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Hong and Lee: Identification of High-risk Groups of Suicide from the Depressed Elderly using Decision Tree Analysis
Original Article

Journal of Korean Academy of Community Health Nursing 2019; 30(2): 130-140.

Published online: 28 June 2019

DOI: https://doi.org/10.12799/jkachn.2019.30.2.130

Identification of High-risk Groups of Suicide from the Depressed Elderly using Decision Tree Analysis

Sehoon Hong1, Dongwon Lee2

1Associate Professor, College of Nursing, CHA University, Pocheon, Korea.

2Assistant Professor, School of Business Administration, Hansung University, Seoul, Korea.

Corresponding author: Lee, Dongwon. School of Business Administration, Hansung University, 116 Samseongyo-ro, 16 gil, Seongbuk-gu, Seoul 02876, Korea. Tel: +82-2-760-4250, Fax: +82-00-2-760-4482, dongwonlee@hansung.ac.kr

Received 31 October 2018       Revised 18 March 2019       Accepted 12 April 2019

© 2019 Korean Academy of Community Health Nursing

Korean Academy of Community Health Nursing

(open-access):

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

Purpose

The aim of this study is to explore levels of suicidal ideation and identify subgroups of high suicidal risk among the depressed elderly in Korea.

Methods

A descriptive cross-sectional design was adopted on secondary data from the 6th (1st year) Korean national health and nutrition examination survey (KNHANES). A total of 239 depressed elders aged 60 or over who participated in the KNHANES. The prevalence of suicidal ideation and its related factors, including sociodemographic, physical, psychological characteristics and quality of life (EQ-5D index) were examined. Descriptive statistics and a decision tree analysis were performed using the SPSS/WIN 23.0 and SPSS Modeler 14.2 programs.

Results

Of the depressed elderly, 28.9% had suicidal ideation. Three groups with high suicidal ideation were identified. Predictive factors included perceived stress level, household income level, quality of life and restriction of activity. In the highest risk group were those depressed elderly with moderate and low levels of stress, less than .71 of EQ-5D index and restriction of activity, and 80.0% of these participants had suicidal ideation. The accuracy of the model was 80.8%, its sensitivity 85.9%, and its specificity 68.1%.

Conclusion

Multi-dimensional intervention should be designed to decrease suicide among the depressed elderly, particularly focusing on subgroups with high risk factors. This research is expected to contribute itself to the policy design and solution building in the future as it suggests policy implications in preventing the suicide of the depressed elderly.

Keywords: Depression, Aged, Suicide, Decision trees

Figures and Tables

Figure 1

Decision tree model to identify high-risk subgroups of suicide in depressed elderly.

jkachn-30-130-g001
Table 1

Differences in Suicidal Ideation according to Characteristics of Subjects (N=239)

jkachn-30-130-i001

BMI=body mass index; EQ-5D=Euro quality of life 5-dimensions; †Separated, bereaved, divorced, single and no answer; ‡t-test.

Table 2

Predictive Performance according to Modeling Methods

jkachn-30-130-i002

C&RT=classification and regression tree; QUEST=quick, unbiased, efficient, statistical tree; CHAID=chi-squared automatic interaction detection.

Table 3

Classification Matrix of CHAID

jkachn-30-130-i003

CHAID=Chi-squared automatic interaction detection.

