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Primary cooking fuel type was self-reported. We used logistic regression and linear regression to evaluate the effects of cooking with biomass fuels on depression and anxiety.

RESULTS

A total of 13,361 participants aged 65 years and older (mean age, 84.2 ± 11.5 years) were included in the presented study. A positive association was found between cooking with biomass fuels and both depression symptoms (adjusted odds ratio 1.23, 95% CI 1.03 to 1.47) and anxiety symptoms (adjusted odds ratio 1.31, 95% CI 1.02 to 1.68). Biomass fuel users had a higher depression scores (0.33, 95% CI 0.03 to 0.61) and a higher anxiety scores (0.20, 95% CI 0.02 to 0.38) compared to clean fuel users. We found no significant interactions between participant characteristics and biomass fuel use on either depression or anxiety symptoms.

CONCLUSIONS

Cooking with biomass fuels was associated with depression and anxiety symptoms in order adults. Further large prospective cohort studies are warranted to confirm this association.

Media Coverage of Senior and Celebrity Suicides and Its Effects on Copycat Suicides among Seniors

This study examined whether suicide rates in the elderly population are associated with media coverage of senior or celebrity suicides. Analyzing data from 2012 to 2015, we found that seniors were likely to be more influenced by media coverage of senior suicides than by celebrity suicides. Furthermore, the effects of media coverage of senior suicides were more significant when the reported reason was either health (mental or physical problems) or financial issues, such as poverty than other reasons.

Childhood Separation From Parents and Self-Harm in Adolescence: A Cross-Sectional Study in Mainland China

As the prevalence of self-harm among adolescents in Chinese escalates, finding out the potential risk factors associated with self-harm behaviors has aroused much attention. This study aims to explore the association between parent-child separation and series of self-harm (SH) subtypes among Chinese adolescents. We survey a total of 4,928 middle school students aged from 12 to 18 years at school. Parent-child separation was investigated from four dimensions-occurrence of parental separation, separation status, age at first separation and duration of separation. Self-harm series are deemed as five subtypes-highly lethal self-harm, less lethal self-harm with visible tissue damage, self-harm without visible tissue damage, self-harmful behaviors with latent damage and psychological self-harm. Multivariate logistic regression is used to explore the associations between parent-child separation and different subtypes of self-harm among adolescents. Paternal separation is associated with each type of self-harm whilst maternal separation is not correlated with highly lethal self-harm. Except for highly lethal self-harm, the other four subtypes of self-harm demonstrate a relation with both length of paternal separation and maternal separation with aOR ranging from 1.02 to 1.06. Individuals who suffer parental separation prior to the age of three were at a higher risk for four types of less-lethal self-harm. The association of parent-child separation with self-harm deserves our attention, and future research is needed to identify the underlying mechanisms.

Hierarchical and nested associations of suicide with marriage, social support, quality of life, and depression among the elderly in rural China: Machine learning of psychological autopsy data

OBJECTIVES

To identify mechanisms underpinning the complex relationships between influential factors and suicide risk with psychological autopsy data and machine learning method.

DESIGN

A case-control study with suicide deaths selected using two-stage stratified cluster sampling method; and 1:1 age-and-gender matched live controls in the same geographic area.

SETTING

Disproportionately high risk of suicide among rural elderly in China.

PARTICIPANTS

A total of 242 subjects died from suicide and 242 matched live controls, 60 years of age and older.

MEASUREMENTS

Suicide death was determined based on the ICD-10 codes. Influential factors were measured using validated instruments and commonly accepted variables.

