Elderly Suicide Research Articles

Inpatient Care for Elderly Suicide Survivors: Nurse-Led Mindfulness-Based Cognitive Therapy.

The aim was to analyze the effects of nurse-led mindfulness-based cognitive therapy (MBCT) in hospitalized elderly suicide survivors. The data of middle-aged and elderly suicide survivors in the medical system and nursing records of our hospital from January 2018 to August 2023 were retrospectively collected. The patients were divided into conventional group and MBCT group according to whether they actively received MBCT. The general demographic data of the patients and the changes in the scores of Suicidal Ideation Scale (SSI), Beck Hopelessness Scale (BHS), Patient Health Questionnaire 15 (PHQ-15), and Geriatric Depression Scale (GDS-15) at admission and 3 and 6 months of follow-up were collected. Propensity score matching was used to balance the baseline data of the 2 groups. Multiple logistic regression analysis was used to determine the effect of the inpatient care program on each score. A total of 160 patients were included in the study, including 100 patients in the MBCT group and 60 patients in the conventional group. There was no significant difference in baseline data between the 2 groups after matching (P > .05). Suicidal Ideation Scale score, BHS score, PHQ-15 score, and GDS-15 score in MBCT group were lower than those in conventional group at 6 months of follow-up (P < .05). At the same time, multiple logistic regression analysis showed that the intervention program was the main factor affecting the SSI (OR = 1.538, P = .010), BHS (OR = 1.614, P = .006), PHQ-15 (OR = 1.797, P = .001), and GDS-15 scores (OR = 1.642, P = .004) at 6 months of follow-up. The application of nurse-led MBCT in hospitalized elderly suicide survivors may reduce suicidal ideation, hopelessness, and depression and improve physical symptoms.

Development and Validation of the Elderly Suicide Screening Scale

Background This study stems from the need to develop and validate a tool for interprofessional teams in Primary health care for screening for suicide among the elderly in the community. Objective To evaluate the psychometric properties of the Non-Institutionalized Elderly Suicide Screening Scale (Escala de Rastreamento de Renúncia à Vida no Idoso não institucionalizado - ERRVI). Methods This is a psychometric study focused on evaluating evidence of content validity and internal structure. The ERRVI construction process followed the guidelines for scale development based on theoretical models derived from qualitative research, which followed the methodological and theoretical approaches of grounded theory and symbolic interaction. The instrument underwent content validity evidence analysis carried out by a panel of experts, considering the Content Validity Index (CVR). After the pre-test, the internal structure was evaluated using Exploratory Factor Analysis (AFE). Reliability was assessed using three indicators: Cronbach's alpha, Omega, and ORION scores. It involved 300 elderly individuals from two municipalities in the central-western region of Sao Paulo, Brazil, and was conducted from September to November 2020. Results The final version comprised 31 items, categorized into four dimensions: autonomy, self-governance, self-care, and life satisfaction. The total explained variance was 50.82%, with factor loadings ranging from 0.31 to 0.86. The reliability indicators revealed a Cronbach’s alpha of 0.88, McDonald's Omega of 0.95, and scores for the dimensions assessed by the Overall Reliability of Fully-Informative Prior Oblique N-EAP (ORION) ranging from 0.78 to 0.84. Conclusion The ERRVI showed evidence of content validity and internal structure in accordance with the recommended psychometric parameters. This is an innovative tool with the social value, given the scarcity of tools that screen the risk of suicide among the elderly in the community. It is the first of its kind in Brazil and the third globally.

A scientometric analysis and visualisation of elderly suicide research from 1951 to 2022.

There are still many gaps in both national and international literature on elderly suicide. This study aimed to identify the most influential journals in elderly suicide, the countries and authors that contribute the most to the field, and the trends in the field. Studies published on elderly suicide between 1951 and 2022 were retrieved utilising the Web of Science Core Collection. Co-authorship analysis of countries and authors, as well as co-occurrence analysis of keywords, were conducted using VOSviewer 1.6.18. There were 2864 articles retrieved, including 95 countries, 889 academic journals, 9162 authors and 4160 keywords. The number of publications in this field has significantly increased after the 2000s, and the United States is the most productive country (996). The most prolific author is Yeates Conwell, while the journal with the highest number of publications in this field is the International Journal of Geriatric Psychiatry. Other than 'suicide' and 'elderly', the most trending keywords are 'depression', 'primary care', 'treatment', 'antidepressant', 'loneliness', 'quality of life' and 'COVID-19'. There has been an increase in both the thematic diversity and quantity of studies on elderly suicide over time. However, these publications predominantly originate from socioeconomically affluent countries with relatively low suicide rates. While the increasing numbers of publications from developing countries in recent years are promising, there is a greater need for publications from countries with lower socioeconomic status for the prevention or intervention of elderly suicides.

