Chronic Disease, Disability, Psychological Distress and Suicide Ideation among Rural Elderly: Results from a Population Survey in Shandong

Four modeling approaches to study restrictions on everyday life and social activities due to chronic diseases with consequences of suicidal behavior

The purpose of this study was to discover the association between disability in everyday life and social activities due to chronic diseases and suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA) from the Korea National Health and Nutrition Examination Survey (KNHANES), considering the cross-sectional design of this study, 2016-2018 dataset. Variables for finding the associated factors of SI, SP, and SA were confirmed through random forest (RF), decision tree, generalized linear model (GLM), and support vector machine (SVM), and the performance of each model is listed. A total of 17,323 (males: 7,530, females: 9793) responders from the KNHANES from 2016 to 2018 were employed for the study. The relationship between restrictions on daily life, social activities, and three stages of suicidal behaviors due to diseases were analyzed using the R function (R version 4.2.0), randomForest, ctree, glm, and ksvm. The F1-score is a measure used to evaluate the accuracy of the performance of a model, in the binary classification. The score of 1 indicates good performance, whereas a score of 0 signifies poor performance. Due to chronic diseases, disability in everyday life and social activities lead to suicide behaviors. In our study, we examined the impact of limitations in daily living and social activities on suicidal behaviors among participants. Our findings revealed that for those experiencing such limitations, the odds ratios (ORs) for SIs were 6.10 (95% CI: 3.99-9.34) for males and 2.61 (1.79-3.81) for females. SPs were 3.69 (2.36-5.78) for males and 3.94 (2.70-5.75) for females. Similarly, the odds ratios for SAs were 5.04 (2.51-10.13) for males and 2.71 (1.48-4.98) for females, indicating a significant association between these limitations and increased suicidal behaviors, with variances observed between genders. These results underscore the necessity of addressing daily living and social activity restrictions when considering mental health interventions and suicide prevention strategies. In RF, GLM, and SVM, F1-score were 0.8192, 0.6887, and 0.9687 in SA, respectively. Among the patients with chronic disease, those with sequelae, low incomes, and low levels of education had limitations in daily activities and social activities, which increased the likelihood of suicidal thoughts, planning, and attempts.

Mediating role of psychological distress in the associations between medical errors, adverse events, suicidal ideation and plan among operating room nurses in China: a cross-sectional study

OBJECTIVES

Medical errors (MEs) and adverse events (AEs) both had long-term impacts on healthcare professionals. Studies investigated the associations between MEs, AEs, psychological distress and suicidal behaviours among healthcare professionals. The aim of the current study was to explore the mediating role of psychological distress in the relationship between MEs/AEs and suicidal ideation/suicide plan among operating room nurses in China.

DESIGN

A cross-sectional study.

SETTING

The survey was conducted between December 2021 and January 2022 in China.

PARTICIPANTS

A total of 787 operating room nurses completed the questionnaires in China.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were MEs and AEs. Secondary outcome measures were psychological distress and suicidal behaviours.

RESULTS

The results showed that 22.1% of operating room nurses were involved in MEs, while 13.9% of operating room nurses were involved in AEs. The associations between suicidal ideation (OR=1.10, p<0.001), suicide plan (OR=1.07, p<0.01) and psychological distress were significant. The associations between suicidal ideation (OR=2.76, 95% CI=1.53 to 4.97, p<0.01), suicide plan (OR=2.80, 95% CI=1.20 to 6.56, p<0.05) and MEs were significant. The associations between suicidal ideation (OR=2.27, 95% CI=1.17 to 4.40, p<0.05), suicide plan (OR=2.92, 95% CI=1.19 to 7.18, p<0.05) and AEs were significant. The psychological distress mediated the relationship between MEs/AEs and suicidal ideation/suicide plan.

CONCLUSION

There were positive associations between MEs, AEs and psychological distress. Moreover, MEs and AEs were also positively associated with suicidal ideation and suicide plan. As expected, psychological distress played an important role in the relationship between MEs/AEs and suicidal ideation/suicide plan.

