Living arrangements and suicidal ideation among the Korean older adults

Objectives: This study examines how living arrangements are associated with suicidal ideation for older adults in South Korea, which has the highest suicide rate among OECD countries, and a particularly high suicide rate for older persons.

Methods: Analyzing a sample of 5795 women and 3758 men aged 65 and older from a nationwide representative cross-sectional data-set, we examined how many older adults think about suicide over a one-year period, why they think about suicide, and whether living arrangements are associated with suicidal ideation.

Results: About 1 out of 12 respondents in our sample reported suicidal ideation. While women and men did not differ in the prevalence of suicidal ideation, women attributed their suicidal feelings to health problems, while men attributed theirs to economic difficulties. Logistic regression results indicated that living arrangements are associated with suicidal ideation for men but not women. Older men living with a spouse were less likely to have suicidal ideation than older men with other living arrangements (i.e., living alone, living with children without spouse, living with spouse, and others).

Conclusions: Our results highlight the importance of living arrangements to older men's suicidal ideation. We discuss gender differences in the implications of living arrangements to suicidal ideation within the context of Confucian culture.     

Suicidal ideation,suicide attempts,and psychological distress among intoxicated adolescents in the pediatric emergency department

Background: Studies have emphasized screening for psychiatric disorders, especially suicide risk in emergency departments. Psychiatric disorders and experimentation with alcohol increase in adolescence and intoxications among patients challenge the staff in emergency departments.

Aims: This study examined the degree of suicidal ideation (SI) and suicidal behavior in adolescents, and the extent to which they differed from non-suicidal patients in terms of alcohol use, psychological distress, self-esteem, and perceived social support.

Methods: The study comprised 120 adolescents, a mean age of 14.2 years. Of them 60% were females. We collected data on the clinical characteristics and assessed the patient’s psychiatric status using self-report scales and analyzed blood samples for alcohol. A consulting psychiatrist interviewed each patient before discharge to evaluate potential SI or suicide attempt (SA) using structured and semi-structured scales.

Results: Of the 120 patients 20% had SI or had made a SA. High psychological distress in girls, low blood alcohol levels (BALs), as well as low scores on self-esteem, on social support and on familial support were associated with patients with SI/SA. Logistic regression showed that the most significant variables with suicidal patients included low BAL and low self-esteem and high alcohol consumption. Psychological distress had a direct and mediational role in the suicidal patients.

Conclusions: Adolescents referred to the pediatric emergency department with intoxication displaying high psychological distress and low self-esteem represent a high-risk group of teens. In this group, careful assessment of mental health status, screening for suicidal ideation, and SAs seems warranted.     

Psychometric validation of the Geriatric Suicide Ideation Scale (GSIS) among older adults with bipolar disorder

Objectives: Across age groups, bipolar disorder (BD) carries the greatest risk of death by suicide of all psychiatric conditions; 25%–50% of those with BD will make one or more suicide attempt. Psychometrically sound instruments are required to reliably measure suicide ideation and risk of self-harm for older adults with BD. For this study, we validate the geriatric suicide ideation scale (GSIS) with adults 50+ years with BD.

Methods: We recruited a global sample of 220 older adults with BD (M = 58.50 years of age) over 19 days using socio-demographically targeted, social media advertising and online data collection. To demonstrate the construct validation of GSIS responses by older adults with BD, we computed correlations and performed regression analyses to identify predictors of suicide ideation.

Results: Our analyses support a four-factor model of responses to the GSIS (ideation, death ideation, loss of personal and social worth, and perceived meaning in life) measuring a higher order latent construct. Older adults with BD reporting low satisfaction with life and current depressive symptoms, and who misuse alcohol, report significantly higher levels of suicide ideation. Sleep quality and cognitive failures are also correlated with GSIS responses.

Conclusions: Results support the factorial validity of the GSIS with older adults with BD. Similar to other populations, the GSIS measures a four-factor structure of suicide ideation. Across BD subtypes, the GSIS appears to reliably measure suicide ideation among older adults with BD.     

Alexithymia,suicidal ideation and health-risk behaviours: a survey of Canadian men

Objective: Restricted emotional abilities may present significant implications for men’s health. The purpose of this study was to examine the relationship between alexithymia and several health-risk behaviours: substance misuse, aggressive and risky behaviours and suicidal ideation.