A brief research report of suicide rates in the Brazilian elderly over a 12-year period: the lack of association of the "Setembro Amarelo" campaign for suicide prevention.

Aiming to disseminate information related to suicide prevention in Brazil, the "Setembro Amarelo" campaign has been conducted since 2015. The objective of this study is to assess the association between this campaign and elderly suicide rates over a 12-year period. Data were gathered from the Mortality Information System and the Notifiable Diseases Information System, established by public institutions in Brazil. An interrupted time-series framework was applied to assess the association between the "Setembro Amarelo" campaign and suicide mortality rates in the elderly population (60 et plus) in the southeastern region of Brazil. We consider three monthly outcomes: all suicides, suicides in males and suicide in females. We operationalize the campaign assuming three effects: short-term, declining and sustained. The period of analysis was from 2011-2022. The suicide-mortality rate over time has remained stable; the average rate in the pre-campaign period was 0.028 and increased slightly to 0.035. Regardless of the campaign's operationalization and the outcome used, results show no significant associations between the campaign and elderly suicide rates. The campaign was associated with non-significant decreased effects of 15% (P=0.532) in the short term, and 16% (P=0.446) assuming the campaign was sustained. There is a lack of association between the campaign and suicide rates, among the elderly in Brazil's southeastern region. As suicide is complex and multifactorial, more research is needed. The campaign, while raising awareness and reducing stigma, may not reduce suicides. To reduce the suicide rate in the elderly requires addressing social, economic and cultural factors, multisectoral interventions, and upholding basic human rights.

The characteristics of elderly suicidal attempters in the emergency department in Korea: a retrospective study.

Although Korea ranks first in the suicide rate of elderly individuals, there is limited research on those who attempt suicide, with preventive measures largely based on population-based studies. We compared the demographic and clinical characteristics of elderly individuals who attempted suicide with those of younger adults who visited the emergency department after suicide attempts and identified the factors associated with lethality in the former group. Individuals who visited the emergency department after a suicide attempt from April 1, 2017, to January 31, 2020, were included. Participants were classified into two groups according to age (elderly, ≥65 years; adult, 18-64 years). Among the 779 adult patients, 123 were elderly. We conducted a chi-square test to compare the demographic and clinical features between these groups and a logistic regression analysis to identify the risk factors for lethality in the elderly group. Most elderly participants were men, with no prior psychiatric history or suicide attempts, and had a higher prevalence of underlying medical conditions and attributed their attempts to physical illnesses. Being sober and planning suicide occurred more frequently in this group. In the elderly group, factors that increased the mortality rate were biological male sex (p<0.05), being accompanied by family members (p<0.05), and poisoning as a suicide method (p<0.01). Suicide attempts in elderly individuals have different characteristics from those in younger adults and are associated with physical illness. Suicides in the former group are unpredictable, deliberate, and fatal. Therefore, tailored prevention and intervention strategies addressing the characteristics of those who are elderly and attempt suicide are required.

노인 치안 안전을 위한 디지털 소외 해소 방안 연구

The security and safety of the elderly are closely related to the safety of society as a whole. As the elderly population increases, digital development is emerging as a social problem along with safety issues such as crime, abuse, and disappearance of the elderly. Digital technology, which has developed rapidly around the world, has created a digital environment that enables consumption, work, life, medical care, and education anywhere, transcending space and time. The 2000s was a time when Korea entered an aging society, and the increase in the elderly population due to aging increased the problem of digital inequality and digital alienation due to new social inequality called digital gap.&#x0D; The increase in the elderly population is facing daily life such as social isolation and alienation, social discomfort, depression, and dementia due to weak information power of the elderly, such as elderly safety, elderly poverty, elderly suicide, elderly crime, and digital financial accidents. Digital alienation is directly related to the safety of the elderly population and is likely to be easily exposed to new threats such as security, voice phishing, anxiety caused by fake news, Internet commerce, financial fraud, and cybercrime due to the increase in smishing.&#x0D; Therefore, economic, social, and emotional support for the elderly is needed for the security and safety of the elderly. In the future, efforts to improve awareness of the problem of digital alienation of the elderly in Korea should be made by forming a full social consensus among members of society based on the use of the elderly population and support from the government and the private sector.