RESULTS

Of the total sample, 270 (55.8%) were male with mean age = 74.2 (SD = 8.2) years old. Four CART models were used to select influential factors using the criteria: areas under the curve (AUC) ≥ 0.8, sensitivity ≥ 0.8, and specificity ≥ 0.8. Each model included a lead predictor plus 8-10 hierarchically nested factors. Depression was the first to be selected in Model 1 as the lead predictor; After depression was excluded, quality of life (QOL) was selected in Model 2; After depression and QOL were excluded, social support was selected in Model 3. Finally, after all 3 lead factors were excluded, marital status was selected in Model 4. In addition, CART demonstrated the significance of several influential factors that would not be associated with suicide if the data were analyzed using the conventional logistic regression.

CONCLUSION

Associations between the key factors and suicide death for Chinese rural elderly are not linear and parallel but hierarchically nested that could not be effectively detected using conventional statistical methods. Findings of this study provide new and compelling evidence supporting tailored suicide prevention interventions at the familial, clinical and community levels.

Building community-centered social infrastructure: a feminist inquiry into China's COVID-19 experiences

The global COVID-19 pandemic has revealed the essential role of care work in sustaining life, health, and maintaining the basics of everyday existence. It has also made visible the disproportionate burden of care work on women that existed before the outbreak, which has intensified rapidly and been gravely exposed during the pandemic. In this article, we take China as a case study to investigate the gendered impact of this pandemic and further problematize the landscape of care provision. With a feminist political economy perspective, we introduce China's provisioning of care prior to the outbreak and investigate how the care crisis has further deepened in the pandemic. Drawing on the most recent data available on China's experience, we explore the role and function of community-centered social infrastructure, an assemblage of state, family, and local resources, in effectively combating the virus and providing care. We further provide comparative international evidence to demonstrate the essential role of community care infrastructure in this pandemic. Building social infrastructure to deliver care at the community level presents important policy implication, especially for many developing countries. Therefore, a critical reflection and discussion on pandemics and women is not only more vital than ever, but also sheds light on the endeavour to develop long-term solutions for the care crisis that will almost certainly outlive the current pandemic.

Understanding the Reasons for Suicide Among Older Adults in Rural China Using In-Depth Interviews

Background: Suicide is a complex public health problem. Suicide rates are higher in rural areas than in urban areas and among older adults than any other age group in China. Aims: This study aimed to acquire a comprehensive understanding of rural older adults' reasons for suicide through qualitative exploration and to provide additional insights for suicide prevention work. Method: In-depth interviews were conducted with people familiar with older adults who had died by suicide ("informants"). The data were analyzed using a thematic approach. Results: Data were available for 242 people who died by suicide. Informants identified two or more reasons for suicide among most people who had died. Physical illness, psychological distress, and interpersonal conflicts were the most common reasons. The rate of mental disorders as diagnosed by psychiatrists was higher than that reported by the informants. Limitations: Information bias is inevitable because of the use of proxy informants. Conclusion: The reasons for suicide are complex and diverse, and research on suicide should focus more on the mechanisms of interaction between reasons. Greater attention should be paid to physical and mental health as well as to improving interpersonal and problem-solving skills for older adults in China.

Relationship between impulsivity and suicide among the rural elderly in China: a case-control psychological autopsy study

Background

The relationship between impulsivity and suicide is inconsistent in different populations. Hence, the relationship between impulsivity and suicide still needs to be studied among the elderly population. The present study intends to explore the relationship between impulsivity and suicide among the rural Chinese elderly.

Methods

A case-control psychological autopsy study was conducted from February 1, 2014 to December 18, 2015 among rural residents over the age of 60 who died by suicide. The sample consisted of 242 suicides as the case group and 242 living individuals as the control group. Data on demographic characteristics, impulsivity, previous history of suicide attempts, social support, negative life events, and suicidal behavior were collected.

Results

Our study found that impulsivity increased the risk of suicide. The case group showed a higher Barratt Impulsiveness Scale score compared with the control group (p < 0.001), which indicates that impulsivity was higher among the elderly suicides. In addition, regression analyses show that impulsivity (odds ratio: 1.03, 95% confidence interval: 1.01–1.06) is an independent risk factor of suicide, after controlling for the effects of marital status, education, family annual income, being left behind, social support, and negative life events. Finally, compared with elderly who do not have a history of attempted suicide, elderly with a history of attempted suicide showed higher impulsivity (p = 0.001).

