Abstract
Loneliness is increasingly recognised as a serious public health issue worldwide. However, there is scarce research addressing the association between loneliness and suicide in older adults in rural China. We set out to examine loneliness and other psychosocial factors in elderly suicide cases and explore their interaction effects. Using a 1 : 1 matched case-control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, loneliness, depression, hopelessness and social support. The chi-square automatic interaction detection (CHAID) tree model and multivariable logistic regression analysis were used to explore the relationships of these factors and suicide. The CHAID tree model showed that loneliness, hopelessness and depressive symptoms were closely associated with completed suicide and that loneliness and hopelessness interacted with each other. The result of multivariable logistic regression showed that individuals who were unemployed [odds ratio (OR) = 2.344; 95% confidence interval (CI): 1.233-4.457], living alone (OR = 2.176; 95% CI: 1.113-4.254), had lower levels of subjective social support (OR = 2.185; 95% CI: 1.243-3.843), experienced depressive symptoms (OR = 6.700; 95% CI: 3.405-13.182), showed higher levels of hopelessness (OR = 7.253; 95% CI: 3.764-13.974) and felt higher levels of hopelessness × higher levels of loneliness (OR = 2.446; 95% CI: 1.089-5.492) were significantly associated with an elevated suicide risk in older people in rural China. Regular evaluation of loneliness, hopelessness and depression can help detect older adults who are at risk of committing suicide. Interventions should target social support systems, particularly among people living alone, to alleviate feelings of loneliness and hopelessness. Treating depression is also key to preventing suicide among elderly people in rural China.
Highlights
Despite the sharp drop in the national suicide rate in China over the past two decades, suicide among older people is of increasing concern (Jiang et al, 2018)
The results showed that three variables had close associations with completed suicide among older adults in rural China: hopelessness, loneliness and depressive symptoms
In this Psychological autopsy (PA) study, the chi-square automatic interaction detection (CHAID) tree model showed that loneliness, hopelessness and depressive symptoms had close associations with completed suicide and that loneliness and hopelessness interacted with each other
Summary
Despite the sharp drop in the national suicide rate in China over the past two decades, suicide among older people is of increasing concern (Jiang et al, 2018). In 2016, the suicide rate among people over 65 was estimated to be 6.5-fold higher than that of younger people, and it was significantly higher in rural older people than those living in an urban area (Zhong et al, 2016). The prevalence of loneliness is higher, ranging between 28 and 63% in high-income countries (Mead, 2018; Pimlott, 2018). Loneliness in older people in China might be even more prevalent (Pimlott, 2018). A national report on the living status of elderly Chinese people showed over half of rural older adults are experiencing empty nest syndrome or have been left behind by their adult children (Cai, 2018). Changes in family structure and the social culture of filial piety have weakened adult children’s
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