Sex differences in the factors that affect medical lethality in elderly suicide attempters

ObjectivesThis study aimed to identify sex differences in the factors that affect medical lethality in elderly suicide attempters.MethodsA total of 253 elderly suicide attempters and 351 middle-aged attempters (comparison group) who visited the emergency room at a general hospital were included. The sociodemographic and clinical characteristics of the patients were investigated. The Chi-squared test and logistic regression analysis were performed. And Spearman’s correlation coefficient was calculated.ResultsIn older males, the risk of high lethality was lower when attempting suicide due to the loss of family members [adjusted odds ratio (AOR): 0.08]. The risk increased as the intent to die became more certain (some AOR: 11.31, certain AOR: 28.75), and this association became more pronounced with age (rho middle-aged: 0.329; young-old: 0.387; old-old: 0.415). In older females, the risk was lower when employed (AOR: 0.28). The method of suicide attempt also affected lethality (agricultural chemicals AOR: 3.71; psychiatric medication AOR: 0.31).ConclusionSex differences in the factors that affect medical lethality were identified among elderly suicide attempters. In particular, medical lethality can be predicted by the degree of suicide intention in older males. These findings will help to establish more efficient preventive strategies with specific targets.

Restrictive fertility policy and elderly suicides: evidence from China

Abstract This paper presents an empirical investigation of the hypothesis that exposure to the restrictive fertility policies of the Chinese “Later, Longer, Fewer” campaign in the 1970s contributes to the dynamics and patterns of elderly suicides in China in the period 2004–2017. We apply an identification strategy that exploits variation in exposure to this policy across birth cohorts that is based on the different timing of the implementation of the fertility policies across Chinese provinces. The results show that cohorts with a greater exposure to the restrictive fertility policy in the 1970s exhibit higher suicide rates during old ages.

Association of Body Mass Index and Cardiometabolic Factors With Elderly Suicide: A Cohort Study of 101,518 Older Taiwanese

Older people have the highest suicide rate across age groups in most countries. The prevalence of cardiometabolic risk factors also increases with age. We investigated the association between body mass index (BMI), cardiometabolic risk factors, and suicide in a large cohort of older people in Taiwan. We conducted a cohort study using data from an elderly health examination program in Taipei City, Taiwan (2005-2010), linked to the national cause-of-death data files. We used competing risk Cox regression models to investigate the associations of BMI (kg/m2) and cardiometabolic factors with suicide after adjusting for sex, age, socioeconomic variables, chronic diseases, psychological distress, and cognitive function. Among 101,518 individuals aged ≥ 65 years, 92 died by suicide during an average follow-up of 3.9 years. Underweight (BMI<18.5) was associated with increased suicide risk (adjusted hazard ratio [aHR]=2.33, 95% confidence interval [CI] 1.20-4.52) (reference: normal weight). Low diastolic blood pressure was associated with increased suicide risk - aHR was 0.51 (95% CI 0.29-0.91) and 0.55 (95% CI 0.31-0.99) for the third and fourth quartiles of diastolic blood pressure (reference: the lowest quartile), respectively. Older people with a higher waist circumference (aHR per 1-standard-deviation increase=0.60 [95% CI 0.37-0.98]) and a higher number of metabolic syndrome criteria (aHR per 1-criterion increase=0.65 [95% 0.46-0.92]) had lower suicide risk. Systolic blood pressure, pulse rate, fasting blood glucose, and lipid profiles were not associated with suicide risk. Underweight, low diastolic blood pressure, and low waist circumference may be markers of increased suicide risk in older people.

노인 자살률은 왜 감소하고 있는가?