Latent characteristics and influencing factors of stigma in rheumatoid arthritis: A latent class analysis

To explore the latent classes of stigma in patients with rheumatoid arthritis, we analyzed the characteristics of the different categories. Adopting a convenient sampling method, socio-demographic and disease-related information from the outpatient clinics and wards of 3 tertiary care hospitals in China was collected. The Chinese version of the Internalized Stigma of Mental Illness scale-Rheumatoid Arthritis was used in this survey. Rheumatoid arthritis stigma was divided into 3 potential categories: Low Stigma-Strong Resistance (83, 41.5%), Medium Stigma-Strong Alienation (78, 39.0%), and High Stigma-Weak Resistance (39, 19.5%). Unordered multinomial logistic regression analysis showed that pain (OR = 1.540, P = .005; OR = 1.797, P < .001), elementary school education and below (OR = 4.051, P = .037), and duration of morning stiffness (OR = 0.267, P = .032) were risk factors for stigma, whereas family history was a protective factor against stigma (OR = 0.321, P = .046). Patients with longer morning stiffness, more severe pain, and less education have a greater risk of heavier stigma. Strong alienation is an early warning of heavy stigma. Resistance to stigma and family support can help patients overcome their psychological obstacles. More attention should be paid to constructing family centered support systems to help resist stigma.

Correlates for the severity of suicidal risk in participants with common mental disorders with comorbid chronic medical conditions in rural primary healthcare settings in India

Context

Suicide is on the rise in low- and middle-income countries (LMICs), including India. There are limited studies assessing factors linked to the severity of suicidal risk in patients with depression and comorbid chronic medical disorders in primary healthcare (PHC) settings.

Aim

This study examines factors linked to suicidal risk among participants in a cluster randomized controlled trial of collaborative care intervention (Healthier Options through Empowerment (HOPE Study)).

Settings and Design

The setting was at 49 PHC in the rural Ramanagara District of Karnataka State in southern India. Study eligibility criteria included being ≥30 years with at least mild depression or generalized anxiety disorder and at least one medical condition (cardiovascular disorder or type 2 diabetes mellitus).

Methods and Material

The severity of suicidal risk at baseline was assessed using the Mini International Neuropsychiatric Interview (MINI), and other measures included the severity of depression (Patient Health Questionnaire-9-items (PHQ-9)), the severity of anxiety (Generalized Anxiety Disorder Scale-7-items (GAD-7)), disability, social support, quality of life, number of comorbid chronic medical illnesses, and body mass index (BMI).

Statistical Analysis Used

Chi-square tests and independent-samples t-tests were used to compare the demographic and clinical characteristics of the no-low and mod-high suicidal risk groups. Logistic regression analysis was used to identify correlates associated with the mod-high suicidal risk group.

Results

Mod-high suicidal risk was significantly positively associated with the severity of depression and disability and significantly negatively associated with social support.

Conclusion

The severity of depression, higher disability scores, and lower social support were found to be independent correlates of mod-high suicidal risk. Screening, managing depression, and facilitating social support for patients with chronic medical illness in PHC settings may reduce suicidal risk.

Designing and determining the effectiveness of a suicide intervention package for psychologists working in the primary health care system

Aims

Suicide is a major public health problem around the world. The present study aimed to design and determine the effectiveness of a suicide intervention package for psychologists working in the primary health care system in Hormozgan Province.

Materials and Methods

This study was conducted in two phases: qualitative and quantitative phases. In the qualitative phase, it was a thematic analysis type, and in the quantitative phase, it was quasi-experimental type with pretest-posttest in two groups of intervention and comparison. To standardize the suicide intervention package, Delphi method was used, and for quantitative content validity, content validity index (CVI) and content validity ratio (CVR) were used. In the quantitative phase of the study, the statistical population of the study included 270 people who had suicidal ideations and had no history of suicide attempt. Among them, 135 people were included in the intervention group and 135 people were included in the comparison group using a convenience sampling method. They were selected among those referred to eight comprehensive rural and urban health service centers in eight cities of Hormozgan Province. The results were analyzed by MANCOVA statistical test.

Results

CVR was more than 0.75 and CVI was more than 0.87. In the quantitative phase, the results showed a significant difference between the means before and after the intervention for the variables of psychological distress, suicidal ideation, and hopelessness (P < 0.01).

Conclusion

It seems that psychological suicide preventive interventions in the primary health care system are effective in reducing psychological distress,suicidal thoughts and hopelessness.

The relationship between culture-related grief beliefs, prolonged grief disorder and suicide ideation among Shidu parents in rural China

BACKGROUND

There are many one-child families in China due to the one-child policy. Parents who have lost their only child and are unable to conceive another child or unwilling to adopt a child are called Shidu parents in China. The death of an only child puts Shidu parents at the risk of mental illness and even suicide. Few studies have explored the influence of cultural beliefs and prolonged grief disorder on suicide ideation.