Methods: A nationally representative sample of 1000 Canadian men responded to a survey containing measures of alexithymia, maladaptive coping behaviours, suicidal ideation and depressive symptoms. A series of hierarchical regressions were conducted using alexithymia as the predictor variable and each health-risk behaviour as the criterion variable, controlling for depressive symptom severity.

Results: Alexithymia was found to be significantly associated with drug use, alcohol use, angry/aggressive behaviour and risk-taking behaviour – as well as suicidal ideation – beyond the effects of depressive symptoms.

Conclusions: The findings provide evidence for the link between alexithymia and several problematic behaviours that pose risks to men’s health.     

The connections among suicidal behavior,lipid profile and low-grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio

Objectives: The role of inflammation and lipid metabolism in the pathophysiology of suicidal behavior has received particular attention in recent years. The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a new and more reliable indicator of low-grade inflammation. NLR has been found to be altered in major depressive disorder (MDD) and has been related to various factors, including chronic stress and impulsivity that were previously reported to be related to suicidal behavior. We aimed to explore the roles of NLR, C-reactive protein (CRP) and serum lipid levels on suicidal behavior in patients with MDD.

Methods: The study group consisted of 139 inpatients diagnosed with MDD [37 suicide attempters (SA); 102 suicide non-attempters (NSA)], 50 healthy controls and matched according to age, gender and education. NLR, PLR, CRP and lipid values were obtained from digital inpatient records.

Results: CRP levels and NLR were substantially higher in patients with SA than in subjects with NSA and healthy comparison subjects after adjusting the confounding factors. The logistic regression included two predictive variables for suicide status in patients with depressive disorder (A) previous suicidal history; (B) NLR.

Conclusions: This is the first study suggesting that NLR may be a trait marker for suicidal vulnerability via a relationship between NLR and a recent suicide attempt in depressed inpatients. Future prospective studies are needed to determine the exact roles of NLR, and other inflammatory markers on suicidality in MDD.     

The relationships among perceived discrimination,self-perceptions of aging,and depressive symptoms: a longitudinal examination of age discrimination

Objectives: This study examined the relationship between changes in perceived discrimination and changes in depressive symptoms among older people. The association between perceived age discrimination and depressive symptoms was also analyzed longitudinally along with tests to determine whether self-perception of aging mediates this association.

Method: Data from two waves (2008 and 2012) of the Health and Retirement Study were used. Longitudinal models were tested using a nationally representative sample of 3921 participants who responded to psychosocial questionnaires in both waves and answered questions about perceived everyday discrimination and attributions of discrimination in 2008.

Results: Changes in perceived discrimination was significantly associated with changes in depressive symptoms over time. Perceived age discrimination was significantly related to a change in depressive symptoms over four years and self-perceptions of aging mediated the relationship between perceived age discrimination and depressive symptoms.

Conclusion: Findings demonstrate the importance of recognizing perceived discrimination and negative self-perceptions of aging as well as how the negative effects of age discrimination on self-perceptions of aging can be risk factors for the development of depressive symptoms in late life.     

Prevalence,stability, 1-year incidence and predictors of depressive symptoms among Norwegian adolescents in the general population as measured by the Short Mood and Feelings Questionnaire

Background In numerous surveys the prevalence of depressive symptoms in adolescents has been examined in single sites and at one time point.

Aims We examined depressive symptoms among adolescents aged 10–19 years in four different large school samples including two cohorts over a 10-year period in different locations in the same health region in central Norway including a total of 5804 adolescents. Two cohorts were retested within a 1-year time period to predict high versus low depressive symptom scores. Changes over a 6-year period in depressive symptom levels were examined in two of the samples of 12–14-year olds.

Methods Depressive symptoms were estimated by the 13-item Short Mood and Feelings Questionnaire (SMFQ). Covariates were student age, sex, school size and location.

Results “Miserable or unhappy”, “Tired”, “Restlessness” and “Poor concentration” were the most commonly reported depressive symptoms. Depressive symptom levels and proportions of high scoring students were consistently higher among girls, in particular in mid and late adolescence. Poisson regression analysis showed that all SMFQ items significantly predicted total scores for the whole sample, while sex (girls having a higher risk) emerged as a consistent 1-year predictor of high depressive symptom levels.

Conclusions The SMFQ constitutes a short, practical and feasible measure. We recommend that this standardized measure should be used in the assessment of depressive symptoms among adolescents in school, primary care and clinical settings but also to evaluate treatment outcome. High scorers should be evaluated in subsequent clinical interviews for the presence of a depressive disorder.     

