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Bae M, Kim Y, Hong I. Factors of Capital on Depression in Older Adulthood: A Comparison of Urban and Rural Regions in Korea. Healthcare (Basel) 2023; 11:2850. [PMID: 37957995 PMCID: PMC10650468 DOI: 10.3390/healthcare11212850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
This study analyses old-age capital in its economic, cultural, and social components, in terms of how it impacts on depression in the elderly, comparing urban and rural regions. Our comparative analysis in urban and rural areas focuses on South Korea, using the Korean Welfare Panel Data from 2012 to 2020. Time-series trends and variables measuring capital and depression in older adults were examined in panel data analyses. Depression among the Korean elderly was at a similar level in urban and rural areas, whereas satisfaction regarding income levels, leisure life, and social relationships was higher for older adults in rural areas. We also found that the higher the economic capital, the higher the leisure life satisfaction (cultural capital), and the higher the social relationship satisfaction (social capital), the lower the rates of depression. Finally, depression among the urban elderly did not decrease as house prices increased as a component of economic capital, and depression decreased among groups participating in volunteer activities as part of the social capital of the rural elderly. In accordance with the socioemotional selectivity theory, older adults in rural areas in Korea have an advantage in terms of cultural capital due to their environment, whereas the psychosocial environment theory is relevant to urban elderly people experiencing relative deprivation in terms of economic capital.
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Affiliation(s)
- MinYoung Bae
- Department of Social Welfare, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - YunYoung Kim
- Department of Social Welfare, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Ijin Hong
- Graduate Institute of National Development, National Taiwan University, Taipei 106216, Taiwan;
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2
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Spatial analysis of mental health and suicide clustering among older adults in North Carolina: An exploratory analysis. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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3
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Wand AP, Browne R, Jessop T, Peisah C. A systematic review of evidence-based aftercare for older adults following self-harm. Aust N Z J Psychiatry 2022; 56:1398-1420. [PMID: 35021912 DOI: 10.1177/00048674211067165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. METHODS Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. RESULTS Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. CONCLUSION Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.
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Affiliation(s)
- Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Older Peoples Mental Health Service, Jara Ward, Concord Centre for Mental Health, Sydney Local Health District, Concord, Australia
| | - Roisin Browne
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,ForeFront Motor Neuron Disease & Frontotemporal Dementia Clinic, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Tiffany Jessop
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, University of NSW (UNSW) Sydney, NSW, Australia.,Capacity Australia, Sydney, NSW, Australia
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Suicide among Older People in Different European Welfare Regimes: Does Economic (in)Security Have Implications for Suicide Prevention? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127003. [PMID: 35742251 PMCID: PMC9222638 DOI: 10.3390/ijerph19127003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 02/01/2023]
Abstract
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.
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Rodríguez Ruzafa M, Carrasco Picazo JP, Junquera Fernández G, Aguilar García-Iturrospe EJ. EUROLD: preliminary results of the ecological study on suicide and its associated socioeconomic variables in people over 85 in Europe. Int Psychogeriatr 2022; 34:1-3. [PMID: 35225213 DOI: 10.1017/s1041610222000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The present study aims to compare the suicide rates in people over 85 years of age in relation to overall suicide rates in different European countries. In addition, the study aims to perform a preliminary analysis of which socioeconomic factors could explain higher suicide rates in this age group in Europe. An analysis of the Eurostat database has been made. In this pilot phase, certain socioeconomic variables representative of people over 85 years of age were chosen based on criteria of suitability, according to the bibliography available for other regions and availability of the information provided. The conditional suicide rate in this age group with respect to the overall suicide rate in each country has been calculated. Furthermore, Spearman correlations between the suicide rates in this age group and the chosen socioeconomic factors were performed. Conditional suicide rates in people over 85 years of age show a marked difference between southern and northern European countries. In the correlational analysis, suicide in this age group was associated with different economic ratios, the old-age dependency ratio, and the self-perceived health ratio. After performing a multivariate regression, the model that best explained the differences between the European countries included the variables "old-age dependency ratio" and "economic impossibility to buy new clothes ratio." Different socioeconomic factors, specifically poverty and economic inequality, added to the old-age dependency ratio, could explain huge differences between the suicide rates in people over 85 years of age in the different European countries.