WITHDRAWN: Health risk assessment of rural older population

Ahead of Print article withdrawn by publisher.

Estimating the risk of suicide associated with mental disorders: A systematic review and meta-regression analysis

BACKGROUND

Mental disorders (MDs) are known risk factors for suicide. This systematic review updates the evidence base for this association and improves upon analytic approaches by incorporating study-level and methodological variables to account for measurement error in pooled suicide risk estimates.

METHODS

A systematic review was conducted to review studies on MDs as risk factors for suicide. Relevant studies were searched using PubMed, Embase, PsychINFO, and existing reviews from 2010 to 19. Studies were eligible if they were longitudinal/case-control studies, representative of the general population, used diagnostic instruments, and quantified suicide risk. The outcome assessed was relative risks (RRs) for suicide due to MDs. A multi-level meta-regression approach was used to obtain pooled RRs adjusted for covariates and between-study effects.

FINDINGS

We identified 20 eligible studies yielding 69 RRs. Disorder type, age, sex, use of psychological autopsy, study design, and adjustment for confounders were tested as predictors of pooled suicide risk. Overall, all disorders were significant predictors of suicide with predicted adjusted RRs ranging from 4·11 [2·09, 8·09] for dysthymia to 7·64 [4·3, 13·58] for major depressive disorder.

INTERPRETATION

Our results indicate that MDs are important risk factors for suicide. This systematic review provides pooled RRs that have been adjusted for methodological sources of bias. Findings from our paper may inform suicide prevention strategies as part of national health agendas.

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.

Suicide risk within 1 year of dementia diagnosis in older adults: a nationwide retrospective cohort study

BACKGROUND

Although severe dementia could protect against suicide death by decreasing a person's capacity to implement a suicide plan, patients with early dementia may have better cognition, giving them more sustained insight into their disease and better enabling them to carry out a suicide plan. This study investigated suicide risk in older adults within 1 year of receiving a diagnosis of dementia.

METHODS

This study used National Health Insurance Service Senior Cohort data and included 36 541 older adults with newly diagnosed dementia (a Mini-Mental State Examination score ≤ 26 and a Clinical Dementia Rating score ≥ 1 or a Global Deterioration Scale score ≥ 3), including Alzheimer disease, vascular dementia and other/unspecified dementia, from 2004 to 2012. We selected older adults without dementia through 1:1 propensity-score matching using sex, age, comorbidities and index year, with follow-up throughout 2013. We estimated adjusted hazard ratios (AHRs) of suicide deaths within 1 year after diagnosis using a time-dependent Cox proportional hazards model.

RESULTS

We verified 46 suicide deaths during the first year after a dementia diagnosis. Older adults with dementia had an increased risk of suicide death compared to those without dementia (AHR 2.57; 95% confidence interval [CI] 1.49-4.44). Older adults with Alzheimer disease (AHR 2.50; 95% CI 1.41-4.44) or other/unspecified dementia (AHR 4.32; 95% CI 2.04-9.15) had an increased risk of suicide death compared to those without dementia. Patients with dementia but without other mental disorders (AHR 1.96; 95% CI 1.02-3.77) and patients with dementia and other mental disorders (AHR 3.22; 95% CI 1.78-5.83) had an increased risk of suicide death compared to patients without dementia. Patients with dementia and schizophrenia (AHR 8.73; 95% CI 2.57-29.71), mood disorders (AHR 2.84; 95% CI 1.23-6.53) or anxiety or somatoform disorders (AHR 3.53; 95% CI 1.73-7.21), respectively, had an increased risk of suicide death compared to patients with those conditions but without dementia.

