Quality of Life, Hopelessness, Impulsivity, and Suicide in the Rural Elderly in China: A Moderated Mediation Analysis of Psychological Autopsy Data

Chen, Guoxiang; Mo, Qiqing; Chen, Xinguang; Yu, Bin; He, Huiming; Wang, Guojun; Jia, Cun-Xian; Zhou, Liang; Ma, Zhenyu

doi:10.3389/fpubh.2022.900156

Cited by 2 publications

(1 citation statement)

References 32 publications

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“…QOL has been associated with suicide among the elderly in China ( 9 , 41 ) and other countries ( 42 ). The current study is the first to delineate a dose-response relationship between the two.…”

Section: Discussionmentioning

confidence: 99%

Hierarchical and nested associations of suicide with marriage, social support, quality of life, and depression among the elderly in rural China: Machine learning of psychological autopsy data

Chen

et al. 2022

Front. Psychiatry

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ObjectivesTo identify mechanisms underpinning the complex relationships between influential factors and suicide risk with psychological autopsy data and machine learning method.DesignA case-control study with suicide deaths selected using two-stage stratified cluster sampling method; and 1:1 age-and-gender matched live controls in the same geographic area.SettingDisproportionately high risk of suicide among rural elderly in China.ParticipantsA total of 242 subjects died from suicide and 242 matched live controls, 60 years of age and older.MeasurementsSuicide death was determined based on the ICD-10 codes. Influential factors were measured using validated instruments and commonly accepted variables.ResultsOf the total sample, 270 (55.8%) were male with mean age = 74.2 (SD = 8.2) years old. Four CART models were used to select influential factors using the criteria: areas under the curve (AUC) ≥ 0.8, sensitivity ≥ 0.8, and specificity ≥ 0.8. Each model included a lead predictor plus 8–10 hierarchically nested factors. Depression was the first to be selected in Model 1 as the lead predictor; After depression was excluded, quality of life (QOL) was selected in Model 2; After depression and QOL were excluded, social support was selected in Model 3. Finally, after all 3 lead factors were excluded, marital status was selected in Model 4. In addition, CART demonstrated the significance of several influential factors that would not be associated with suicide if the data were analyzed using the conventional logistic regression.ConclusionAssociations between the key factors and suicide death for Chinese rural elderly are not linear and parallel but hierarchically nested that could not be effectively detected using conventional statistical methods. Findings of this study provide new and compelling evidence supporting tailored suicide prevention interventions at the familial, clinical and community levels.

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Section: Discussionmentioning

confidence: 99%

Hierarchical and nested associations of suicide with marriage, social support, quality of life, and depression among the elderly in rural China: Machine learning of psychological autopsy data

Chen

et al. 2022

Front. Psychiatry

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A systematic review of psychosocial protective factors against suicide and suicidality among older adults

Ki,

Lapierre,

Gim

et al. 2024

Int. Psychogeriatr.

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Background: Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults. Method: First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis. Results: A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures. Conclusion: Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.

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Quality of Life, Hopelessness, Impulsivity, and Suicide in the Rural Elderly in China: A Moderated Mediation Analysis of Psychological Autopsy Data

Cited by 2 publications

References 32 publications

Hierarchical and nested associations of suicide with marriage, social support, quality of life, and depression among the elderly in rural China: Machine learning of psychological autopsy data

Hierarchical and nested associations of suicide with marriage, social support, quality of life, and depression among the elderly in rural China: Machine learning of psychological autopsy data

A systematic review of psychosocial protective factors against suicide and suicidality among older adults

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