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Affiliation(s)
| | | | | | - Eduardo Jesús Aguilar García-Iturrospe
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, Valencia 46010, Spain
- Department of Psychiatry, Faculty of Medicine of Valencia, Valencia 46010, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
- Biomedical Research Institute INCLIVA, Valencia 46010, Spain
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KIM BJ, KIHL T. Suicidal ideation associated with depression and social support: a survey-based analysis of older adults in South Korea. BMC Psychiatry 2021; 21:409. [PMID: 34407801 PMCID: PMC8375215 DOI: 10.1186/s12888-021-03423-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study examined the effect of depression on suicidal ideation among older adults in South Korea. Furthermore, this study investigated how social support, as a factor that reduces depression among older adults, mediates the relationship between depression and suicidal ideation. METHODS Based on a survey of 260 older adults in Seoul and Gyeonggi Province, suicidal ideation, depression, and social support were evaluated using the Beck Scale for Suicidal Ideation, the Center of Epidemiological Studies Depression Scale, and the Measurement of Social Support in the Elderly, respectively. RESULTS A multiple regression analysis confirmed that depression and social support were significantly associated with suicidal ideation. Based on path analysis, we found that social support mediated the relationship between depression and suicidal ideation. CONCLUSIONS Therefore, this study provides concrete insights for policymakers and social workers about how suicidal ideation among older adults may be diminished. Particularly, the role of depression and social support in suicidal ideation is a matter of concern for older adults in South Korea.
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Affiliation(s)
- Bum Jung KIM
- grid.254224.70000 0001 0789 9563Department of Social Welfare, Chung-Ang University, Seoul, South Korea
| | - Taesuk KIHL
- grid.263136.30000 0004 0533 2389Graduate School, Sangmyung University, Seoul, South Korea
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Still ready to give up on life? A longitudinal phenomenological study into wishes to die among older adults. Soc Sci Med 2021; 284:114180. [PMID: 34266673 DOI: 10.1016/j.socscimed.2021.114180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/11/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE There is a paucity of empirical studies exploring wishes to die (WTD) in older adults without a life-threatening disease or psychiatric disorder, especially on how these WTD evolve over time. OBJECTIVE This study aims to deepen our understanding of living with a WTD by elucidating multifaceted trajectories of death wishes in older adults without a life-threatening disease or psychiatric disorder. METHODS Interviews were conducted between 2013 and 2019 with Dutch men and women aged 70 and older who expressed a WTD (preferably at a self-chosen moment). Using a phenomenological, longitudinal analysis approach, 35 serial interviews were analyzed. RESULTS This resulted in four thematic meanings following four trajectories, namely: 1) a realized WTD, facing the ultimate decision with both freedom and a sense of fate; 2) an intensifying WTD, reaching a deadlock; 3) a diminishing WTD, experiencing tentative space for new possibilities; and 4) a vanishing WTD, being surprised by an unexpected turn. In the cases examined, the individuals' WTD was characterized by ambivalence and subject to change over time. Fluctuating, often asynchronous patterns of physical, social, psychological, and existential distress were lived intertwined. The WTD should thus be understood as dynamic and unpredictable, often impacted by external circumstances. CONCLUSIONS An important clinically relevant finding is that even persons with a pronounced WTD can experience openness to new possibilities, leading to a diminished or vanished WTD and/or desire to act on their WTD. Often such changes were related to (re-)establishment of connections with other people and/or society or with themselves. Since most research in this area is cross-sectional, the current longitudinal findings of this study are unique in providing insight into changes over time, thus contributing to the fields of death and suicide studies.
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8
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Fitzpatrick SJ, Read D, Brew BK, Perkins D. A sociological autopsy lens on older adult suicide in rural Australia: Addressing health, psychosocial factors and care practices at the intersection of policies and institutions. Soc Sci Med 2021; 284:114196. [PMID: 34271402 DOI: 10.1016/j.socscimed.2021.114196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
This paper examines the interrelationship between suicide, health, socioeconomic, and psychosocial factors in contributing to suicide in older adults in rural Australia. Drawing on a coronial dataset of suicide cases and a mixed methods sociological autopsy approach, our study integrated a quantitative analysis of 792 suicide cases with a qualitative analysis of medico-legal reports from 30 cases. The sociological autopsy provided novel insights into the entanglement of policy and service provision at the state-level with individual end-of-life decisions. Particular attention is drawn to age and gendered dimensions of suicide, especially in relation to health and social issues. The study showed a continuity between suicide and the patterning of an individual's life course, including experiences and consequences of inequality and marginality; a desire to meet culturally-normative ideals of autonomy; and a fragmented, under-funded, and intimidating social care system that offered limited options.
