Mediating Effects of Social Support on Depression and Suicidal Ideation in Older Korean Adults With Hypertension Who Live Alone

Abstract

Background: Older adults who live alone are less physically and emotionally healthy and report higher levels of depression relative to those who do not live alone. Suicide is the most problematic health issue reported by older adults who live alone. In particular, vulnerable older adults who live alone experience difficulty obtaining self-care and medical services; therefore, early detection of depression is difficult, and there are few opportunities to implement suicide prevention strategies in this population. In addition, social support for depression is an important factor affecting illness and economic vulnerability in older adults who live alone. Purpose: This study aimed to examine the relationship between depression and suicidal ideation in vulnerable older Korean adults with hypertension and to explore the mediating effect of social support on this relationship. Methods: The study used a cross-sectional design. Vulnerable older adults who were 65 years old or older with hypertension and who received home visit services from a public health center were invited to participate. The participants completed structured questionnaires, including the 15-item Short-Form Geriatric Depression Scale, 12-item Multidimensional Scale of Perceived Social Support, and 19-item Scale for Suicidal Ideation, and provided information regarding their demographic characteristics, health status, and economic status. Descriptive and correlation analyses were performed to examine the correlations among these variables. The three-step regression analysis method proposed by Baron and Kenny was used to examine the mediating effect of social support. Results: The mean depression, social support, and suicidal ideation scores of participants were 23.64 (± 2.04), 35.94 (± 15.40), and 7.80 (± 7.73), respectively. In addition, depression was negatively correlated with social support ( r = −.27) and positively correlated with suicidal ideation ( r = .21), whereas social support was negatively correlated with suicidal ideation ( r = −.35). Social support mediated the relationship between depression and suicidal ideation ( Z = 2.69). Conclusions: Social support was identified as an important variable for older adults with chronic illness who lived alone. Interventions that include social support hold the potential to reduce depression and suicidal ideation in this population.

The Relationship Between Health Literacy, Social Support, Depression, and Frailty Among Community-Dwelling Older Patients With Hypertension and Diabetes in China

“…As indicated by a meta-analysis, depression and frailty may share common risk factors and pathophysiological pathways, and patients subject to depressive disorder often exhibit frailty at significantly high levels (33), revealing that depression may be a vital target to mitigate and prevent frailty and its consequences. Previous studies have indicated that social support is a significant predictor of depression (30,31). In this study, however, poor social support was not identified to be associated with higher levels of depressive symptoms, which is in agreement with Ang et al (61).…”

“…In addition, Patra et al argued that social support can effectively reduce patients' psychological distress, such as depression (29). Social support was found to be a significant predictor of depression among older hypertensive patients and adults with diabetes (30,31). Furthermore, Stewart et al demonstrated that social support could be a mediator of the relationship between health literacy and depression among smokers (32).…”

<p>Predictors of Passive and Active Suicidal Ideation and Suicide Attempt Among Older People: A Study in Tertiary Care Settings in Thailand</p>

“…Remarkably however, perceived social support was a significant protective factor for SA. Although many studies have shown that SI is related to poor social support, 5,43,[48][49][50][51] this study, perceived social support came into play in SA but not in SI. This study emphasizes the importance of social support in reducing the likelihood of individuals with SI attempting suicide.…”

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

“…On the other hand, many studies have found that social support had a significant indirect effect on suicidal ideation via depression (53,54). For instance, a study conducted among older Korean adults with hypertension found that social support mediated the relationship between depression and suicidal ideation (55). These results may explain the interaction between depression and social support to some degree.…”