kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2017.17.3.193 kjhp-17-193 Original Article 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- ChoiYeunsoon KimMiji SeoAe Rim KimHyun Ok ParkKi Soo 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 012017 19012017 173193 198 24052017 24082017 Copyright © 2017 The Korean Society of Health Promotion and Disease Prevention 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. 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.

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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.

Suicidal ideation by demographic characteristics of study population

Characteristics Suicidal ideation Pa
No Yes
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.

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

Mediating effect of depression on the relationship between frailty and suicidal ideationa

Pathb 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.

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

Calculated by multiple logistic regression analysis.