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Affiliation(s)
- Scott J Fitzpatrick
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia.
| | - Donna Read
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Bronwyn K Brew
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, School of Women and Children's Health, University of New South Wales, Sydney, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
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9
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Kwak M, Ahn S. Childhood adversity predicted suicidal ideation in older age: Results from a National Survey in Korea. Aging Ment Health 2020; 24:1141-1148. [PMID: 31129992 DOI: 10.1080/13607863.2019.1616161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Suicide is a major mental health concern in South Korea, where a rapid increase in suicide rates among older adults is evident. This study aims to understand the association of childhood adversity with suicidal ideation in later life, and whether gender differences in the effects of childhood adversity exist.Method: The sample consisted of older adults aged 60 years and more in six waves of the Korea Welfare Panel Study from 2012 to 2017 (N = 4,105). A mixed effect logistic regression with random intercept was used to test the effects of childhood adversity on the risk of 12-month suicidal ideation.Results: After controlling for socioeconomic status, psychosocial resources, and health conditions, the mixed effect models using longitudinal data indicated that parental death predicted an increased risk of suicidal ideation and that a greater number of childhood adversities predicted a higher likelihood of suicidal ideation. No gender differences were found in the effects of childhood adversity on suicidal thoughts.Conclusion: These findings support a life course perspective, highlighting the importance of assessing early life disadvantages to understand suicidal ideation among older adults. The findings suggest that interventions targeting older adults who experienced parental death in childhood or multiple adversities may be effective in preventing suicidal ideation.
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Affiliation(s)
- Minyoung Kwak
- Department of Social Welfare, Daegu University, Daegu, South Korea
| | - Seoyeon Ahn
- Pension Research Division, National Pension Research Institute, Jeonju, South Korea
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10
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Abstract
PURPOSE OF REVIEW This review aims to discuss situations where patients would prefer to consider dying rather than survive, particularly in the context of choosing whether to be subjected to active medical management aimed at increasing their life span. RECENT FINDINGS Obviously, there are no randomized trials on evaluating whether patients would choose death rather than life. Moreover, the topic of the review is rarely addressed in a conventional scientific way. Instead, we review the suffering that people may go through when receiving futile care in both the short and long-term in acute hospitals and how this may influence people's decisions about their own Goals of Care. SUMMARY The review describes the failure of acute hospitals to recognize people at the end of life until very late and, when they are recognized, the failure to manage the dying process well. The inference is that if patients were genuinely aware of the potential short and long-term suffering involved in futile care, they would consider those states worse, may be worse than death, especially when death is almost certainly inevitable with or without conventional treatment.
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11
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Wand APF, Peisah C, Draper B, Brodaty H. Carer insights into self-harm in the very old: A qualitative study. Int J Geriatr Psychiatry 2019; 34:594-600. [PMID: 30592092 DOI: 10.1002/gps.5057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 12/20/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the insights of carers to better understand self-harm in their older relatives. METHODS An in-depth interview was conducted with the nominated relative/friend (carer) of a person over 80 who had self-harmed within the last month. Carer interpretation and experience of the self-harm and clinical care were explored qualitatively. Audio recordings were transcribed and the content thematically analyzed using N-VIVO. RESULTS Thirty-two carers of 30 older people who self-harmed were interviewed. Physical, social, and psychological issues were identified as contributory to self-harm. Themes relating to the perceived barriers to seeking help included "they can't communicate," "suicide and secrets," and "invalidation." Themes for the intent of self-harm were "attention seeking" and "wanting to die." Themes which emerged for consequences of self-harm for carers were "anger," "guilt and self-blame," and "it made us ill." Themes for solutions to address the underlying factors leading to self-harm were "more practical support and structure," "improving communication," "removing means of self-harm," "advance care directives as a solution for suffering," and "ignoring self-harm." Clinical care themes were "shared shame and stigma," "safety and supervision vs being locked up," "clinicians dismissing the carer," and "relief and support." CONCLUSIONS Validation of carer perspectives and understanding family dynamics may improve communication at various system levels and inform interventions for older persons, concurrently support families, and potentially reduce risk of repeat self-harm. Good care must be holistic, be person-centred, and relieve carer burden. A shared understanding and psychotherapeutic approaches to management of self-harm in late life should be considered.