Past suicidal ideation as an independent risk factor for suicide behaviours in patients with depression

Objectives: As South Korea has the highest incidence of completed suicides, the present study aimed to investigate the predictive power of the variables that have been associated with suicide attempts in Korean patients diagnosed with depression.

Methods: Hundred participants were divided into two groups: suicide attempters (31%) and suicide non-attempters (69%). Participants with a history of more than one suicidal attempt were assigned to the suicide attempter group. A hierarchical logistic regression analysis was performed to determine the predictive strengths of the variables that were likely to be associated with suicide attempts.

Results: After controlling for the effects of such variables as the severity of depressive symptoms, life stress events and impulsivity, the severity of past suicidal ideation was the most important predictive factor for discriminating suicide attempters from suicide non-attempters. The odds ratio for attempting suicide relative to not attempting suicide increased by a factor of 4.408 for each unit of increase in suicidal ideation.

Conclusions: The present study suggests that the most severe suicidal ideation throughout one’s entire life should not be overlooked and may be a major predictor of the risk of suicide.     

Association of socio-demographic factors and parental education with depressive symptoms among older African Americans and Caribbean Blacks

Objective: The purpose of this study was to examine ethnic variation in the relationship between individual socio-demographic factors, parental educational level, and late-life depressive symptoms in older African Americans and Caribbean Blacks.

Method: This cross-sectional study used data from the National Survey of American Life. A subsample of older African Americans (N = 837) and Caribbean Blacks (N = 271) was analyzed using multiple regression analysis.

Results: Findings suggest differences in predictors of depressive symptoms for the two ethnic groups. Among older African Americans, lower educational attainment and lower income were predictive risk factors for higher depressive symptoms. Findings among older Caribbean Blacks suggest that nativity and income were significantly associated with depressive symptoms. This study did not find support for any association between parental education and late-life depressive symptoms.

Conclusion: This study adds new information by considering ethnic variation in an examination of depressive symptoms in older Black Americans. The results contribute to the growing awareness of the older Caribbean Black population in the United States.     

Changes in depressive symptoms during widowhood among older Mexican Americans: the role of financial strain,social support,and church attendance

Objectives: This study examines how depressive symptoms change during the widowhood process among older adults of Mexican descent. This research also investigates whether financial strain, social support, and church attendance moderate changes in depressive symptoms in the context of widowhood.

Method: This study uses seven waves of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly collected at approximately two-year intervals. This research applies multiphase growth models to examine changes in depressive symptomatology before, during, and after the transition to widowhood (the measurement wave at which spousal bereavement was first reported) among 385 older adults of Mexican descent who experienced the death of a spouse during the survey.

Results: This study demonstrates that older adults of Mexican descent experienced a significant increase in depressive symptoms pre-widowhood and in particular, during the transition to widowhood. The levels and rates of changes in depressive symptoms post-widowhood did not differ from the pre-widowhood ones. Greater social support was related to more depressive symptoms during the transition to widowhood. More frequent church attendance was a protective factor against increases in depressive symptoms pre-widowhood.

Conclusion: This study highlights the multiphase pattern in the effects of the widowhood process on depressive symptomatology among older adults of Mexican descent. The findings also suggest that social support and church attendance can have implications for the interplay between widowhood and depressive symptoms.     

Suicidal ideation and associated factors among students aged 13–15 years in Association of Southeast Asian Nations (ASEAN) member states, 2007–2013

Objective: The aim of this study was to assess suicidal ideation and associated factors in school-going adolescents in the Association of Southeast Asian Nations (ASEAN) member states.

Methods: The analysis included 30,284 school children aged 13–15 years from seven ASEAN countries that participated in the cross-sectional global school-based student health survey (GSHS) between 2007 and 2013.

Results: The overall prevalence of suicidal ideation in the past 12 months across seven ASEAN countries was 12.3%, significantly higher in girls (15.1%) than boys (9.3%). Among seven ASEAN countries with the highest prevalence of suicidal ideation was in the Philippines (17.0%) and Vietnam (16.9%) and the lowest in Myanmar (1.1%) and Indonesia (4.2%). In multivariable logistic regression analysis, female gender, older age (14 or 15 years), living in a lower middle income country, having no friends, loneliness, bullying victimisation, having been in a physical fight in the past 12 months, lack of parental or guardian support, tobacco use and having a history of ever got drunk were associated with suicidal ideation.

Conclusions: Different rates of suicidal ideation were observed in ASEAN member states. Several risk factors for suicidal ideation were identified which can help guide preventive efforts.     