LIMITATIONS

This study examined only elderly patients in South Korea, a population with a substantially higher suicide rate than the global population. Caution must be exercised when generalizing the results to populations with dissimilar backgrounds.

CONCLUSION

Patients with dementia had an increased risk of suicide death within 1 year after diagnosis compared to those without dementia.

Completed Suicide With Violent and Non-violent Methods by the Elderly in Rural China: A Psychological Autopsy Study

Background: Late-life suicide is a severe public health problem in rural China; however, knowledge regarding the specific characteristics and risk factors for completed suicide via violent and non-violent methods among elderly individuals in rural China is limited. Methods: Subjects aged 60 years or older were selected from rural areas in Shandong, Hunan, and Guangxi provinces in China. This study was a 1:1 matched case-control design conducted by using the psychological autopsy method. Results: According to the univariate analyses, the presence of mental disorder, higher degree of depression, loneliness, lack of social support, hopelessness, impulsivity, and increased quantity of life events were associated with suicide in both violent and non-violent methods. For violent suicide, another risk factor was the lack of pesticides at home. For non-violent suicide, other risk factors were not currently married, family suicide history, and alcohol use disorder (P < 0.05). Variables that remained in the logistic regression model were the severity of depressive symptoms for both violent and non-violent suicide. For non-violent suicide, the degree of hopelessness was another independent risk factor. In addition, violent suicides were more likely to lack pesticides at home, choose the spring season and have an increased quantity of life events than those who died by suicide via non-violent methods. Conclusion: The major risk factor for both violent and non-violent suicide was the severity of depressive symptoms. Suicide prevention measures that focus on depression among this vulnerable population are urgently needed. Moreover, the characteristics of suicides via violent methods differed from those via non-violent methods among elderly individuals. Suicide prevention efforts should be tailored to the specific characteristics of the different suicide methods utilized by older adults in rural areas.

Time Trends and Predictions of Suicide Mortality for People Aged 70 Years and Over From 1990 to 2030 Based on the Global Burden of Disease Study 2017

Background: High suicide rate in the elderly is an important global public health problem but has not received the attention it deserves. This study aimed to examine time trends of suicide mortality for people aged 70 years and over by sex, age, and location from 1990 to 2017, and to provide predictions up to 2030. Methods: Using data from the Global Burden of Disease study 2017, we presented elderly suicide mortality changes and compared the patterns for the elderly with that for all ages. We estimated associations between socio-demographic index (SDI) and suicide mortality rates using a restricted cubic spline smoother, and predicted suicide mortality rates up to 2030. Results: In 2017, 118,813 people aged 70 years and over died from suicide, indicating a mortality rate of 27.5 per 100,000, with the highest rates in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, and Central Sub-Saharan Africa, and for countries and territories, the highest were in South Korea, Zimbabwe, Lesotho, Mozambique, and Senegal. Between 1990 and 2017, suicide mortality rate for the elderly aged 70 years and over decreased globally (percentage change -29.1%), and the largest decreases occurred in East Asia, Southern Latin America, and Western Europe. Nationally, the largest decrease was found in Chile, followed by Czech Republic, Hungary, Turkey, and Philippines. For most countries, the elderly mortality rate was higher than the age-standardized rate, with the largest percentage differences in China and countries in Sub-Saharan Africa. The elderly suicide mortality rate decreased as SDI increased, except for a slight rebound at mid to high SDI. According to projections, 10 out of 195 countries were expected to meet the SDGs indicator of a third reduction by 2030. Conclusions: Variability in suicide mortality rates for the elderly aged 70 years and over by sex, age, region, country, and SDI can guide preventive policies, but causes of the variability need further study. Comprehensive strategies should be adopted to reduce suicide rates and close the gap to the 2030 SDGs.

Prospective study of association of characteristics of hotline psychological intervention in 778 high-risk callers with subsequent suicidal act

OBJECTIVES

This study aimed to assess the association of the quality scores of hotline psychological intervention and the reduction of subsequent suicidal acts among high suicidal risk callers.