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Affiliation(s)
- Anne Pamela Frances Wand
- Academic Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia.,Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Brian Draper
- Academic Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Discipline of Psychiatry, School of Medicine, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Academic Department of Aged Care Psychiatry, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration and Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Fry M, Abrahamse K, Kay S, Elliott RM. Suicide in older people, attitudes and knowledge of emergency nurses: A multi-centre study. Int Emerg Nurs 2019; 43:113-118. [PMID: 30711435 DOI: 10.1016/j.ienj.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Suicide in older people is a public health concern. Emergency nurses are ideally placed to identify suicide risk. Therefore, the aim of this research was to explore emergency nurses' knowledge, confidence and attitudes about suicide in older people. METHODS This descriptive exploratory study was conducted in four emergency departments in Sydney, Australia. Data were collected using a 28-item survey from a convenience sample of emergency nurses. Descriptive quantitative statistics and conventional content analysis were performed. Ethics approval was provided. RESULTS The response rate was 58% (n = 136); the majority were female with an average of seven years emergency experience. The majority (n = 124, 91%) reported that they frequently managed suicidal behaviour and recognized suicide as a common event (80%). 51% (n = 69) recognized that suicide was a common event for older people. Only 16% (n = 22) reported receiving suicide prevention training with 11% feeling confident in managing suicidal behaviour. CONCLUSION The findings contribute to the discourse on how suicide in older people is recognised by emergency nurses. Few nurses considered it a problem for older people and were not confident about their knowledge. There is a need for suicide prevention training as a priority particularly to identify risks in older people.
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Affiliation(s)
- Margaret Fry
- Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
| | - Kirsten Abrahamse
- Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.
| | - Steve Kay
- Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.
| | - Rosalind M Elliott
- Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
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Abstract
Arthritis is not only a chronic disease but also causes physical inactivity. We investigated the association between arthritis and quality of life and psychological problems, as measured by suicidal ideation. We used data from the 2013 Community Health Survey, and 162,598 persons aged 40 years and older were included as study subjects. Our main focus was to investigate association of arthritis with suicidal ideation and quality of life. Multivariate survey logistic regression analysis was used to estimate the odds ratio for suicidal ideation, and multivariate survey linear regression analysis used to identify associations between variables and scores on the EuroQol Visual Analogue Scale(EQ-VAS). 8.30% of male and 13.90% of female experienced suicidal ideation, and 16.17% of and 21.23% of female suffered from arthritis. Individuals with arthritis were more likely to report suicidal ideation and have lower health-related quality of life (HRQOL) scores. Furthermore, higher rates of suicidal ideation and lower HRQOLs were also associated with older age, low income and less education. Arthritis was associated with higher rates of suicidal ideation and lower HRQOL scores. These results should contribute to the development and implementation of polices and management strategies to alleviate suicidal ideation and increase HRQOL scores among arthritis patients.
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Affiliation(s)
- Jeong Hun Park
- a Research Planning and Coordination Department , Korea Institute for Health and Social Affairs , Sejong , Republic of Korea
| | - Dong Jun Kim
- b Department of Health Administration and Management , Soonchunhyang University Graduate School , Asan , Republic of Korea.,c Center for Healthcare Management Science , Soonchunhyang University , Asan , Republic of Korea
| | - Sun Jung Kim
- c Center for Healthcare Management Science , Soonchunhyang University , Asan , Republic of Korea.,d Department of Health Administration and Management, College of Medical Science , Soonchunhyang University , Asan , Republic of Korea
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Wand APF, Peisah C, Draper B, Brodaty H. Understanding self-harm in older people: a systematic review of qualitative studies. Aging Ment Health 2018; 22:289-298. [PMID: 28326821 DOI: 10.1080/13607863.2017.1304522] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Rates of suicide in older adults are generally higher than other age groups. Although risk factors for suicide attempts, and self-harm more generally, in this population are well-characterised, many of these vulnerabilities are common to older people and individual motivations are less well understood. Qualitative research may reveal more about the underlying thought processes, meaning and experiences of older people who self-harm. METHODS A systematic review of qualitative studies examining the reasons why older people have self-harmed was undertaken by searching databases and screening the reference lists of articles. The quality of studies was critically appraised. A content analysis was performed to identify themes. RESULTS The search yielded eight studies of variable quality which met the inclusion criteria; three pertained to indirect self-harm (refusal to eat or take medications and self-neglect) and five related to suicidal behaviour. Themes emerging from the analysis of studies of people who had self-neglected included control, impaired decision-making and coping skills and threats to self-identity and continuity. In those who had suicidal behaviour, themes related to loss of and regaining control; alienation, disconnectedness and invisibility; meaningless and raison d'etre; and accumulated suffering and a 'painful life'. CONCLUSIONS There is scant literature evaluating self-harm in older people using qualitative methods. Nonetheless, this review suggests that active and passive self-harm should be considered as distinct entities as the underlying motivations and intents differ. Understanding individual perceptions and experiences which lead to self-harm may guide clinicians in delivering more sensitive, holistic interventions and counter ageism.
