Structural Equation Modeling of Suicidal Ideation and Associated Factors among Elderly Women in Korea

Hung Sa Lee; Dohyun Lee

doi:10.15384/kjhp.2014.14.4.162

Korean J Health Promot > Volume 14(4); 2014 > Article

Lee and Lee: Structural Equation Modeling of Suicidal Ideation and Associated Factors among Elderly Women in Korea

Original Article

Korean Journal of Health Promotion 2014;14(4):162-171.

Published online: January 20, 2014

DOI: https://doi.org/10.15384/kjhp.2014.14.4.162

Structural Equation Modeling of Suicidal Ideation and Associated Factors among Elderly Women in Korea

¹Department of Nursing Science, College of Health Science, Sun Moon University, Asan, Korea

²PhD student, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA

Hung Sa Lee¹, Dohyun Lee^2,

Corresponding author：Dohyun Lee, PhD student School of Public Health, Indiana University Bloomington, 1025 E. 7th Street, SPH 192, Indiana University, Bloomington, IN, USA
Tel: +1-812-327-4525, Fax: +1-812-327-4525 E-mail: dohylee@indiana.edu

Received October 24, 2014 Accepted November 27, 2014

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

Background

Although the suicide rate in Korea is the highest in the world, only limited studies have been done on suicide and its associated factors. In this regard, we studied a conceptual model and the relationships and interactions of activity of daily living (ADL), social support, depression, and suicidal ideation among elderly women in Korea.

Methods

A cross-sectional descriptive study, subjects included 194 community-dwelling elderly women. Their ADL, multi-dimensional scale of perceived social support (MSPSS), depression, and suicidal ideation (SI) were examined. The t-test, ANOVA test, Pearson's correlation coefficient, multiple regression analysis, and structural equation modeling were utilized in data analysis.

Results

There were significant correlations between SI and economic status, social support, and depression. Depression was correlated with not only SI but also ADL (r=0.195, P=0.006) and social support (r=-0.337, P<0.001). Absolute fit indices demonstrated that the research model had a good model fit. There were significant factor loading values from depression to SI (standardized estimate=0.157, P=0.023) and from social support to SI (standardized estimate=-0.308, P<0.001). There were two indirect effects from social support to SI and from ADL to SI. The mediating factor of these two indirect effects was depression.

Conclusions

Suicidal ideation in the elderly needs to be prevented; and more attention should be given to this end. Social support programs encouraging family participation are greatly effective in prevention of senior citizens' suicidal ideation.

Keywords: Suicidal ideation, Social support, Depression, Aged

Figure 1.

Regression model of variables by SEM (standardized regression weights)

Table 1.

Differences of variables according to general characteristics of study participants^a

Characteristics	N	ADL	SS	Dep	SI
Age, y	77.50 (±5.84)
65–74	54 (27.8)	7.33 (±1.71)	4.03 (±0.99)	4.59 (±3.29)	5.68 (±1.51)
75 & over	140 (72.8)	7.52 (±1.79)	3.90 (±0.99)	5.91 (±4.18)	5.92 (±1.86)
t (P)^b		–0.66 (0.508)	0.77 (0.442)	2.31 (0.022)	–0.83 (0.407)
Marital status
Married	98 (50.5)	7.67 (±2.23)	3.89 (±0.97)	5.41 (±4.05)	5.83 (±1.57)
Bereaved	96 (49.5)	7.26 (±1.06)	3.99 (±1.02)	5.67 (±3.95)	5.87 (±1.96)
t (P)		1.64 (0.102)	–0.69 (0.489)	–0.45 (0.653)	–0.15 (0.881)
Education level
No education	96 (49.5)	7.78 (±2.38)^A	3.83 (±1.07)	6.47 (±4.18)^A	5.82 (±1.67)
Elementary school	85 (43.8)	7.18 (±0.69)^B	4.00 (±0.91)	4.72 (±3.69)^B	5.85 (±1.85)
Junior high school	13 (6.7)	7.00 (±0.01)^C	4.32 (±0.88)	4.00 (±2.91)^B	6.07 (±2.10)
F (P)		3.09 (0.047)	1.60 (0.204)	5.61 (0.004)	0.11 (0.890)
		A>B>C		A>B
Economic status
Low	54 (27.8)	7.77 (±2.27)	3.48 (±1.10)^A	8.03 (±3.85)^A	6.83 (±2.36)^A
Middle	109 (56.2)	7.38 (±1.59)	4.15 (±0.92)^B	4.74 (±3.83)^B	5.47 (±1.38)^B
High	31 (16.0)	7.22 (±1.25)	3.98 (±0.79)^C	4.03 (±2.79)^C	5.48 (±1.06)^B
F (P)		0.36 (0.698)	8.72 (<0.001)	17.44 (<0.001)	12.73 (<0.001)
			A<B	A<B<C	A<B
Living together
Alone	87 (44.8)	7.37 (±1.35)	3.95 (±0.97)	6.02 (±4.13)	5.79 (±1.74)
Spouse	63 (32.5)	7.77 (±2.55)	4.01 (±1.02)	5.44 (±3.83)	5.76 (±1.68)
Children	44 (22.7)	7.20 (±0.82)	3.82 (±1.01)	4.75 (±3.88)	6.11 (±1.96)
F (P)		1.57 (0.209)	0.48 (0.615)	1.52 (0.221)	0.60 (0.548)
Health status
Bad	103 (53.1)	7.74 (±2.23)	3.86 (±1.03)	6.21 (±4.20)^A	6.01 (±1.90)
Middle	48 (24.7)	7.12 (±0.73)	4.14 (±0.95)	5.10 (±3.61)^B	5.47 (±1.35)
Good	43 (22.1)	7.18 (±1.07)	3.88 (±0.93)	4.44 (±3.65)^B	5.88 (±1.82)
F (P)		2.79 (0.064)	1.39 (0.251)	3.45 (0.034)	1.53 (0.219)
				A>B
Living area
Urban	41 (21.1)	7.09 (±0.37)	3.71 (±0.98)	5.19 (±3.45)	5.85 (±1.85)
Rural	153 (78.9)	7.56 (±1.96)	4.00 (±0.99)	5.64 (±4.13)	5.85 (±1.76)
t (P)		–2.77 (0.006)	–1.61 (0.107)	–0.63 (0.528)	–0.08 (0.994)
Working
No	99 (51.0)	7.58 (±1.94)	3.91 (±1.07)	6.36 (±4.23)	5.98 (±2.00)
Yes	95 (49.0)	7.34 (±1.55)	3.97 (±0.91)	4.70 (±3.56)	5.71 (±1.49)
t (P)		–0.94 (0.349)	0.38 (0.700)	–2.94 (0.004)	–1.07 (0.238)
Total	194 (100)	7.46 (±1.76)	3.94 (±0.99)	5.54 (±3.99)	5.85 (±1.77)

