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Lee H, Singh GK, Jemal A, Islami F. Living alone and cancer mortality by race/ethnicity and socioeconomic status among US working-age adults. Cancer 2024; 130:86-95. [PMID: 37855867 DOI: 10.1002/cncr.35042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/26/2023] [Accepted: 08/28/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Previous studies have shown an association between living alone and cancer mortality; however, findings by sex and race/ethnicity have generally been inconsistent, and data by socioeconomic status are sparse. The association between living alone and cancer mortality by sex, race/ethnicity, and socioeconomic status in a nationally representative US cohort was examined. METHODS Pooled 1998-2019 data for adults aged 18-64 years at enrollment from the National Health Interview Survey linked to the National Death Index (N = 473,648) with up to 22 years of follow-up were used to calculate hazard ratios (HRs) for the association between living alone and cancer mortality. RESULTS Compared to adults living with others, adults living alone were at a higher risk of cancer death in the age-adjusted model (HR, 1.32; 95% CI, 1.25-1.39) and after additional adjustments for multiple sociodemographic characteristics and cancer risk factors (HR, 1.10; 95% CI, 1.04-1.16). Age-adjusted models stratified by sex, poverty level, and educational attainment showed similar associations between living alone and cancer mortality, but the association was stronger among non-Hispanic White adults (HR, 1.33; 95% CI, 1.25-1.42) than non-Hispanic Black adults (HR, 1.18; 95% CI, 1.05-1.32; p value for difference < .05) and did not exist in other racial/ethnic groups. These associations were attenuated but persisted in fully adjusted models among men (HR, 1.13; 95% CI, 1.05-1.23), women (HR, 1.09; 95% CI, 1.01-1.18), non-Hispanic White adults (HR, 1.13; 95% CI, 1.05-1.20), and adults with a college degree (HR, 1.22; 95% CI, 1.07-1.39). CONCLUSIONS In this nationally representative study in the United States, adults living alone were at a higher risk of cancer death in several sociodemographic groups.
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Affiliation(s)
- Hyunjung Lee
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Gopal K Singh
- Office of Health Equity, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Farhad Islami
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
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Jørgensen M, Smith OR, Wold B, Bøe T, Haug E. Tracking of depressed mood from adolescence into adulthood and the role of peer and parental support: A partial test of the Adolescent Pathway Model. SSM Popul Health 2023; 23:101440. [PMID: 37691980 PMCID: PMC10492161 DOI: 10.1016/j.ssmph.2023.101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 09/12/2023] Open
Abstract
•Adolescent depressed mood predicts adult depressed mood.•Peer acceptance during adolescence is not associated with adult depressed mood.•Household income moderates the effect of parental closeness on adult depressed mood.
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Affiliation(s)
- Magnus Jørgensen
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Otto R.F. Smith
- Norwegian Institute of Public Health, Bergen, Norway
- Department of Teacher Education, NLA University College, Bergen, Norway
| | - Bente Wold
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Tormod Bøe
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Ellen Haug
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
- Department of Teacher Education, NLA University College, Bergen, Norway
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Wang J, Zhang WS, Jiang CQ, Zhu F, Jin YL, Thomas GN, Cheng KK, Lam TH, Xu L. Persistence of social isolation and mortality: 10-year follow-up of the Guangzhou Biobank Cohort study. Psychiatry Res 2023; 322:115110. [PMID: 36827858 DOI: 10.1016/j.psychres.2023.115110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
Although social isolation has been associated with higher mortality risk, the associations of persistence of social isolation with mortality are unclear. We investigated the prospective associations of intermittent and persistent social isolation with all-cause and cause-specific mortality, considering the social contact types (face-to-face and non-face-to-face). 30,518 participants were recruited in 2003-2008 initially and 18,104 participants with re-assessed social isolation information in 2008-2012 were followed up to Dec 2019 in Guangzhou Biobank Cohort Study (GBCS). During an average of 9.7 years of follow-up, 2,119 deaths occurred. The isolation at baseline survey, isolation at second survey and persistent isolation were positively associated with all-cause mortality in the minimal adjusted model (adjusted hazard ratio (AHR) =1.24, 95% CI 1.12-1.38, 1.11, 1.00-1.23 and 1.23, 1.05-1.43, respectively). Totally 47.2% of the risk was explained by health status, SEP, and biological, behavioural and psychological factors. Persistent isolation from face-to-face with co-inhabitants, versus no isolation, was associated with higher risks of all-cause (HR=1.40, 1.09-1.81) and CVD (subdistribution hazard ratio (SHR)=1.92, 1.31-2.81) mortality in fully adjusted model. Our study showed that intermittent and persistent isolation were generally associated with higher risks of mortality, and the risks were even higher in those with persistent face-to-face isolation with co-inhabitants.