References

1. Korea Suicide Prevention Center Research Evaluation Team. Analysis of domestic and international suicide status - Focusing on 2017 OECD health data and 2016 cause of death statistics. KSPC Research Brief. Seoul: Korea Suicide Prevention Center (KSPC);2017. 12. Report No.: 2017-4. Available from: http://www.spckorea.or.kr/new/sub03/sub11.php?Kind=1330&Code=&page=1&Next=list&Category=&Year=&Month=&Day=&il=1&choose_Month=yes.
2. Statistics Korea. 2017 Population and Housing Census [Internet]. Seoul: Author;c2017. cited 2018 August 27. Available from: http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&aSeq=370326.
3. Ministry of health & Welfare, Korea Suicide Prevention Center. 2018 suicide prevention white book. Seoul: Ministry of Health & Welfare, Korea Suicide Prevention Center (KSPC);2018. 04. Report No.:11-1352000-001635-10. Available from: http://www.spckorea.or.kr/new/sub03/sub11.php?Kind=1330&Code=&page=1&Next=list&Category=&Year=&Month=&Day=&il=1&choose_Month=yes.
4. Chang S, Suh EY, Choi HJ. Risk factors on suicidal ideation and suicidal attempt among community dwelling older adults: Based on 2014 community health survey. The Korean Journal of Rehabilitation Nursing. 2017; 12(2):111–121. DOI: 10.7587/kjrehn.2017.111.
crossref
5. Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatric Clinics of North America. 2011; 34(2):451–468. DOI: 10.1016/j.psc.2011.02.002.
crossref
6. Lapierre S, Erlangsen A, Waern M, De Leo D, Oyama H, Scocco P, et al. A systematic review of elderly suicide prevention programs. Crisis. 2011; 32(2):88–98. DOI: 10.1027/0227-5910/a000076.
crossref
7. O'Connell H, Chin AV, Cunningham C, Lawlor BA. Recent developments: Suicide in older people. British Medical Journal. 2004; 329:895–899. DOI: 10.1136/bmj.329.7471.895.
8. Oh KS, Han KH, Park JE, Sohn JH, Cho MJ. Association of pain with suicidality in depressed elderly. Journal of Korean Geriatric Psychiatry. 2014; 18(2):45–50.
9. Lee JE, Lyu JY. Suicide among the elderly in Korea: A meta-analysis. Journal of the Korean Gerontological Society. 2017; 37(3):601–616.
10. Lee DW, Moon SH, Lee HJ, Lee SD. Data mining analysis of factors to predict the suicidal risk of the elderly. Korean Policy Studies Review. 2016; 25(1):297–329.
11. Kim MH, Kim HS. A review on the risk factors for suicidal ideation among the Korean elderly (2000–2010). Korean Journal of Public Health. 2011; 48(1):23–34.
12. Son ES, Moon SK. Factors affecting the suicide ideation and attempted suicide of the elderly at risk for depression - Focused on Chungcheongnam-do -. Crisisonomy. 2013; 9(11):133–153.
13. Minayo MC, Cavalcante FG. Suicide attempts among the elderly: A review of the literature (2002/2013). Ciencia & Saude Coletiva. 2015; 20(6):1751–1762. DOI: 10.1590/1413-81232015206.10962014.
14. Bae WS, Cho DH, Seok KH, Kim BS, Choi KL, Lee JE, et al. Data mining using SAS enterprise miner. Seoul: Kyowoosa;2008. p. 326.
15. Delmater R, Hancock M. Data mining explained: A manager's guide to customer-centric business intelligence. Boston, MA: Digital Press;2001. p. 392.
16. Kim BJ. Convergence study on the related risk factors of elderly's suicidal ideation based on the 6th Korea national health and nutrition examination survey. Journal of Digital Convergence. 2016; 14(11):27–35. DOI: 10.14400/JDC.2016.14.11.27.
crossref
17. Handley TE, Hiles SA, Inder KJ, Kay-Lambkin FJ, Kelly BJ, Lewin TJ, et al. Predictors of suicidal ideation in older people: A decision tree analysis. American Journal of Geriatric Psychiatry. 2014; 22(11):1325–1335. DOI: 10.1016/j.jagp.2013.05.009.
crossref
18. Kim HC, Sohn YM. A study on the characteristics of elderly suicide and suicidal type. The Korean Journal of Culture and Social Issues. 2006; 12(2):1–19.
19. Kim GS, Kim BN, So YS. A study on effects of daily stress factors on the suicidal ideation - Focused on the elderly people in Jeonju city -. Korean Journal of Local Government & Administration Studies. 2012; 26(1):285–315.
20. Lee HK, Chang CG. The relations of health-related quality of life, mental health, and suicidal ideation among Korean elderly. Korean Journal of Public Health. 2012; 38(1):69–79.
21. Yoon MS, Kim SH, Chae WS. The effects of alcohol use, mental health factors on seniors' ideation of suicide. Journal of the Korean Alcohol Science. 2010; 11(1):27–44.
22. Oh CS. The effects of the elderly's subjective health perceptions and quality of life on their depression and suicide ideation. The Korean Journal of Health Service Management. 2012; 6(2):179–191.
crossref
23. Koo CY, Kim JS, Yu JO. A study on factors influencing elders' suicidal ideation: Focused on comparison of gender differences. Journal of Korean Academy of Community Health Nursing. 2014; 25(1):24–32. DOI: 10.12799/jkachn.2014.25.1.24.
crossref
24. Kim KT, Choi SS, Park MJ, Park SH, Ko SH, Park HS. The effect of family structures and psycho-social factors on suicidal ideation of senior citizens. Journal of Welfare for the Aged. 2011; 52:205–228.
25. Kim K, Kim JS, Lee BS, Lee EK, Ahn YM, Choi MH. A study about the factors affecting the suicidal thought in Korean elders. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2010; 19(4):391–399.
crossref
26. Chung Y, Cho YH. Gender difference in quality of life after controlling for related factors among korean young-old and old-old Elderly. Journal of Agricultural Medicine and Community Health. 2014; 39(3):176–186. DOI: 10.5393/JAMCH.2014.39.3.176.
crossref
27. Kim JI. Levels of health-related quality of life(EQ-5D) and its related factors among vulnerable elders receiving home visiting health care services in some rural areas. Journal of Korean Academy of Community Health Nursing. 2013; 24(1):99–109. DOI: 10.12799/jkachn.2013.24.1.99.
28. VanItallie TB. Subsyndromal depression in the elderly: Underdiagnosed and undertreated. Metabolism. 2005; 54:Suppl 1. 39–44.
crossref
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ORCID iDs

Sehoon Hong
https://orcid.org/0000-0001-6585-8815

Dongwon Lee
https://orcid.org/0000-0003-4264-7120

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