METHODS

This study involved rural Shidu parents from Sujiatun district of Shenyang, China. Questionnaires consisted of the Prolonged Grief questionnaire - 13 (PG-13), the Culture-related Grief Beliefs of Shidu Parents Questionnaire (CBSQ), one question from the baseline National Comorbidity Survey (NCS) to measure suicide ideation and demographic and bereavement-related information. Bivariate logistic regression analyses were conducted to explore associated factors of suicide ideation.

RESULTS

Sixty-nine (28.8%) of the 240 Shidu parents reported having suicide ideation. Having chronic disease (OR = 5.509, p < 0.01), having religious belief (OR = 3.923, p < 0.05) and having a grandchild (OR = 2.552, p < 0.05) were associated with an increased risk of suicide ideation. Destiny belief (a subscale of CBSQ) was negatively associated with suicide ideation (OR = 0.818, p < 0.05). Prolonged grief disorder (OR = 9.280, p < 0.01) and perceived stigma (a subscale of CBSQ) (OR = 1.200, p < 0.05) was positively associated with suicide ideation after adjusting for controlling variables.

CONCLUSIONS

Suicide ideation is prevalent in rural Shidu parents. Reducing perceived stigma and alleviating prolonged grief disorder may decrease the risk of suicide among rural Shidu parents.

Self-reported sleep quality and mental health mediate the relationship between chronic diseases and suicidal ideation among Chinese medical students

High prevalence and strong associations of chronic disease, poor sleep quality, poor mental health, and suicidal ideation (SI) have been reported worldwide. However, the underlying mechanism remains unexamined. The participants were 2646 Chinese medical college students with an average age of 20.13 years. Pittsburgh Sleep Quality Index, the Kessler Psychological Distress Scale, and SI was evaluated. The lifetime SI, past 12-month SI, and chronic disease prevalence rates were 10.0%, 8.4%, and 4.6%, respectively. The results of logistic regression analysis in this study found that chronic disease, self-reported poor sleep quality, poor mental health, gender and scholarship were associated with lifetime SI. Similar results were also found for 12-month SI with an exception of region. This result indicated that the effects of chronic diseases on the SI were mediated by self-reported sleep quality and mental health. Physical diseases, sleep-related concerns, and mental health issues need to be addressed through a multidisciplinary team approach and various delivery systems to prevent SI among medical college students.

Carbon Monoxide Poisoning was Associated With Lifetime Suicidal Ideation: Evidence From A Population-Based Cross-Sectional Study in Hebei Province, China

Objectives: We want to test the association between carbon monoxide poisoning (CMP) experiencing and lifetime suicidal ideation/suicide plan among community residents.

Methods: This is a population-based cross-sectional study conducted among community residents in Hebei province, China. We analyzed a total of 21,376 valid questionnaires. CMP experience and lifetime suicidal ideation/suicide plan were assessed in this study. Logistic regression and false discovery rate correction were conducted to analyze the associations and correct the p values.

Results: We found that CMP (OR = 2.56, p &lt; 0.001, corrected-p = 0.001) was associated with lifetime suicidal ideation, and the other risk factors were female (OR = 0.53, p &lt; 0.001, corrected-p = 0.001). The association between CMP and suicide plan was not supported after false discovery rate correction (OR = 2.15, p = 0.035, corrected-p = 0.385). For the CMP patients, experiencing ≥2 times CMP (OR = 2.76, p = 0.001, corrected-p = 0.011) was also in higher risk of lifetime suicidal ideation. The association between CMP times and lifetime suicidal plan was not supported after false discovery rate correction (OR = 4.95, p = 0.021, corrected-p = 0.231).

Conclusion: CMP patients are in higher risk of lifetime suicidal ideation. For CMP patients, some strategies are needed to control their suicidal ideation.

Association of the time spent on social media news with depression and suicidal ideation among a sample of Lebanese adults during the COVID-19 pandemic and the Lebanese economic crisis