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Affiliation(s)
- Jiao Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wei Sen Zhang
- Guangzhou Twelfth People's Hospital, Guangzhou, China.
| | | | - Feng Zhu
- Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Ya Li Jin
- Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Graham Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, China; School of Public Health, The University of Hong Kong, Hong Kong, China.
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Kammar-García A, Ramírez-Aldana R, Roa-Rojas P, Lozano-Juárez LR, Sánchez-García S, Tella-Vega P, García-Peña C. Association of loneliness and social isolation with all-cause mortality among older Mexican adults in the Mexican health and aging study: a retrospective observational study. BMC Geriatr 2023; 23:45. [PMID: 36698115 PMCID: PMC9876411 DOI: 10.1186/s12877-023-03750-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Plenty of evidence shows how social isolation and loneliness are associated with increased risk for numerous diseases and mortality. But findings about their interactive or combined effects on health outcomes and mortality remains inconclusive. OBJECTIVE Analyze the longitudinal association of loneliness, social isolation and their interactions, with the all-cause mortality among older adults in Mexico. METHODS A retrospective observational study was conducted. Mexican adults older than 50 years were included. Data from the Mexican Health and Aging Study (MHAS) in the 2015 and 2018 waves were used. The subjects were classified according to their level of loneliness and the presence of social isolation. Multivariate logistic regression analyzes were performed to determine the degree of association between loneliness and social isolation with all-cause mortality at a 3-year follow-up. RESULTS From the total sample of 11,713 adults aged 50 years or over, 707 (6%) did not survive, 42% presented loneliness, and 53% were classified as socially isolated. After multivariate adjustment only social isolation (OR = 1.30, 95%CI:1.03-1.64) was associated with all-cause mortality, loneliness (Mild: OR = 0.83, 95%CI:0.59-1.16; Severe: OR = 1.03, 95%CI:0.71-1.64), and the interaction between loneliness and social isolation were not associated with all-cause mortality. CONCLUSION Social isolation, but not loneliness or their interaction, was associated with all-cause mortality in Mexican adults older than 50 years. This finding may help direct possible future interventions that help improve mental health in older adults from a highly collectivistic country.
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Affiliation(s)
| | | | - Paloma Roa-Rojas
- Health Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
| | | | - Sergio Sánchez-García
- Epidemiological Research Unit and Health Services, Aging Area, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Pamela Tella-Vega
- Health Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Carmen García-Peña
- Health Research Director, Instituto Nacional de Geriatría, Mexico City, Mexico.
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Associations of face-to-face and non-face-to-face social isolation with all-cause and cause-specific mortality: 13-year follow-up of the Guangzhou Biobank Cohort study. BMC Med 2022; 20:178. [PMID: 35501792 PMCID: PMC9059436 DOI: 10.1186/s12916-022-02368-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although social isolation has been associated with a higher mortality risk, little is known about the potential different impacts of face-to-face and non-face-to-face isolation on mortality. We examined the prospective associations of four types of social isolation, including face-to-face isolation with co-inhabitants and non-co-inhabitants, non-face-to-face isolation, and club/organization isolation, with all-cause and cause-specific mortality separately. METHODS This prospective cohort study included 30,430 adults in Guangzhou Biobank Cohort Study (GBCS), who were recruited during 2003-2008 and followed up till Dec 2019. RESULTS During an average of 13.2 years of follow-up, 4933 deaths occurred during 396,466 person-years. Participants who lived alone had higher risks of all-cause (adjusted hazard ratio (AHR) 1.24; 95% confidence interval (CI) 1.04-1.49) and cardiovascular disease (CVD) (1.61; 1.20-2.03) mortality than those who had ≥ 3 co-habitant contact after adjustment for thirteen potential confounders. Compared with those who had ≥ 1 time/month non-co-inhabitant contact, those without such contact had higher risks of all-cause (1.60; 1.20-2.00) and CVD (1.91; 1.20-2.62) mortality. The corresponding AHR (95% CI) in participants without telephone/mail contact were 1.27 (1.14-1.42) for all-cause, 1.30 (1.08-1.56) for CVD, and 1.37 (1.12-1.67) for other-cause mortality. However, no association of club/organization contact with the above mortality and no association of all four types of isolation with cancer mortality were found. CONCLUSIONS In this cohort study, face-to-face and non-face-to-face isolation were both positively associated with all-cause, CVD-, and other-cause (but not cancer) mortality. Our finding suggests a need to promote non-face-to-face contact among middle-aged and older adults.