METHODS

High-risk callers at a national crisis hotline service in China were recruited and prospectively followed for up to 3 months after receiving a hotline psychological intervention. The quality of the intervention was evaluated by supervisors who listened to the tape-recorded calls using the Counseling Skills Rating Scale for Psychological Support Hotlines, which assessed three counseling domains: process, attitude and communication skill. The primary outcome was the occurrence of suicidal acts during the follow-up period. Secondary outcomes were before versus after changes during the intake intervention call in hopefulness, psychological stress and suicide intention reported by the callers.

RESULTS

Over the 3-month follow-up, 45 of 778 high-risk callers reported 61 suicide attempts, and 3 other callers died by suicide. Subsequent suicidal act was significantly more common in callers classified as being at higher risk during the intake call. Higher scores on the quality of suicidality assessing of the Counseling Skills Rating Scale for Psychological Support Hotlines were associated with reduced risk of suicidal acts during follow-up (hazard ratio = 0.38, 95% confidence interval = [0.18, 0.85]). Higher scores on the communication skill domain were associated with increases in hopefulness (β = 0.09) after the intervention, and higher scores on the counseling process domain (β = -0.12) and higher suicidal risk scores (β = -0.12) were associated with decreased suicide intention after intervention.

CONCLUSION

Several characteristics of a hotline intervention for suicide prevention were associated with decreased risk of suicidal acts during follow-up. Intervention skill training for hotline operators should emphasize these specific counseling skills.

The pattern of stressful life events prior to suicide among the older adults in rural China: a national case-control psychological autopsy study

Background

There is a lack of evidence concerning the stressful life events experienced prior to suicide which may be associated with an increased suicide risk among Chinese rural older adults. The aim of this study was to identify the pattern of stressful life events prior to suicide among the older adults in China.

Methods

Twelve counties were randomly selected using two-stage stratified cluster sampling method. Suicide cases aged 60 years and older (n = 242) were collected from those counties from June 2014 to September 2015. Matched living controls were selected 1:1 with suicide cases by age, gender, and location. Data were collected using face-to-face interviews by a psychological autopsy method. The Life Event Scale for the Elderly was used to measure the stressful life events prior to suicide/interviews.

Results

Approximately 99.6% of suicide cases and 88.4% of controls experienced at least one stressful life event. The suicide group experienced more long-term stressful life events than recent stressful life events. The top three most frequent stressful life events for the suicide group were being diagnosed with chronic disease, hospitalization, and being diagnosed with terminal illness. More female suicide cases experienced the death of a spouse, while more males experienced hospitalization, diagnosis with terminal illness and family poverty. Experiencing at least one stressful life event, an unstable marital status, physical diseases and mental disorders were shown to increase the risk of suicide.

Conclusions

Stressful life events were common for the rural older adults, especially long-term stressful life events. The experience of at least one stressful life event can increase suicide risk among this population. More attention should be paid to the rural older adults who experienced more long-term stressful life events and health related life events.

Suicide in the elderly: approach to social determinants of health in the Dahlgren and Whitehead model

OBJECTIVE

Identify in literature the social determinants of health related to suicide in the elderly, according to the model proposed by Dahlgren and Whitehead.

METHOD

Integrative review of articles indexed in the databases BDENF, CINAHL, LILACS, and MEDLINE, with the following main descriptors: aged, suicide, social determinants of health, and risk factors. Primary studies were included which addressed social determinants of health and suicide in the elderly.

RESULTS

From the 19 articles analyzed, three categories emerged: proximal social determinants of health (male gender, mental disorders, physical illnesses, white race, 70-74 years old); intermediate social determinants of health (substance abuse, use of alcohol or psychotropic drugs, marital status, marital, social, and family problems, violence, previous suicide attempt, history of admission to psychiatric service); and distal social determinants of health (schooling, economic issues, sanitation, stressful events).

