The validity of proxy-based data on loneliness in suicide research: a case-control psychological autopsy study in rural China

Lu Niu,Liang Zhou,Zhenyu Ma,Cunxian Jia,Guojun Wang,Zhenjun Yu

doi:10.1186/s12888-018-1687-x

Abstract

BackgroundThere is a lack of evidence for the role of loneliness on suicide using psychological autopsy method, and the validity of proxy informants’ reports on loneliness is not well established. This study aimed to investigate the validity of proxy respondent reports on loneliness, and the reliability and validity of the University of California Los Angeles Loneliness Scale-6 (ULS-6) as used in psychological autopsy method with rural elderly people in China.MethodsTwo hundred forty-two suicide cases and 242 normal community controls were selected, and the psychological autopsy method was utilized to collect information. Data from proxy respondents of the living controls were compared with data reported by the targets (gold standards).ResultsSubject-proxy concordance for ULS-6 was fair (ICC = 0.447) in the living controls. The suicide cases were more likely to have a higher score of ULS-6 than the living controls. Additionally, our data supported that ULS-6 had adequate psychometric properties in both suicide and control groups: factor analyses yielded one-factor component solution; Cronbach’s alpha (both > 0.90) demonstrated excellent internal consistency; the Spearman correlation analysis indicated that the ULS-6 score was positively correlated with depression; and negatively correlated with QOL and social support.ConclusionsResults support proxy-based data on loneliness in research of suicide in older adults in rural China, and the ULS-6 is a psychometrically sound instrument for measuring loneliness in psychological autopsy studies.

Highlights

There is a lack of evidence for the role of loneliness on suicide using psychological autopsy method, and the validity of proxy informants’ reports on loneliness is not well established
The University of California Los Angeles Loneliness Scale-6 (ULS-6) was adopted to measure loneliness in this study. In this case-control psychological autopsy study, we aimed to assess the concordance of subject and proxy reports on loneliness in the Chinese rural elderly; and to evaluate the psychometric properties of ULS-6 in individuals who died by suicide and, separately, in matched community-based control subjects in rural China
Subject-proxy agreement on loneliness In the living controls, the mean score of ULS-6 reported by the subjects themselves was 9.8 (SD = 3.9)

Summary

Introduction

There is a lack of evidence for the role of loneliness on suicide using psychological autopsy method, and the validity of proxy informants’ reports on loneliness is not well established. This study aimed to investigate the validity of proxy respondent reports on loneliness, and the reliability and validity of the University of California Los Angeles Loneliness Scale-6 (ULS-6) as used in psychological autopsy method with rural elderly people in China. It was predicted that Chinese elderly suicide rates, especially among the rural elderly population, were likely to go up again [2]. Given the rapid aging of Chinese population, elderly suicide prevention should be given greater priority for reducing. Studies have linked loneliness to various correlates of suicidal behaviors. A high correlation was reported between loneliness and substance use as well [10].

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