Effects of Depressive Symptom and Health Status on Several Factors that Affect Suicidal Ideation among the Elderly Living Alone in Rural Area -The Fully Mediating Effect of Depressive Symptom-

Yeunsoon Choi; Miji Kim; Ae Rim Seo; Hyun Ok Kim; Ki Soo Park

doi:10.15384/kjhp.2017.17.3.193

Journal List > Korean J Health Promot > v.17(3) > 1089917

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Effects of Depressive Symptom and Health Status on Several Factors that Affect Suicidal Ideation among the Elderly Living Alone in Rural Area -The Fully Mediating Effect of Depressive Symptom-

Original Article

Korean J Health Promot 2017;17(3):193-198.

Published online: 19 January 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.3.193

Effects of Depressive Symptom and Health Status on Several Factors that Affect Suicidal Ideation among the Elderly Living Alone in Rural Area -The Fully Mediating Effect of Depressive Symptom-

Yeunsoon Choi, Miji Kim, Ae Rim Seo, Hyun Ok Kim, Ki Soo Park

Department of Preventive Medicine, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea

Corresponding author : Ki Soo Park, MD, PhD Department of Preventive Medicine, Gyeongsang National University School of Medicine and Institute of Health Sciences, 15 Jinju-daero 816beon-gil, Jinju 52727, Korea Tel: +82-55-772-8095, Fax: +82-55-772-8099 E-mail: parkks@gnu.ac.kr

Received 24 May 2017 Accepted 24 August 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

The study was performed to investigate effects of depression and health status on several factors of influencing suicidal ideation among living-alone elderly in rural area. And we assessed if depressive symptom mediates fully suicidal ideation among living-alone elderly in the rural area.

Methods:

The subjects of this study used the survey data of elderly people living alone for the elderly mental health promotion project at the city health center. In the questionnaire, 200 people were interviewed by one of the public health center staffs directly. We analyzed a four step approach in which several logistic regression analyses were conducted and significance of the coefficients was examined at each step.

Results:

The results from step 1 show that the total effect of health status(frailty) was significantly related to suicidal ideation(Exp(β)=2.198, P=0.042). In step 2, the direct effect of health status on depression was significant(Exp( β)=3.925, P<0.001) too. Step 3 analysis showed that the effect of depression on suicidal ideation was significant(Exp(β)=7.115, P=0.001). Step 4 showed that after controlling for depression, health status was not significant for suicidal ideation(P=0.322). Based on analysis results, the finding supports that suicidal ideation among living-alone elderly in the rural area was fully mediated by depressive symptom.

Conclusions:

Above findings imply that it is crucial to decrease depression in order to control suicidal ideation among living-alone elderly in rural area. To do that, early diagnosis and developing programs to decrease elderly depression and organizational approach according to characteristics of areas and elderly circunstances are needed.

Keywords: Depression, Health status, Suicidal ideation, Mediator

REFERENCES

1.Statistics Korea. 2015 Elderly Statistics. Daejeon: Statistics Korea;2015. [Accessed January 17, 2017].http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&aSeq=348565.

2.Sohn JN. A study on factors influencing the suicidal ideation in elderly people who live alone or live with family. J Korean Acad Psychiatr Ment Health Nurs. 2012. 21(2):118–26.

3.Song YD., Son JA., Park SM. An analysis of ecosystematic factors influencing suicidal ideation of the elderly who are living alone. J Korean Gerontol Soc. 2010. 30(2):643–60.

4.Seo IG., Lee YS. Mediated effects of depression on the relationship between social resources of the elderly living alone and their suicidal ideation-with a focus on the comparison between the elderly living alone in rural and urban areas. Korean J Gerontol Soc Welf. 2016. 71(2):219–31.

5.Park BG., Chun SK. A study of factors influencing older adults suicidal ideation through the intermediary of depression. Ment Health Soc Work. 2006. 22(6):58–90.

6.Kim HS. A study on epistemology of Korean elder's suicidal thought among elderly Koreans. J Korean Gerentol Soc. 2002. 22(1):159–72.

7.Han SS., Kang SW., Jeong SH. Experiences of depressive symptom and suicidal thinking between the elderly living alone and the elderly couples. KJOHSM. 2012. 6(3):29–38.

8.Kim JG. The impact of family type on health behavior of elderly people. J Welf Aged Inst. 2011. 51:35–55.

9.Conwell Y., Duberstein PR., Caine ED. Risk factors for suicide in later life. Biol Psychiatry. 2002. 52(3):193–204.

10.Park JH., No YH., Wi DH. Clinical analysis of attempted suicide in the elderly. J Korean Soc Emerg Med. 2001. 12(2):135–42.

11.Jeong IY. Effect of social participation influencing elderly's suicidal ideation. J Korean Contents Assoc. 2013. 13(9):164–77.

12.Kim GY., Hwang MG. The effect of level of knowledge on aging on suicide ideation among the older adults: focused on the mediating effect of attitude toward elderly, self-esteem, and depression. Korean J Counselling. 2009. 10(2):651–68.

13.Beck AT., Kovacs M., Weissman A. Assessment of suicidal intention: the scale for suicide ideation. J Consult Clin Psychol. 1979. 47(2):343–52.

14.Shin MS., Park KB., Oh KJ., Kim ZS. A study of suicidal ideation among high school students: the structural relation among depression, hopelessness, and suicidal ideation. Korean J Clin Psychol. 1990. 9(1):1–19.

15.Hwang HS., Kwon IS., Park BJ., Cho B., Yoon JL., Won CW. The validity and reliability of Korean frailty index. J Korean Geriatr Soc. 2010. 14(4):191–202.

16.Kee BS. A preliminary study for the standardization of geriatric depression scale short form-Korea version. J Korean Neuro-psychiatr Assoc. 1996. 33(2):298–300.