CONCLUSION

Proximal determinants have more effects on suicide. Intermediate determinants are composed mainly of changeable factors. Distal determinants showed lesser associations.

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

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.

Reliability and validity of short Beck Hopelessness Scale in psychological autopsy study among Chinese rural elderly

BACKGROUND

Older adults represent the segment of population most exposed to the risk of suicide nearly everywhere in the world. Previous studies showed that hopelessness was an important risk factor for suicide.

AIMS

This study aimed to evaluate the reliability and validity of the four-item Beck Hopelessness Scale (BHS-4) in psychological autopsy study among Chinese rural elderly.

METHOD

Two-stage stratified cluster sampling method was used to select research sites. Using case-control psychological autopsy study, face-to-face interviews were conducted to collected information.

RESULTS

A total of 242 elderly suicide deaths and 242 matched living comparisons were investigated, including 135 males and 107 females for each group. Intraclass Correlation Coefficients (ICC) of the controls were 0.682-0.713. The median score of BHS-4 among suicides was significantly higher than that among controls. The corrected correlation coefficient between items and total score were 0.184-0.723. Cronbach's Alphas coefficient was 0.834. Only one common factor was precipitated by exploratory factor analysis and the cumulative variance contribution rates were 59.558% for suicides and 52.722% for living controls. The correlation coefficient between hopelessness and depression were 0.481 among suicide death and 0.617 among living controls.

CONCLUSION

The information provided by the informants through psychological autopsy method had high reliability to reflect the actual situation of suicides and controls. BHS-4 has good reliability and validity among Chinese rural elderly suicides. It is suitable for psychological autopsy study among Chinese rural elderly.

Family Functioning and Suicide Among the Elderly in Rural China: A Case-Control Psychological Autopsy Study

This study aimed to examine the association between family functioning and suicide among the elderly in rural China. This 1:1 paired case-control psychological autopsy study included 242 suicides at age 60 or more and an equal number of controls matched on age (±3 years), gender, and residency. Family functioning was assessed by the Family Adaptation Partnership Growth Affection Resolve Index. Family dysfunction was reported more frequently in suicides than in paired controls. Severe family dysfunction denoted a significant risk factor for suicide only in women after adjusting for potential confounding factors. Suicides with family dysfunction were prone to have unstable marital status, physical illness, mental disorders, family suicide history, and more stressful life events than those with good family functioning. The findings suggest that the intervention enhancing family functioning may be effective in decreasing suicide among the elderly in rural China.

Health Risk Assessment Indicators for the Left-Behind Elderly in Rural China: A Delphi Study

In China, many young and middle-aged rural residents move to urban areas each year. The rural elderly are left behind. The number of the rural left-behind elderly is increasing with urbanization, but it is unclear which indicators can be used to assess their health condition. The health risk assessment index system was developed to improve the health level of the rural left-behind elderly. A two-round web-based Delphi process was used to organize the recommendations from fifteen Chinese experts in geriatrics, health management, social psychology who participated in this study. Meaningfulness, importance, modifiability, and comprehensive value of the health risk assessment indicators in the index system were evaluated. The effective recovery rates of the two-round Delphi were 86.67% and 92.31%, respectively. The judgement coefficient and the authority coefficient were 0.87 and 0.82, respectively. The expert familiarity was 0.76. Ultimately, the health risk assessment index system for the rural left-behind elderly consisted of five first-level indicators, thirteen second-level indicators, and sixty-six third-level indicators. The final indicators can be used to evaluate the health of the rural left-behind elderly and provide the basis for additional health risk interventions.