The elderly suicide rate in South Korea has declined sharply over the past decade. This study inferred that the decrease in the elderly suicide rate is due to the achievement of expanding the coverage of major social security systems rather than demographic changes. Therefore, we analyzed whether the expansion of the service guarantee and income security system had an impact on the elderly suicide rate. The research method is a panel fixed-effects analysis with the dependent variable of the elderly suicide rate from 2011 to 2020 at the county level and the independent variables of the long-term care for the elderly, the national pension (old-age pension), and the basic pension. The results show that all but 12 of the nation's 228 cities and counties experienced a decrease in the elderly suicide rate, and that the expansion of the elderly long-term care coverage over the past decade has contributed significantly to the decrease in the elderly suicide rate. In the model with social security coverage, a one percentage point increase in long-term care coverage was associated with a 2.26 percentage point decrease in the suicide rate, and a one percentage point increase in old-age pension coverage was associated with a 1.35 percentage point decrease in the suicide rate. In the model that included the amount of benefits, the additional amount of old-age pension was statistically significant, with a 1.5 percentage point decrease in the suicide rate for every 100,000 won per capita increase. The results suggest that the challenge of responding to elderly suicides is to strengthen the security of the social security system rather than individual welfare programs in the city and county, and that the main way to do so is to expand the entitlement of the universal social insurance system.

Trends of completed suicide rates among Malaysian elderly between 1995 and 2020

BackgroundSuicide among the elderly has become a global public health concern. This study was carried out to determine the trend of completed suicide rates according to age, sex, and ethnicity and the suicidal methods among the elderly in Malaysia.MethodsAll suicide-related deaths in elderly aged 60 years and above from the Year 1995 to 2020 reported to the National Registration Department (NRD) were analyzed. Causes of death for suicide were coded based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). The completed suicide rate was calculated by dividing the completed suicide number by the total elderly population for the respective year.ResultsOverall, the analysis of 1,600 suicide-related deaths was investigated over 26 years. Male was seen to be correlated with higher suicidal risk, with a male–female relative risk (RR) = 1.89 (95%CI:1.46,2.45). The risk of suicide was also found to be significantly higher for those aged 60 to 74 years old and Chinese, with RR = 4.26 (95%CI:2.94, 6.18) and RR = 5.81 (95%CI: 3.70, 9.12), respectively. Hanging was found to be a statistically significant suicide method (IRR:4.76, 95%CI:2.34,9.65) as compared to pesticide poisoning. The completed suicide rate was fluctuating over the years.ConclusionsIn conclusion, it is believed that Malaysia's elderly suicide rate has reached an alarmingly high incidence. By identifying the crucial criteria of sociodemographic factors, the government and responsible agencies have the essential and additional information to put together a more effective strategy and approach to overcome the issue in the future.

Elderly suicides in Turkey

Due to the unique physical and psychosocial characteristics of this age group, it is expected that the characteristics of elderly suicides are different from other groups. Knowing the characteristics of elderly suicides guides prevention strategies. The objective of this study was to evaluate the demographic characteristics, methods and reasons for suicide in elderly suicide cases using the data of the Turkish Statistical Institute between 2002 and 2019.Of the completed suicides among older adults, 4,208 (74%) cases were men and 1,481 (26%) were women. Crude suicide rates of all elderly age groups were higher than the general population. Illness was the most common reason for suicide. The second leading cause of suicide was marital conflicts in women, while financial difficulties were observed in men. Hanging was the most common method in both genders. It is remarkable that the use of gunshot considerably increases as years progress and the ratio of men (n:962) to women (n:16) reach 60.Considering these findings together with epidemiologic data predicting that this increase in the elderly population will almost double within less than 30 years, it is apparent that suicide is a major issue among older adults.

Family companionship and elderly suicide: Evidence from the Chinese Lunar New Year

Mental health problems among the elderly have attracted increasing attention. The most serious mental health problems may result in suicide, and lack of family companionship is often speculated to be a major cause. In this paper, we use high-frequency suicide rate data and utilize a novel temporal variation in the lunisolar calendar to provide evidence on the protective effects of the Chinese Lunar New Year (when the elderly people receive unusually high level of family companionship) on elderly suicide. We find that elderly suicide rate decreases by 8.7% during the Chinese Lunar New Year, and the protective effects are stronger in counties where the typical level of daily family companionship for the elderly is lower. In addition, the dynamic effects are different for men and for women, and men are more sensitive to the shock of the Chinese Lunar New Year. We consider a variety of alternative mechanisms, and conclude that family companionship is an important channel. Our study calls for greater attention to the mental health status and suicide problem of the elderly, especially with the rapid population aging and increasing prevalence of the “empty-nest” elderly in developing countries.