The main objectives were to associate between social media news consumption during these unstable times and depression, as well as suicidal ideation among a sample of Lebanese adults, in addition to associate between fear of Covid-19, depression and suicidal ideation. Secondary objectives aimed to check the mediating effect of depression in the association between time spent on social media to get the news and the presence of suicidal ideation. This is a cross-sectional study executed between April and May 2021. It involved 402 Lebanese citizens aged 18 years and above, selected randomly from all Lebanese districts. Having cancer (Beta = 0.20) or lung disease (Beta = 0.27), more fear of COVID-19 (Beta = 0.16), a higher time spent on social media for news (Beta = 0.13) and a higher household crowding index (Beta = 0.29) were significantly associated with more depression, whereas having a pet in the house (Beta = -0.13) and working in the medical field (Beta = -0.17) were significantly associated with less depression. Higher depression (aOR = 1.19) was significantly associated with higher odds of having suicidal ideation, whereas more fear of COVID-19 (aOR = 0.84) and older age (aOR = 0.96) were significantly associated with less odds of having suicidal ideation. Depression did not mediate the association between time spent on social media to get the news and suicidal ideation. This study showed that more time spent on social media reading the news is associated with higher depression but not suicidal ideation. Fear of Covid-19 is associated with more depression, but less suicidal ideation. Further studies are needed to identify the causality between social media news consumption, depression and suicidal ideation. Moreover, awareness campaigns should be organized to teach people how to consume social media news in a responsible way, without letting it affect their emotions directly, which may cause psychological disorders.

Pain, functional disability and mental disorders as potential mediators of the association between chronic physical conditions and suicidal ideation in community living older adults

OBJECTIVES

To examine the associations between chronic physical conditions and suicidal ideation and to assess whether associations are mediated by pain, anxiety, depression, post-traumatic stress syndrome (PTSS), and functional disability.

METHODS

The study sample includes 1533 older adults aged 65+ recruited in primary care clinics between 2011-2013 and participating in Quebec's Health Survey on Services "Étude sur la Santé des Aînés-Services" (ESA-S) study. Path analysis was used to assess the associations. The presence of suicidal behaviour was ascertained using 4 questions. PTSS was based on a validated scale for primary care older adults. Anxiety and depression were assessed according to DSM-IV criteria. Pain was self-reported on an ordinal scale and functional disability was based on the presence of disability in 8 dimensions of activities of daily living. The main predictors included a list of 13 physical disorders identified by diagnostic codes. Suicidal ideation was also controlled by a number of socio-demographic and psychosocial factors.

RESULTS

PTSS, depression, and functional disability mediate the association between various chronic conditions and suicidal ideation. Although pain and anxiety are associated with many physical disorders, they did not mediate the association with suicidal ideation.

CONCLUSIONS

Chronic physical disorders are associated with suicidal ideation, either directly or indirectly through PTSS, depression, and functional disability. The findings underscore the importance of early identification and management of older patients with specific chronic disorders in primary care as they may be most at risk for suicidal ideation.

Risk factors for suicidal behaviour in late-life depression: A systematic review

BACKGROUND

Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing.

AIM

To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population.

METHODS

A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide).

RESULTS

Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms.

CONCLUSION

To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.

Analysis of Factors Associated with the Risk of Suicide in a Brazilian Capital: Cross-Sectional Study

Suicide and suicide attempts are considered global health problems. With regard to the main causes of unnatural deaths, Brazil ranks as the eighth country with the highest absolute number of suicides. The aim of this study was to analyze the factors associated with the risk of suicide in a metropolitan city in Brazil. This was a cross-sectional study carried out in Recife, in the northeast region of Brazil. Epidemiological surveillance was conducted on the information systems regarding attempted suicide, suicide, and undetermined deaths in the period from 2007 to 2017. A record linkage between the information systems was performed. Descriptive statistics, bivariate analysis, and logistic regression were performed with an adopted a significance level of 5%. In the city of Recife, there were 4495 suicide attempts in the period, and the most frequent suicide attempts were by single females, aged between 20 and 39 years old, and who used either medication or poison to die by suicide. A total of 141 individuals died by suicide, and exogenous intoxication was the most common method. Knowing the common characteristics and associated factors of those who attempt and die by suicide is key for the development of prevention policies and intervention strategies for suicide.

Risk factors for suicide in individuals with cancer: an integrative literature review

OBJECTIVE

to develop an integrative literature review on risk factors for suicide in individuals with cancer.

METHOD

searching for articles was conducted in the Scientific Electronic Library Online, Medicinal Literature Analysis and Retrieval System Online, Latin American & Caribbean Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature and SciVerse Scopus databases, using the descriptors "suicide" and "cancer".

RESULTS

eighteen articles were selected. Lung, bladder and colorectal cancers are the types of highest risk for suicide. Male, white and over 60 years of age are demographic factors with higher risk for suicide in individuals with cancer.

CONCLUSION

this review made it possible to verify that cancer may be a risk factor for suicide. This evidence can be useful for planning preventive actions in order to reduce the risk of suicide.