Interpersonal Psychotherapy for Late-life Depression and its Potential Application in China

Interpersonal psychotherapy (IPT) is a time-limited, structured, interpersonally oriented psychotherapy, with demonstrated efficacy for the treatment of major depression across the lifespan. IPT uses a medical model of illness and links depressed mood to four research-informed interpersonal problem areas: complicated grief, role transitions, role disputes, and interpersonal deficits/sensitivity. The IPT model of vulnerability to depression nicely dovetails with interpersonal issues that are faced by older adults, and this article focuses on the application of IPT for late-life depression in China. The group format of IPT may be a practical and efficient method of improving access to an established depression-focused treatment for China's rapidly aging population and has the advantage of providing important social support for patients who feel lonely, isolated, and stigmatized. Short-term interventions like IPT are more cost-effective from a public health perspective and can easily be delivered in primary care facilities, where many elderly patients receive care. IPT is effective in different cultures, and possible cultural adaptations of IPT for older adults in China are discussed herein.

Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: A multi-center cross-sectional study

BACKGROUND

In recent years, there have been increasing calls for integrating late-life mental health services into primary care in China, but data on the epidemiology of depressive disorders in older adults receiving primary care are very limited. This study examined prevalence, correlates and recognition of depressive disorders among Chinese older adults receiving primary care.

METHODS

A total of 752 older patients (65+ years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0.

RESULTS

One-fifth (20.3%) of the older adults met DSM-IV criteria for depressive disorders during the month prior to the interview: 10.2% had major depression, 4.8% had dysthymia, and 5.3% had minor depressive disorder. The recognition rate of older patients with depressive disorders was 1.3% only. In multiple logistic regression analysis, factors significantly associated with depressive disorders included female gender (OR = 1.61), an education of primary school and below (OR = 1.69), poor financial status (OR = 2.44), poor or fair family relationship (OR = 1.66), loneliness (OR = 1.77), hypertension (OR = 1.91), heart disease (OR = 2.02), chronic gastric ulcer (OR = 6.01), and arthritis (OR = 3.55).

LIMITATIONS

Older adults from primary care clinics of economically underdeveloped regions of China were not included.

CONCLUSIONS

Depressive disorders are prevalent but poorly recognized in Chinese older adults receiving treatment in primary care clinics. In order to improve the emotional well-being and health of older adults, it is time to integrate the management of common mental disorders into primary healthcare in China.

Suicide Means Used by the Older Adults in Rural China: A Comparison Between Those Using Pesticides and Other Means

BACKGROUND

The most frequently used means of committing suicide was pesticide poisoning in rural China, yet little is known about the characteristics and risk factors for suicides committed with pesticides compared to those committed via other means in older adults.

METHODS

The participants were 242 older adults (aged 60 or older) who had committed suicide in the rural areas of 3 provinces (Shandong, Hunan, and Guangxi) in China. This study was conducted using the psychological autopsy (PA) method.

RESULTS

In univariate analyses, no statistically significant differences were found between those who committed suicide with pesticide or with other means in terms of demographic and clinical variables except age, prevalence of mental disorders, suicidal intent, number of recent life events, social support, hopelessness, impulsivity, and depressive symptoms (P > .05); age, history of suicide attempts, having pesticides available at home, the total number of life events, and the number of long-term life events were significantly different (P < .05) between the 2 groups. In multivariate logistic regression model, the factors associated with committing suicide with pesticides were the availability of pesticides at home (odds ratio [OR] = 3.48, 95% confidence interval [CI]: 1.99-6.08) and the number of long-term life events (OR = 0.87, 95% CI: 0.78-0.97).

CONCLUSION

The older adults who committed suicide by pesticides and those using other means are probably the same population. The main determinant of choosing pesticides as suicide means was likely the availability of pesticides at home. Suicide risk among older adults might be reduced by placing appropriate restrictions on access to pesticides.

Depressive Symptoms in Elderly Chinese Primary Care Patients: Prevalence and Sociodemographic and Clinical Correlates

OBJECTIVE

To estimate the prevalence of depressive symptoms (depression thereafter) and to identify the sociodemographic and clinical correlates of depression in a sample of elderly patients treated in the primary care setting in Wuhan, China.

