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-

Article information

Korean J Health Promot. 2017;17(3):193-198

Publication date (electronic) : 2017 January 19

doi : https://doi.org/10.15384/kjhp.2017.17.3.193

Yeunsoon Choi , Miji Kim , Ae Rim Seo , Hyun Ok Kim , Ki Soo Park

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

Received 2017 May 24; Accepted 2017 August 24.

Abstract

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.

Keywords: Depression; Health status; Suicidal ideation; Mediator

Table 1.

Distribution of demographic characteristics of study population

Table 2.

Suicidal ideation by demographic characteristics of study population

Table 3.

Mediating effect of depression on the relationship between frailty and suicidal ideation^a

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Table 1.

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.

Table 2.

Suicidal ideation by demographic characteristics of study population

Characteristics	Suicidal ideation		P^a
Characteristics	No	Yes	P^a
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.

Table 3.

Mediating effect of depression on the relationship between frailty and suicidal ideation^a

Path^b	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.