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Affiliation(s)
- Anne Pamela Frances Wand
- a Department of Aged Care Psychiatry , Prince of Wales Hospital , Sydney , Australia.,b Discipline of Psychiatry, School of Medicine , University of New South Wales , Sydney , Australia
| | - Carmelle Peisah
- b Discipline of Psychiatry, School of Medicine , University of New South Wales , Sydney , Australia.,c Discipline of Psychiatry, Sydney Medical School , University of Sydney , Sydney , Australia.,d Capacity Australia , New South Wales , Australia
| | - Brian Draper
- a Department of Aged Care Psychiatry , Prince of Wales Hospital , Sydney , Australia.,b Discipline of Psychiatry, School of Medicine , University of New South Wales , Sydney , Australia
| | - Henry Brodaty
- e Dementia Collaborative Research Centre and Centre for Healthy Brain Ageing , University of New South Wales , Sydney , Australia
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15
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Rational Suicide, Euthanasia, and the Very Old: Two Case Reports. Case Rep Psychiatry 2016; 2016:4242064. [PMID: 27833774 PMCID: PMC5090095 DOI: 10.1155/2016/4242064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/26/2016] [Indexed: 01/08/2023] Open
Abstract
Suicide amongst the very old is an important public health issue. Little is known about why older people may express a wish to die or request euthanasia and how such thoughts may intersect with suicide attempts. Palliative care models promote best care as holistic and relieving suffering without hastening death in severely ill patients; but what of those old people who are tired of living and may have chronic symptoms, disability, and reduced quality of life? Two cases of older people who attempted suicide but expressed a preference for euthanasia were it legal are presented in order to illustrate the complexity underlying such requests. The absence of a mood or anxiety disorder underpinning their wishes to die further emphasises the importance of understanding the individual's narrative and the role of a formulation in guiding broad biopsychosocial approaches to management.
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16
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Kim JL, Kim JM, Choi Y, Lee TH, Park EC. Effect of Socioeconomic Status on the Linkage Between Suicidal Ideation and Suicide Attempts. Suicide Life Threat Behav 2016; 46:588-597. [PMID: 26991513 DOI: 10.1111/sltb.12242] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 12/16/2015] [Indexed: 11/27/2022]
Abstract
Previous suicide attempts are a leading risk factor for completed suicide. To identify specific characteristics of those at high risk for attempts, we investigated associations with socioeconomic status (SES). Data from the 2013 Korean Community Health Survey (KCHS) included adults who reported suicidal ideation (N = 220,245). Attempts in the past 12 months were assessed. Associations of demographic, socioeconomic, and suicide-related behavioral factors were analyzed using multiple logistic regression. Among those with suicidal ideation, 862 (3.9%) had attempted suicide. After stratification by age and gender, results showed that low education and unemployed young adult men and women had significantly higher rates of attempts. The lowest income level was associated with significantly higher rates of attempts in only young adult women. Among those with the lowest and highest income, the association between ideation and attempts was attenuated, whereas it was enhanced among other income groups.