BACKGROUND

Primary care is an opportune setting for the management of late-life depression in China, but there have been no representative studies on the clinical epidemiology of depression in elderly Chinese primary care patients.

METHODS

In total, 752 elderly patients (≥ 65 years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire. Depression was assessed with the 15-item Geriatric Depression Scale (GDS-15).

RESULTS

Of the elderly Chinese primary care patients, 30.6% had depression (GDS-15 ≥ 5). Correlates of depression were an education level of primary school or less (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.36-2.77, P < .001), poor financial status (OR: 2.19, 95% CI: 1.16-4.15, P = .016), lack of an exercise habit (OR: 1.40, 95% CI: 1.06-1.74, P = .023), 2 or more chronic medical conditions (OR: 1.90, 95% CI: 1.34-2.69, P < .001), and loneliness (OR: 3.53, 95% CI: 2.46-5.08, P < .001).

CONCLUSIONS

Depression is prevalent among elderly Chinese primary care patients, indicating that elderly patients treated in primary care have a high level of need for mental health services in China. There is an urgent need to integrate mental health services into primary health care.

Validating the Life Events Scale for the Elderly with proxy-based data: A case-control psychological autopsy study in rural China

AIM

The present study aimed to evaluate the validity of proxy informants' reports on Life Event Scale for the Elderly (LESE) by using psychological autopsy method among rural older adults in China.

METHODS

A multistage stratified cluster sampling method was used to select research sites. Using a case-control psychological autopsy study, face-to-face interviews were carried out to collect information from 242 suicide cases and 242 living controls. We compared the intensity and number of life events to assess the validity and reliability of LESE with proxy data reported by different informants. Data from proxy respondents of the living controls were compared with data reported by the targets (gold standards). Intraclass correlation coefficients were computed to evaluate the consistency of informants. Spearman's correlation analysis was used to analyze the convergent validity and discriminate validity of the LESE.

RESULTS

The number of life events between different informants showed higher intraclass correlation coefficients values than the intensity of life events, but the results of correlation analysis was similar. The LESE was positively correlated with depression, loneliness and hopelessness, and negatively correlated with quality of life, family function and social support both in suicide cases and living controls.

CONCLUSIONS

The LESE has good convergent validity and discriminant validity. LESE is a valid instrument for measuring life events in psychological autopsy studies. We suggest using the number of life events to assess the validity and reliability with proxy data in a psychological autopsy study, which is more reliable than using the intensity of life events. Geriatr Gerontol Int 2019; 19: 547-551.

Disability in Daily Living Activities, Family Dysfunction, and Late-Life Suicide in Rural China: A Case-Control Psychological Autopsy Study

Background: Although late-life suicide in rural China is a matter of concern, research is scarce addressing the association between capability of daily living activities, family function, and late-life suicide. We conducted this psychological autopsy study to explore associations between disability in daily living activities, family dysfunction, and late-life suicide in rural China. Methods: Using a 1:1 matched case-control design, we collected data from 242 elderly suicide cases and 242 living community controls in rural China using the psychological autopsy method. We used Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID), Activities of Daily Living Scale (ADL), and Family Adaptive, Partnership, Growth, Affection and Resolve scale (APGAR) to assess the presence of mental disorders, capability of daily living activities, and family function, respectively. Results: Compared with the living controls, suicide cases presented more severe impairment in capability of daily living activities and poorer family function. After controlling for all other factors, capability of daily living activities and family function remained in the final model. The results of the multivariate analysis also show that the presence of a mental disorder, lower levels of social support, and increased number of life events in the last year were significantly associated with elevated suicide risk. Conclusions: Disability in daily living activities and family dysfunction are associated with elevated risk of late-life suicide in rural China. It is warranted to design programs, including family interventions, peer-support groups, and community programs, to help the rural elderly improve activities of daily living and obtain the social support they need to prevent suicidal behaviors.