17.Baron RM., Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986. 51(6):1173–82.

18.Park CG., Park KS., Kang YS. Job Stress, Job Satisfaction, and Organizational Commitment of Customized Home Health Care Nurse. J Agric Med Community Health. 2013. 38(1):39–48.

19.Lee G., Cho E. A study on the effect of main variables to the suicidal ideation among the elderly living alone: focused on the direct and indirect effects of social support. Health Social Welf Review. 2013. 33(1):162–89.

20.Kim HS., Kim BS. A path analysis on suicidal ideation in the elderly. Korean J Counseling Psychotherapy. 2007. 19(3):801–18.

21.Kim C., Hwang J. A Study on the Effects of Senile Disease and Depression on the Seniors' Ideation of Suicide. J Korean Gerontol Soc. 2008. 28(3):425–42.

22.Brown JH., Henteleff P., Barakat S., Rowe CJ. Is it normal for terminally ill patients todesire death? Am J Psychiatry. 1986. 143(2):208–11.

23.Chochinov HM., Wilson KG., Enns M., Mowchun N., Lander S., Levitt M, et al. Desire for death in the terminally ill. Am J Psychiatry. 1995. 152(8):1185–91.

24.Duberstein PR., Conwell Y., Conner KR., Eberly S., Caine ED. Suicide at 50 years of age and older: perceived physical illness, family discord and financial strain. Psychol Med. 2004. 34(1):137–46.

25.Lee HS., Kim HS., Jung YM. Depression and quality of life in Korean elders. J Korean Acad Community Health Nurs. 2002. 20(1):12–22.

26.Buttler J., Ciarrochi J. Psychological acceptance and quality of life in the elderly. Qual Life Res. 2007. 16(4):607–15.

27.Yang OK., Ju SH. An exploratory study on the influencing factors to suicidal ideation among single-household elderly population. Ment Health Soc Work. 2011. 37:321–47.

28.Choi KS. A research on the Relationship between the socio-economic factors of the regions and suicidal ideation of the elderly-by utilizing the multi-level analyses-. J Korean Academia-Industrial Cooperation Society. 2016. 17(11):584–94.

29.Lee SC. Socio-economic factors of elderly suicide. J Soc Security. 2010. 26(4):1–19.

Table 1.

Distribution of demographic characteristics of study population

Characteristics	Values
Sex
Male	50 (25.0)
Female	150 (75.0)
Age
<75	71 (35.3)
≥75	129 (64.5)
Mean±SD	76.6±5.9
Marital status
Never married	13 (6.5)
Bereaved	119 (59.5)
Divorced/separated	68 (34.0)
Educational level
Ineducation	113 (56.5)
Elementary school graduate	54 (27.0)
Middle school graduate or above	33 (16.5)
Duration of living-alone
<5 years	31 (15.5)
5 to 10 years	20 (10.0)
10 to 20 years	43 (21.5)
≥20 years	106 (53.0)
Economic satisfaction (range; 2-8)	4.1±1.37
Health status (frailty)
Non-frail (<4.5)	136 (68.0)
Frail (≥4.5)	64 (32.0)
Depression
Normal (<14)	76 (38.0)
Minor depressive (≥14)	124 (62.0)

Abbreviation: SD, standard deviation. Values are presented as number (%) or mean±SD unless otherwise indicated.

Table 2.

Suicidal ideation by demographic characteristics of study population

Characteristics	Suicidal ideation		P^a
Characteristics	No	Yes	P^a
Sex
Male	40 (80.0)	10 (20.0)	0.919
Female	119 (79.3)	31 (20.7)
Age
<75	56 (78.9)	15 (21.1)	0.871
≥75	103 (79.8)	26 (20.2)
Marital status
Never married	11 (84.6)	2 (15.4)	0.638
Bereaved	92 (77.3)	27 (22.7)
Divorced/separated	56 (82.4)	12 (17.6)
Education level
Ineducation	86 (76.1)	27 (23.9)	0.180
Elementary school graduate	43 (79.6)	11 (20.4)
Middle school graduate or above	30(90.9)	3 (9.1)
Duration of living-alone
<5 years	24 (70.8)	7 (29.2)	0.585
5 to 10 years	15 (75.0)	5 (25.0)
10 to 20 years	32 (74.4)	11 (25.6)
≥20 years	88 (83.0)	18 (17.0)
Economic satisfaction (range; 2-8)	4.2±1.32	3.5±1.44	0.003
Health status (frailty)
Non-frail (<4.5)	115 (84.6)	21 (15.4)	0.010
Frail (≥4.5)	44 (68.8)	20 (31.3)
Depression
Normal (<14)	72 (94.7)	4 (5.3)	<0.001
Minor depressive (≥14)	87 (70.2)	37 (29.8)
Total	159 (79.5)	41 (20.5)

Values are presented as number (%) or mean±standard deviation unless otherwise indicated.

^a Calculated by chi-square test and t-test for binary outcomes.

Table 3.

Mediating effect of depression on the relationship between frailty and suicidal ideation^a

Path^b	B	S.E.	P	Exp (β)	R²
Frailty→suicidal ideation	0.787	0.387	0.042	2.198	0.150
Frailty→depression	1.367	0.385	<0.001	3.925	0.213
Depression→suicidal ideation	1.962	0.570	0.001	7.115	0.235
Frailty→suicidal ideation (controlling depression)
Frailty	0.407	0.410	0.322	1.502	0.242
Depression	1.847	0.581	0.001	6.343

Abbreviations: SE, standard error; Exp, exponential.

^a Data are adjusted for sex, age, marital status, educational level, duration of living-alone and economic satisfaction.

^b Calculated by multiple logistic regression analysis.

TOOLS

Similar articles