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Marital status, educational attainment, and suicide risk: a Norwegian register-based population study. Popul Health Metr 2021; 19:33. [PMID: 34247635 PMCID: PMC8273935 DOI: 10.1186/s12963-021-00263-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background The presence and quality of social ties can influence suicide risk. In adulthood, the most common provider of such ties is one’s partner. As such, the link between marital status and suicide is well-documented, with lower suicide risk among married. However, the association between marital status and educational level suggest that marriage is becoming a privilege of the better educated. The relationship between educational attainment and suicide is somewhat ambiguous, although several studies argue that there is higher suicide risk among the less educated. This means that unmarried with low education may concurrently experience several risk factors for suicide. However, in many cases, these associations apply to men only, making it unclear whether they also refer to women. We aim to investigate the association between marital status, educational attainment, and suicide risk, and whether these associations differ across sexes. Methods Our data consist of Norwegian residents aged 35–54, between 1975 and 2014. Using personal identification-numbers, we linked information from various registers, and applied event history analysis to estimate suicide risk, and predicted probabilities for comparisons across sexes. Results Overall, associations across sexes are quite similar, thus contradicting several previous studies. Married men and women have lower suicide risk than unmarried, and divorced and separated have significant higher odds of suicide than never married, regardless of sex. Low educational attainment inflates the risk for both sexes, but high educational attainment is only associated with lower risk among men. Being a parent is associated with lower suicide risk for both sexes. Conclusions Higher suicide risk among the divorced and separated points to suicide risk being associated with ceasing of social ties. This is the case for both sexes, and especially those with low educational attainment, which both healthcare professionals and people in general should be aware of in order to promote suicide prevention.
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Koh-Bell A, Chan J, Mann AK, Kapp DS. Social isolation, inflammation, and cancer mortality from the National Health and Nutrition Examination Survey - a study of 3,360 women. BMC Public Health 2021; 21:1289. [PMID: 34210304 PMCID: PMC8252233 DOI: 10.1186/s12889-021-11352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluates the role of social isolation on inflammation and cancer mortality among women. Methods Data were abstracted from the U.S. National Health and Nutrition Examination Survey from 1988 to 1994. The Social Network Index was used to assess participants’ degree of social isolation. C-reactive protein and fibrinogen levels were included as markers of inflammation. We used the National Death Index to identify causes and dates of mortality. Chi-square and multivariable Cox regressions were employed for statistical analyses. Results Of 3360 women (median age: 54 years), the most isolated, very isolated, somewhat isolated, and not isolated comprised 14.5, 30.2, 37.1, and 18.2% of the sample, respectively. The most isolated participants were more likely to have low income (56.8% vs 12.2%, p < 0.001), have fewer years of education (40.8% vs 12.3%; p < 0.001), have low physical activity (27.3% vs 14.7%; p < 0.003), be obese (32.5% vs 24.4%; p = 0.02), and be current smokers (34.2% vs 10.3%; p < 0.001) compared to the not isolated ones. Mean fibrinogen levels increased with degree of social isolation (p = 0.003), but C-reactive protein showed no association (p = 0.52). Kaplan-Meier estimates indicated higher cancer mortality rates among participants with elevated fibrinogen levels, though not with statistical significance (p = 0.08). Furthermore, there was no association between social isolation and cancer mortality (p = 0.54). On multivariate analysis, obesity (HR = 1.56; 95% CI: 1.11–2.18), higher education (HR = 1.36; 95% CI: 1.01–1.83), and smoking (HR = 4.42, 95% CI: 2.84–6.88) were independent predictors for cancer mortality, while high physical activity predicted for lower mortality from cancer (HR = 0.67, 95% CI: 0.51–0.87). However, social isolation was not a predictor. Conclusion Social isolation among women was associated with an increased level of fibrinogen, but not associated with cancer mortality. The relationship between inflammation and cancer mortality warrants further investigation. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11352-0.
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Affiliation(s)
| | | | - Amandeep K Mann
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA.