Positive attitude toward life,emotional expression,self-rated health,and depressive symptoms among centenarians and near-centenarians

Objectives: Favorable attitudes, emotions, personality characteristics, and self-rated health have been associated with successful aging in late life. However, less is known regarding these constructs and their relationships to mental health outcomes in the oldest old persons. This study examined cross-sectional relationships of these psychological factors to depressive symptoms in centenarians and near-centenarians.

Methods: A selected sample of Ashkenazi Jewish older adults aged 98–107 (n = 54, 78% female) without significant cognitive impairment participated. Cognitive function was assessed by Mini-Mental Status Examination, positive attitude toward life and emotional expression by the Personality Outlook Profile Scale (POPS), self-rated health by participants' subjective rating of their present health, and depressive symptoms by the Geriatric Depression Scale.

Results: Results demonstrated inverse associations of the positive attitude toward life domain of the POPS and self-rated health with participants' levels of depressive symptoms even after adjusting for the effects of history of medical illnesses, cognitive function, and demographic variables. Additionally, participants with high levels of care showed higher levels of depressive symptoms. Path analysis supported the partially mediating role of positive attitude toward life in the relationship between self-rated health and depressive symptoms.

Conclusion: These findings emphasized the important roles of positive attitudes and emotions as well as self-rated health in mental health outcomes in the oldest old. Although, limited by its cross-sectional design, findings suggest these psychological factors may exert protective effects on mental health outcomes in advanced age.     

Worry about not having a caregiver and depressive symptoms among widowed older adults in China: the role of family support

Objectives: Using the stress-coping framework, this study examined whether worry about not having a caregiver in old age was associated with depressive symptoms among widowed Chinese older adults, including the moderating effects of self-perceived family support.

Method: Using a sample of 5331 widowed adults aged 60 years old or older from the 2006 National Sample Survey of the Aged Population in Urban/Rural China, we regressed measures of depressive symptoms on worry about not having a caregiver. We also tested moderation effects of family support.

Results: Individuals who were worried about not having a caregiver reported significantly higher levels of depressive symptoms. Feeling that their children are filial, having instrumental support from children, and having only daughters moderated the effects of worry about not having a caregiver on depressive symptoms.

Conclusion: Our findings indicate the detrimental effects of worry about not having a caregiver on the psychological well-being of widowed older adults. This study also highlights some forms of family support that may help reduce such negative effects of widowhood.     

Life-space mobility and dimensions of depressive symptoms among community-dwelling older adults

Objectives: To examine the association between life-space mobility and different dimensions of depressive symptoms among older community-dwelling people.

Methods: Cross-sectional analyses of baseline data of the ‘Life-Space Mobility in Old Age’ cohort study were carried out. The participants were community-dwelling women and men aged 75–90 years (N = 848). Data were gathered via structured interviews in participants’ home. Life-space mobility (the University of Alabama at Birmingham (UAB) Life-Space Assessment – questionnaire) and depressive symptoms (Centre for Epidemiological Studies Depression Scale, CES-D) were assessed. Other factors examined included sociodemographic factors, difficulties walking 500 m, number of chronic diseases and the sense of autonomy in participation outdoors (subscale of Impact on Participation and Autonomy questionnaire).

Results: Poorer life-space mobility was associated with higher prevalence of different dimensions of depressive symptoms. The associations were partially mediated through walking difficulties, health and the sense of autonomy in participation outdoor activities.

Conclusion: Poorer life-space mobility interrelates with higher probability for depressive symptoms, thus compromising older adults’ mental wellbeing. A focus on older adults’ life-space mobility may assist early identification of persons, who have elevated risk for depressive symptoms. The association between life-space mobility and depressive symptoms should be studied further utilizing longitudinal study designs to examine temporality and potential causality.     

Prevalence of restless legs symptoms according to depressive symptoms and depression type: a cross-sectional study

Background: Restless legs syndrome is a sensorimotor disorder and it is associated with several other diseases especially mental illnesses.

Aims: To analyze the relationship between the symptoms of restless legs syndrome and the severity of depressive symptoms and the prevalence of restless legs symptoms in depression subtypes.

Methods: A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in 706 patients with increased depressive symptoms and 426 controls without a psychiatric diagnosis by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory (BDI) and the psychiatric diagnosis was confirmed by means of a diagnostic interview (Mini-International Neuropsychiatric Interview). The subjects with increased depressive symptoms were divided into three groups (subjects with depressive symptoms without a depression diagnosis, melancholic depression and non-melancholic depression).