Suicide among young-old and old-old adults in rural China: A case-control psychological autopsy study.

Late-life suicide is a vital public health concern. Though gerontological research suggested the young-old and old-old phases were heterogeneous, age differences in the elderly suicide have not been well studied due to the lack of comparable control groups and small samples. The study aimed to examine the age-specific suicidal characteristics and risk factors among the young-old (60-79) and old-old (over 80) elderly. Two hundred and forty two suicide decedents and 242 living comparisons were enrolled in a 1:1 matched case-control psychological autopsy study in rural China: 173 young-old and 69 old-old in each group. Suicidal characteristics, demographic characteristics, living arrangements, physical health, mental disorder, and psychosocial factors were collected. We used logistic regression models to assess risk factors of suicide and test for interactions between age and each risk factor. Pesticide suicide was more prevalent among young-old suicides than old-old suicides (56.07% vs. 40.58%, p=0.029). Non-currently married, unemployment, mental disorder, higher disability in physical activities of daily living, higher hopelessness and higher depressive symptom were significantly associated with suicide among older adults. The effect of poor function in physical activities of daily living on suicide was significantly greater during younger ages (p for interaction=0.038). Findings indicated that most suicidal characteristics and risk factors for completed suicide were generally similar among young-old and old-old adults. But poor function in physical activities of daily living predicted increase suicide risk only at younger ages. In addition to common risk factors, age-specific factors should also be noted in suicide prevention. According to the ICMJE, purely observational studies (those in which the assignment of the medical intervention is not at the discretion of the investigator) will not require registration. Our study was not registered because this is a case-control study. But all procedures of the study were carried out in accordance with the latest version of the Declaration of Helsinki. The study were approved by the Institutional Review Boards of the Central South University, Shandong University, and Guangxi Medical University.

Characteristics of Patients who Visited the Emergency Department due to self-poisoning Suicide Attempt: A Retrospective Study.

Background: The aim of this study is to evaluate the sociodemographic characteristics, clinical conditions, and results of patients who were admitted to the emergency department (ED) due to suicide attempts by self-poisoning intentionally.&#x0D; Methods: This retrospective study was conducted between January 1 and December 31, 2017, in the ED of Istanbul Lutfi Kırdar City Hospital, University of Health Sciences. Patients of only attempted suicide through taking overdose drugs with the intent of self-poisoning and over 12 ages were included in the study, which included 391 cases. Patients who attempted suicide in any different ways than self-poisoning were excluded.&#x0D; Results: Our study is consisted 69.8% (n=273) of female and 30.2% (n=18) of male patients. The mean age of the total cases was 31.01±12.064, which the youngest case being 14 years old and the oldest being 73 years old. The marital status of the cases is as follows: 140 (35.8%) married, 205 (52.4%) unmarried, 42 (10.7%) divorced, and 4 (1%) widow/widower. Istanbul is covering a major population of patients (93.1%) as a living place. The study has resulted in 58.3% ED discharge, 27.1% hospital leaving, and 10.5% Psychiatry unit admission. It can be stated that elderly people aim for death more than young people via their suicide attempts. The reasons for the suicide of the patients included in the study were grouped as a secondary gain, anger, and death. We found that secondary gain was the reason for teens mostly. We divided into categories clinical results as ED discharge, psychiatrist hospitalization, Intensive care unit (ICU) admission, and discharge against medical advice (DAMA). The patients who attempted suicide with the aim of death were hospitalized in the psychiatry unit, and the attempts caused by secondary gain were discharged from the ED. Patients who had taken paracetamol for suicide, which is contain 70.10% of the total cases, were discharged from the ED, after the examination. It was detected that 39.29% of the cases who had Suicidal ideations again, had a psychiatric disease in their medical history.&#x0D; Conclusions: Suicidal behavior is a very comprehensive topic when considering its etiology and risk factors, there are many variables as well. Since it is one of the serious public health issues and causes of death, the risk factors must be identified and preventions to be taken should be determined. In addition, when elderly people attempt suicide, more medical care should be taken during ED, since they are more focused to die and fall into the category of severe cases.