The relationship between activities of daily living and suicidal ideation among Chinese rural older adults: a multiple mediation model through sleep quality and psychological distress

Few studies clarified the mechanisms underlying the relationship between activities of daily living and suicidal ideation among older adults. This study aimed to explore the multiple mediating roles of sleep quality and psychological distress between this relationship. A total of 3,243 rural older adults were included. Multiple mediation analysis was performed using Mplus 8.3. Activities of daily living was found to directly affect suicidal ideation (β=0.092, 95% CI=0.043−0.140) and through three significantly mediation pathways: (1) the path through sleep quality (β=0.019, 95% CI=0.007−0.031), which accounted for 9.79 % of the total effect; (2) the path through psychological distress (β=0.049, 95% CI=0.036−0.063), which accounted for 25.26 % of the total effect; (3) the path through sleep quality and psychological distress (β=0.034, 95% CI=0.026−0.042), which accounted for 17.53 % of the total effect. The total mediating effect was 52.58%. Attention should be paid to sleep quality and mental health among the Chinese rural older adults with activities of daily living limitation. For early detection and prevention of suicidal ideation, it is necessary to take sleep-based and positive psychological interventions for older adults with activities of daily living limitation.

Association of urban built environment and socioeconomic factors with suicide mortality in high-density cities: A case study of Hong Kong

Population ageing, climate change and urbanization have been occurring rapidly globally. Evidence-based healthy city development is required to improve living quality and mitigate the adverse impact of city living on both physical and mental health. We took a high-density city as an example to explore the association of built environment and suicide mortality and preferably to offer some implications for better future city development. Poisson generalized linear models with generalized estimation equations were employed to regress suicide mortality rate on four urban built environment variables (frontal area density (FAD), sky view factor (SVF), ground coverage ratio (GCR), and street coverage ratio (SCR)), as well as socioeconomic factors, population density, and greenery. The association for different causes of death and within different subgroups was also investigated. Generally, higher FAD and GCR were associated with higher suicide mortality while higher SVF and SCR were associated with lower suicide mortality. Age was a significant effect modifier. An interquartile range increase in FAD, SVF, and GCR was associated with 0.81 (95% confidence interval (CI) 0.71-0.92), 1.41 (95% CI 1.04-1.91), and 0.70 (95% CI 0.50-0.98) times the risk of suicide among the people aged over 70, respectively. Higher population density and unmarried status were generally associated with higher suicide rate whereas higher education level was associated with a decreased risk. Unfavorable built environment could increase risks for successful suicide attempts. Better urban development with morphological control mitigating intensifying urban heat island and other micro-environment changes are warranted to promote not only physical but psychological health.

Suicide risk during the lockdown due to coronavirus disease (COVID-19) in Colombia

The study aimed to estimate the high suicide risk during the COVID-19 lockdown in the Colombian population. A total of 700 adults aged between 18 and 76 years (M = 37.1, SD = 12.7; 68.0% women) completed an online questionnaire. Findings showed that 7.6% of participants reported a high suicide risk. High suicide risk was associated with high perceived stress related to COVID-19, risk of depressive episode, and insomnia. Our study suggests that 1 out of 13 Colombians in a non-probability sample reports a high suicide risk during COVID-19. Findings need to be corroborated in a representative sample of Colombians.

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

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

Determinants of Suicide-related Ideation in Late Life Depression: Associations with Perceived Stress

Objectives: Perceived stress is emerging as a potential contributing factor in suicide-related ideation in older adults. We hypothesized higher levels of perceived stress would be associated with increased self-reported suicidal ideation independent of depressive symptom severity.Methods: This study used data from community-dwelling older adults aged ≥65 with a current diagnosis of major depression. Eligible participants completed measures of depression symptom severity (Hamilton Depression Rating Scale-17 item), current suicidal ideation (Geriatric Suicide Ideation Scale), and perceived stress (Perceived Stress Scale).Results: Participants were 225 older adults with a mean age of 71.4 (SD = 5.6). Sixty-five percent of the sample was female. Fifteen percent of the variance in suicidal ideation was accounted for by lower education (p = .03), male sex (p = .03) and higher current perceived stress (p < .001). Specifically, stress accounted for 12% of the variance.Conclusions: Perceived stress is an important avenue to increase identification of individuals with a higher risk of suicide-related ideation among older adults with a current diagnosis of major depression.Clinical Implications: Screening for perceived stress may allow for improved screening and prevention of suicidal activity in depressed older adults.