Results: In the whole study population, the prevalence of restless legs symptoms increased with the severity of depressive symptoms. The prevalence of restless legs symptoms was highest in the melancholic and non-melancholic depressive patients (52 and 46%, respectively) and then in subjects with depressive symptoms without a depression diagnosis (43.4%), but the prevalence was also substantial (24.6%) in subjects without a psychiatric diagnosis.

Conclusions: Restless legs symptoms are very common in primary care among subjects with depression, regardless of the depression type. The prevalence of restless legs symptoms increased with increasing severity of depressive symptoms, regardless of the diagnosis. These findings should be considered in clinical evaluation and treatment of patients visiting their physician due to restless legs or depressive symptoms.     

Personality and suicidal ideation in the elderly: factorial invariance and latent means structures across age

Objectives: Suicide among the elderly is a dramatic global health problem. Although fatal attempts are frequent in the elderly, research indicated that they rarely present long-term elaboration of suicidal ideation and communicate their intents. Consequently, risk factor detection and assessment are salient. Although evidence on the association between personality and suicidal ideation in young adults is accumulating, little is known about its relevance in the elderly. The purpose of the present study was to analyze the components of a measurement model that are invariant across young adults and older adults and then investigate the relations among dimensions of personality and suicide risk. We postulated a specific relation pattern a priori and tested the hypotheses statistically in order to examine the models for equivalency of the factorial measurement.

Method: We investigated 316 young adults and 339 older adults, who were administered self-report questionnaires to assess depression, hopelessness, alternative five-factor model of personality, and self–other perception.

Results: Multigroup confirmatory factor analyses were conducted, yielding a final model with excellent fit to the data. This model showed a similar pattern of associations between suicidal ideation and personality across both groups.

Conclusions: Although the elderly are exposed to specific life stressors associated with suicidal ideation, our findings suggest that the elderly and young adults may be similar on personality and psychopathology variables predicting suicidal ideation than previously hypothesized. Implications are provided for enhanced assessment and intervention of the elderly high in neuroticism, depression, hopelessness, and with negative self–other perception.     

Risk and protective factors for depressive symptoms among American Indian older adults: Adverse childhood experiences and social support

Objectives: Despite efforts to promote health equity, many American Indian and Alaska Native (AI/AN) populations, including older adults, experience elevated levels of depression. Although adverse childhood experiences (ACE) and social support are well-documented risk and protective factors for depression in the general population, little is known about AI/AN populations, especially older adults. The purpose of this study was to examine factors related to depression among a sample of AI older adults in the midwest.

Method: Data were collected using a self-administered survey completed by 233 AIs over the age of 50. The survey included standardized measures such as the Geriatric Depression Scale-Short Form, ACE Questionnaire, and the Multidimensional Scale of Perceived Social Support. Hierarchical multivariate regression analyses were conducted to evaluate the main hypotheses of the study.

Results: Two dimensions of ACE (i.e., childhood neglect, household dysfunction) were positively associated with depressive symptoms; social support was negatively associated with depressive symptoms. Perceived health and living alone were also significant predictors.

Conclusion: ACE may play a significant role in depression among AI/AN across the life course and into old age. Social support offers a promising mechanism to bolster resilience among AI/AN older adults.     

Death ideation in older adults: psychological symptoms of depression,thwarted belongingness,and perceived burdensomeness

Death ideation is commonly reported by older adults in the United States; however, the factors contributing to death ideation in older adults are not fully understood. Depressive symptoms, as well as components of the interpersonal theory of suicide, perceived burden, and thwarted belonging may contribute to death ideation.

Objectives: The purpose of this study was to investigate the moderating relationship of the psychological symptoms of depression on the relation between perceived burdensomeness and death ideation, and thwarted belongingness and death ideation.

Method: A sample of 151 older adults completed questionnaires assessing numerous covariates, as well as perceived burdensomeness, thwarted belongingness, death ideation, and the psychological symptoms of depression.

Results: The results of this study indicated that the proposed moderating relationship was supported for the relationship between perceived burdensomeness and death ideation, but was not supported for the relationship between thwarted belongingness and death ideation when covariates (loneliness and hopelessness) were controlled.

Conclusion: This suggests that the psychological symptoms of depression are significantly associated with death ideation in older adults experiencing feelings of perceived burdensomeness. Additionally, the findings suggest that loneliness and hopelessness are also important factors to consider when assessing death ideation in older adults.