Physical diseases and elderly suicide in rural China: A case–control psychological autopsy study

Abstract

Objectives: Physical diseases are well-established risk factor for suicide, particularly among older adults. However, little is known about the underlying mechanism of the association. This study aimed to describe the prevalence of physical diseases and their influences on the elderly in rural China and to examine the underlying mechanisms of the relationship between physical diseases and suicide. Methods: This matched case–control psychological autopsy study was conducted from June 2014 to September 2015. Consecutive suicide cases (242) among people aged 60 years or above were identified in three Chinese provinces. The suicide cases were 1:1 matched with living comparisons based on age, gender and residential area. Two informants for each participant were interviewed to collect data on their demographic characteristics, the severity index of physical diseases, depressive symptoms, feelings of hopelessness, mental disorders and social support. Results: A significant difference was found between suicide cases and living comparisons regarding the prevalence of physical diseases (83.5% vs 66.5%, p < 0.001) and their severity (11.3 ± 6.2 vs 6.7 ± 5.3, p < 0.001). Independent risks of suicide included the following: not currently married (OR = 2.81, 95% CI = [1.04, 7.62]), mental disorders (OR = 7.18, 95% CI = [1.83, 28.13]), depressive symptoms (OR = 1.15, 95% CI = [1.05, 1.26]) and feelings of hopelessness (OR = 1.51, 95% CI = [1.20, 1.90]). The structural equation model indicated that the relationship between the severity index of physical diseases and suicide was mediated by depressive symptoms, feelings of hopelessness and mental disorders. Conclusion: The severity and number of physical diseases were found to be correlated with suicide among the elderly in rural China, after controlling for demographic characteristics. Physical diseases elevate one’s suicide risk by increasing depressive symptoms, feelings of hopelessness and mental disorders. Efforts for suicide prevention should be integrated with strategies to treat physical diseases along with psychological interventions.

Suicide among young‐old and old‐old adults in rural China: A case‐control psychological autopsy study

“…This discrepancy could be explained by the difference in operational rating of physical illness 21 . Besides, physical diseases elevate suicide risk via increasing depression, hopelessness, and perceived burden 43 . However, we did suggest substantial effect modification by age in the predict effects of disability in physical activities of daily living on suicide.…”

“…The present study suggested that higher depressive symptoms, and hopelessness were major predictors of suicide among the elderly population without age difference. These negative psychological feelings might be the proximal performance of the combined effects of multiple suicide risk factors such as living alone, being left‐behind, physical disease, and other stressful life events 24,43 . In the current sample, more than 90% of suicide decedents experienced depressive symptoms and over a half suffered from clinical depression, but only 4.13% sought professional help from psychiatrists.…”

The Influence of Disease Status on Loneliness of the Elderly: Evidence from Rural China

“…The health problems of the elderly are not only reflected in the physiological aspects, but also in the psychological aspects. As an important indicator of mental health, loneliness is not only a reflection of the mental health status of the rural elderly, but also a sensitive indicator of depression and suicidal ideation [ 17 ]. This paper selects the loneliness of the rural elderly as the explanatory variable.…”

“…At present, research on the rural elderly mainly focuses on the following directions: first, the subjective welfare and health of the rural elderly [ 2 , 3 , 4 , 5 ]; second, the willingness and mode of providing for the elderly in rural areas [ 6 , 7 ]; third, the intergenerational relationship between the rural elderly and their children [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Among them, research on the mental health problems of the rural elderly is mostly discussed from the level of children and does not deeply explore whether the elderly’s diseases and other self-factors will produce loneliness and bring psychological problems [ 15 , 16 , 17 , 18 , 19 ]. From the perspective of empirical research, it is suggested that the illness of the elderly will produce or aggravate the sense of loneliness.…”

“…The quality of physical condition will affect mental health. On the other hand, because of diseases, physical diseases will distort people’s psychology, resulting in inferiority complex, resentment, depression and other changes [ 17 ]. That is, the quality of physical condition will affect mental health.…”