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Affiliation(s)
- Jeong Lim Kim
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea.,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Man Kim
- Department of Health Business Administration, Woosong University, Daejeon, Korea
| | - Young Choi
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea.,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Lee
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea.,Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea. .,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
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17
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Sinyor M, Tan LPL, Schaffer A, Gallagher D, Shulman K. Suicide in the oldest old: an observational study and cluster analysis. Int J Geriatr Psychiatry 2016; 31:33-40. [PMID: 25809553 DOI: 10.1002/gps.4286] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The older population are at a high risk for suicide. This study sought to learn more about the characteristics of suicide in the oldest-old and to use a cluster analysis to determine if oldest-old suicide victims assort into clinically meaningful subgroups. METHODS Data were collected from a coroner's chart review of suicide victims in Toronto from 1998 to 2011. We compared two age groups (65-79 year olds, n = 335, and 80+ year olds, n = 191) and then conducted a hierarchical agglomerative cluster analysis using Ward's method to identify distinct clusters in the 80+ group. RESULTS The younger and older age groups differed according to marital status, living circumstances and pattern of stressors. The cluster analysis identified three distinct clusters in the 80+ group. Cluster 1 was the largest (n = 124) and included people who were either married or widowed who had significantly more depression and somewhat more medical health stressors. In contrast, cluster 2 (n = 50) comprised people who were almost all single and living alone with significantly less identified depression and slightly fewer medical health stressors. All members of cluster 3 (n = 17) lived in a retirement residence or nursing home, and this group had the highest rates of depression, dementia, other mental illness and past suicide attempts. CONCLUSIONS This is the first study to use the cluster analysis technique to identify meaningful subgroups among suicide victims in the oldest-old. The results reveal different patterns of suicide in the older population that may be relevant for clinical care.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Lynnette Pei Lin Tan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Damien Gallagher
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Kenneth Shulman
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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van Wijngaarden E, Leget C, Goossensen A. Experiences and Motivations Underlying Wishes to Die in Older People Who Are Tired of Living: A Research Area in its Infancy. OMEGA-JOURNAL OF DEATH AND DYING 2014; 69:191-216. [DOI: 10.2190/om.69.2.f] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The wish to die in older people who are tired of living and the possibilities to organize death are currently being discussed within the debate on self-determination and physician-assisted suicide. Until now insight into the experiences and thoughts of people who are tired of life but not suffering from a severe depression or a life-threatening disease is lacking. Studies focussing specifically on this topic are rare. This review provides an overview of this research area in its infancy. The existential impact of age-related loss experiences play an important role in developing a wish to die. Other influencing factors are: personal characteristics, biographical factors, social context, perceptions and values. Further research to experiences and motivations underlying these specific age-related wishes to die and the existential impact of the loss-experiences seems necessary to deepen the understanding of this group of older people and for the development of policy and good care.
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19
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Wu J, Värnik A, Tooding LM, Värnik P, Kasearu K. Suicide among older people in relation to their subjective and objective well-being in different European regions. Eur J Ageing 2013; 11:131-140. [PMID: 28804321 DOI: 10.1007/s10433-013-0297-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to establish how different types of welfare states shape the context of the everyday life of older people by influencing their subjective well-being, which in turn might manifest itself in suicide rates. Twenty-two European countries studied were divided into Continental, Nordic, Island, Southern, and post-socialist countries, which were subdivided into Baltic, Slavic, and Central-Eastern groups based on their socio-political and welfare organization. Suicide rates, subjective well-being data, and objective well-being data were used as parameters of different welfare states and obtained from the World Health Organization European Mortality Database, European Social Survey, and Eurostat Database. This study revealed that the suicide rates of older people were the highest in the Baltic countries, while in the Island group, the suicide rate was the lowest. The suicide rate ratios between the age groups 65+ and 0-64 were above 1 (from 1.2 to 2.5), except for the group of the Island countries with a suicide rate ratio of 0.8. Among subjective well-being indicators, relatively high levels of life satisfaction and happiness were revealed in Continental, Nordic, and Island countries. Objective well-being indicators like old age pension, expenditure on old age, and social protection benefits in GDP were the highest in the Continental countries. The expected inverse relationship between subjective well-being indicators and suicide rates among older people was found across the 22 countries. We conclude that welfare states shape the context and exert influence on subjective well-being, and thus may lead to variations in risk of suicide at the individual level.
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Affiliation(s)
- Jing Wu
- Estonian-Swedish Mental Health and Suicidology Institute, Õie 39, 11615 Tallinn, Estonia.,Institute of Social Work, Tallinn University, Narva mnt 25, 10120 Tallinn, Estonia
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute, Õie 39, 11615 Tallinn, Estonia.,Institute of Social Work, Tallinn University, Narva mnt 25, 10120 Tallinn, Estonia.,Institute of Sociology and Social Policy, University of Tartu, Lossi 36-417, 51003 Tartu, Estonia
| | - Liina-Mai Tooding
- Institute of Sociology and Social Policy, University of Tartu, Lossi 36-417, 51003 Tartu, Estonia
| | - Peeter Värnik
- Estonian-Swedish Mental Health and Suicidology Institute, Õie 39, 11615 Tallinn, Estonia.,The Estonian Institute for Population Studies, Tallinn University, Narva mnt 25, 10120 Tallinn, Estonia
| | - Kairi Kasearu
- Institute of Sociology and Social Policy, University of Tartu, Lossi 36-417, 51003 Tartu, Estonia
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Injeong Lee. Moderating Effects of Life Problems, Social Support on the Relationship between Depression and Suicidal Ideation of Older People. ACTA ACUST UNITED AC 2011. [DOI: 10.15709/hswr.2011.31.4.34] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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