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
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Social Isolation and Its Impact on the Geriatric Community. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Luo F, Guo L, Thapa A, Yu B. Social isolation and depression onset among middle-aged and older adults in China: Moderating effects of education and gender differences. J Affect Disord 2021; 283:71-76. [PMID: 33524661 DOI: 10.1016/j.jad.2021.01.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/03/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Most studies exploring the association between social isolation and depression tend to focus on Western countries. The primary aim of this longitudinal study was to examine the association between social isolation and depression onset among middle-aged and older adults in China. METHODS Data on 6,817 participants (mean age = 57.91, SD = 8.77; men, 52.1%) from the first and fourth waves of the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Binary logistic regressions were used to evaluate the association between social isolation and depression onset. The moderating effects of socioeconomic status (education) and gender differences were also examined. RESULTS Social isolation was significantly associated with depression onset (OR = 1.24, 95% CI = 1.10-1.41). Compared to men with lower education (OR = 0.97, 95% CI = 0.77-1.23), those with higher education (OR = 1.91, 95% CI = 1.40-2.60) exhibited a greater association between social isolation and depression onset. Moderating effect of education was not found for women. LIMITATIONS Depression were self-reported, which might be less reliable than clinical interview. CONCLUSIONS Our results suggested that high level of social isolation was significantly associated with a higher incidence of depression among middle-aged and older adults in China. Education played a moderating role in this association for men rather than women.
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Affiliation(s)
- Fengping Luo
- Department of Psychiatry and Psychology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Lizhi Guo
- School of Education, Tianjin University, Tianjin, China; Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Amrish Thapa
- Department of Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Bin Yu
- Department of Psychiatry and Psychology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.
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Calati R, Ferrari C, Brittner M, Oasi O, Olié E, Carvalho AF, Courtet P. Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. J Affect Disord 2019; 245:653-667. [PMID: 30445391 DOI: 10.1016/j.jad.2018.11.022] [Citation(s) in RCA: 289] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/27/2018] [Accepted: 11/03/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Social isolation is one of the main risk factors associated with suicidal outcomes. The aim of this narrative review was to provide an overview on the link between social isolation and suicidal thoughts and behaviors. METHODS We used the PubMed database to identify relevant articles published until April 13, 2018. We focused on: (a) systematic reviews, meta-analyses, and narrative reviews; (b) original observational studies with large samples (N ≥ 500); and (c) qualitative studies. We included all relevant suicidal outcomes: suicidal ideation (SI), suicidal planning, non-suicidal self-injury, deliberate self-harm, suicide attempt (SA), and suicide. RESULTS The main social constructs associated with suicidal outcomes were marital status (being single, separated, divorced, or widowed) and living alone, social isolation, loneliness, alienation, and belongingness. We included 40 original observational studies, the majority of them performed on adolescents and/or young adults (k = 23, 57.5%). Both the objective condition (e.g., living alone) and the subjective feeling of being alone (i.e., loneliness) were strongly associated with suicidal outcomes, in particular with SA and SI. However, loneliness, which was investigated in most studies (k = 24, 60%), had a major impact on both SI and SA. These associations were transculturally consistent. LIMITATIONS Confounding factors can limit the weight of the results obtained in observational studies. CONCLUSIONS Data from the observational studies suggest that both objective social isolation and the subjective feeling of loneliness should be incorporated in the risk assessment of suicide. Interventional studies targeting social isolation for suicide prevention are needed.
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Affiliation(s)
- Raffaella Calati
- INSERM, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France; Department of Psychiatry, Mount Sinai Beth Israel, New York, USA.
| | - Chiara Ferrari
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Marie Brittner
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Osmano Oasi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Emilie Olié
- INSERM, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - André F Carvalho
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Philippe Courtet
- INSERM, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
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Sang J, Ji Y, Li P, Zhao H. Effect of perceived organizational support on suicidal ideation of young employees: The mediator role of self-esteem. J Health Psychol 2016; 22:1357-1364. [PMID: 26865539 DOI: 10.1177/1359105315627501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to explore the relationships among perceived organizational support, self-esteem, and suicidal ideation of young employees. A total of 447 unmarried employees completed the survey of perceived organizational support, Rosenberg self-esteem scale, and suicide ideation scale. The results revealed that perceived organizational support, self-esteem, and suicidal ideation were significantly correlated with each other. Stepwise regression analysis and path analysis both indicated that self-esteem partially mediated the effect of perceived organizational support on suicidal ideation.
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Affiliation(s)
| | - Yongbao Ji
- 2 Shanghai University of Finance and Economics, China
| | - Ping Li
- 1 Shandong University of Technology, China
| | - Hao Zhao
- 1 Shandong University of Technology, China
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