Abstract
BackgroundWorldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted.MethodsA total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population.ResultsSI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56–2.98), item 4 (inferiority) (OR = 1.62, 1.23–2.13), item 5 (insomnia) (OR = 1.52, 1.13–2.05), and physical domain of WHOQOL (OR = 0.84, 0.72–0.99). QOL15 (mobility) (OR = 0.64, 0.46–0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44–0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24–15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15–0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20–0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients.ConclusionTo provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.
Highlights
Worldwide, the elderly are at a greater risk of suicide than other age groups
For patients admitted to surgical wards (n = 908, 41.2%), most were under the care of general surgery (n = 249, 11.32%)
Primary analysis of factors including demographic variables, The 5-item brief symptom rating scale (BSRS-5), and four domains of Quality of life (QOL) related to suicidal ideation (SI) Our study found depression, inferiority, insomnia in BSRS-5, and the sum of physical domain of QOL were significantly associated with SI
Summary
The elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. A study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted. The associated risk factors and prevalence for suicidal behaviors are diverse and are closely related to setting, measures, age groups, and different populations [1]. Quality of life (QOL) has been found to be associated with the risk of SI or suicidal behaviors in the elderly [6, 7]. Most of the cases with suicide death had a wish to die (WTD) [8], which was found to be associated with all-cause mortality during five-year follow up in elderly primary care patients [9]. There are other risk factors related to SI and suicidal behaviors, which include clinical depression [5, 10,11,12,13,14], substance misuse [13, 15, 16], poor perception of health [11, 17], financial problems [12, 14], relationship problem [11, 14], poor social support [13, 15], living alone [18], marital status [15, 18], impaired cognition [19, 20], history of traumatic events [1], and the burden of physical illness [21]
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