Abbreviations: ADL, activity of daily living; SS, social support; Dep, depression; SI, suicidal ideation.

^a Values are presented as mean±SD or N (%) unless otherwise indicated.

^b Calculated by t-test or ANOVA test and Sheffe test.

Table 2.

Correlations between ADL, social support, depression, and suicidal ideation^a

Variables	Education	Economic status	Health status	ADL	SS	Dep	SI
Education	1
Economic status	0.031 0.673	1
Health status	0.273 <0.001	0.270 <0.001	1
ADL	–0.133 0.064	–0.100 0.165	–0.143 0.047	1
SS	0.068 0.345	0.197 0.006	0.026 0.724	–0.055 0.445	1
Dep	–0.176 0.014	–0.363 <0.001	–0.180 0.012	0.195 0.006	–0.337 <0.001	1
SI	0.104 0.150	–0.280 <0.001	–0.051 0.484	0.056 0.441	–0.393 <0.001	0.289 <0.001	1

Abbreviations: ADL, activity of daily living; SS, social support; Dep, depression; SI, suicidal ideation.

^a Assessed by Pearson correlation coefficient (controlled age).

Table 3.

Variables influencing suicidal ideation of subjects^a

Predictor	Β	SE	β	t	P
(constant)	4.57	2.10		2.17	0.031
Age	0.04	0.02	0.14	1.81	0.071
Economic status	–0.45	0.18	–0.17	–2.45	0.015
Education	0.51	0.21	0.18	2.42	0.016
ADL	0.01	0.06	0.01	0.20	0.837
SS	–0.04	0.01	–0.32	–4.67	<0.001
Dep	0.06	0.03	0.14	2.01	0.046
R²=0.245, Adj R²=0.221, F=10.12, P<0.001

Abbreviations: SE, standard error; ADL; activity of daily living; SS, social support; Dep, depression; Adj R², adjusted R square.

^a Calculated by multiple regression analysis.

Table 4.

Standardized parameter statistics in hypothetical model^a (regression weights)

Path of variables			Standardized estimate	S.E.	C.R.	P	Label	Direct effect	Indirect effect
Dep	←	SS	–0.337	0.062	–4.847	<0.001	par_6	–0.337^c	0.000
Dep	←	ADL	0.190	0.150	2.850	0.004	par_7	0.190^c	0.000
Friend support	←	SS	0.927					0.927	0.000
Neighbor support	←	SS	0.943	0.051	19.461	<0.001	par_1	0.943^c	0.000
Family support	←	SS	0.734	0.045	12.989	<0.001	par_2	0.734^c	0.000
SI	←	Dep	0.157	0.031	2.276	0.023	par_3	0.157^b	0.000
SI	←	ADL	0.003	0.064	0.052	0.958	par_4	0.003	0.030
SI	←	SS	–0.308	0.029	–4.184	<0.001	par_5	–0.308^c	–0.053
e10	↔	d2	–0.296	0.307	–3.766	<0.001	par_8

Abbreviations: S.E., standard error; C.R., critical ratio; Dep, depression; ADL; activity of daily living; SS, social support; SI, suicidal ideation.

^a Calculated by structural equation model analysis.

^b P<0.05.

^c P<0.01.

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