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Abstract
Our study aims to explore the risk factors for suicidal ideation and their interaction among the elderly in nursing homes in Hunan province, China. A cross-sectional study was conducted among the elderly in nursing homes in Hunan Province. Twenty-four nursing homes were selected by multistage cluster random sampling, and 817 elderly residents were investigated using a set of structured questionnaires. The main outcome measures included general information, suicidal ideation, depression symptoms, social support, activities of daily living (ADL), stressful life events, and sleep quality. Multivariate binary logistic regression was performed to explore the risk factors for suicidal ideation among the elderly in nursing homes, and additive interaction was used to analyze the interaction between risk factors. The prevalence of suicidal ideation among the elderly in nursing homes in Hunan province was 17.9% (95% confidence interval(CI): 15.2%, 20.6%). Living in a rural area (odds ratio(OR)=1.88, 95% CI: 1.03, 3.44), infrequent visits from relatives (OR=2.61, 95% CI: 1.42, 4.78), history of chronic disease (OR=2.34, 95% CI: 1.09, 5.01), depression symptoms (OR=8.11, 95% CI: 4.52, 14.54), lower social support (OR=3.85, 95% CI: 1.94, 7.61), and ADL disability status (OR=4.38, 95% CI: 2.10, 9.14) increased the risk of suicidal ideation. Additive interactions were detected between depression symptoms and ADL status, with a relative excess risk due to interaction (RERI) of 8.73 (95% CI: 2.04, 15.43), and between depression symptoms and social support, with an RERI of 5.98 (95% CI: 0.86, 11.10). The prevalence of suicidal ideation among the elderly in nursing homes is relatively high. Both physical conditions and psychosocial factors were associated with suicidal ideation among the elderly. These findings have significant implications for the prediction and prevention of suicidal behaviors.
Highlights
Suicide has gradually become a major public health problem; it is ranked the 13th leading cause of death and accounts for 1.4% of all deaths [1]
Based on a large population, our study found that the prevalence of suicidal ideation was 17.9% among elderly nursing home residents
This result is comparable to a previous study conducted among rural elderly Chinese adults living in nursing homes, which reported that 19.5% of participants had experienced suicidal ideation [14] in the past week
Summary
Suicide has gradually become a major public health problem; it is ranked the 13th leading cause of death and accounts for 1.4% of all deaths [1]. In China, suicide is the 5th leading cause of death, and the incidence of suicide is estimated to be 6.6/100,000 people per year [2]. In China, according to a meta-analysis in 2005, the estimated lifetime prevalence of suicidal ideation was 3.9% (95% confidence interval (CI): 2.5%, 6.0%) in the general population [9]. Another meta-analysis conducted in 2014 that included 11,526 subjects indicated that the prevalence of suicidal ideation among Chinese elderly adults ranged from 2.2% to 21.5%. With the ageing of the population in China, more attention should be paid to the pattern of suicidal ideation considering its relationship with suicidal behavior
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