Warning Signs of Elderly Suicide and Factors Affecting Professional Help-Seeking: Case of Sri Lanka

Though the suicide rate is remarkably high among older persons in many countries, seeking external assistance in dealing with suicidality is infrequent. Against this background, the objectives of this paper are twofold: to identify possible depressive signs and suicide warnings exhibited by older people before the act of suicide, and to examine the factors affecting the help-seeking behavior of older people who die by suicide. The study revealed that angry outbursts, sleep disturbance, isolation, reduced speaking, and thoughts of the meaninglessness of life are the significant possible signs of depression. However, only a few older persons directly expressed early warnings such as ‘talking about death or suicide.’ Yet, it seems that family members are unaware of the early warning signs. The study found four significant factors that limit the help-seeking behavior of older people dealing with suicidality: a weak social network, poor understanding of depressive and suicidal signs by family members, negative attitudes relating to old age culture, and a crisis of personal perspectives in help-seeking. We conclude that promoting mental health services to older persons and improving their help-seeking behavior in response to various life stressors would help prevent suicide in the older population.

초고령사회의 사회운용 패러다임의 전환에 대한 연구

As Korea's aging population progressed rapidly, 40% (Statistics Office) of cities, counties, and districts nationwide already entered a super-aged society. UN standards classify aging society, aging society, and super-aged society when the proportion of people aged 65 or older to the total population is 7%, 14%, and 20%. According to the National Statistical Office's forecast (2020-2070 Future Population Estimation) according to the current trend, the entire country will enter a super-aged society by 2025. As such, aging requires a major shift in the paradigm of social management as a phenomenon that has a great ripple effect on society as a whole. If Korea's population aging progresses slowly over 100 years like other countries in the world, society will gradually adapt and change in line with the changing demographic structure. However, the pace of aging in Korea is unprecedentedly fast. Korea ranks first in the elderly poverty rate and the elderly suicide rate among OECD member countries. The quality of life of the elderly falls short of the OECD average. These phenomena are inevitable results of failure to prepare for a new paradigm shift of population aging. Some experts warn that more problems will emerge in the future as Korea's elderly population is close to 38% in 2050 and is expected to become the world's oldest country. This is a well-known fact that no group, no policy, or specific person can be held accountable. Overall, it is a topic that individuals, groups (businesses, etc.), and countries should constantly think about. Hints were obtained from Japan, which currently lives in a super-aged society, and the contents that previous researchers commonly pay attention to were collected and prioritized. In conclusion, in order to solve the aging problem, the elderly must be the subject of production and consumption. Just as customers are aging, it is necessary to consider an alternative family community due to the improvement of the education system system system and the increase of single-person households for fundamental social system adjustment and change.

Elder suicides: A reminder from the forgotten generation …….

Elder suicide is a significant public health issue in many countries. This reflects the complex underlying psychosocial, mental and physical health issues that older adults face. Increased life expectancy in developing countries has resulted in a gradual transition to an ageing population. Furthermore, in countries such as Sri Lanka, the transition occurs at a lower per capita income than in developed countries. This will negatively impact the availability of resources and service delivery to at-risk individuals. Thus, addressing elder suicide and concerns of elders are timely issues. This paper looks at the underlying risk factors associated with elder suicide and strategies that can be implemented in preventing elder suicide in the South Asian context, with reference to Sri Lanka.

Elderly suicides in Denizli, Turkey: a retrospective study from 2011 to 2020

BackgroundAlthough suicide rates and methods used may vary according to society, gender, and age there are epidemiological studies reporting that suicide rates increase with advanced age in all societies, particularly accelerating after the age of 65 years. This study aimed to investigate the demographic data and suicide characteristics—such as the location and method, among others—of the elderly suicide deaths among forensic deaths between 2011 and 2020 in Denizli, Turkey.ResultsIt was determined that elderly suicides constituted 13.8% of all suicides and increased gradually over the years during the 10-year period. The vast majority of cases were male (82%). It has been observed that hanging is the most frequently used method. It is also noteworthy that although firearm suicide among men was the second most common method, women do not choose this method at all. The majority of elderly suicides (88.5%) in Denizli occurred in the home and its annexes.ConclusionsSuicide prevention programmes should promote the elderly to benefit widely from social and health services. Therefore, there is a need to include widespread home care services and firearms regulations in prevention programmes.

The Mediating Role of Depressive Symptoms, Hopelessness, and Perceived Burden on the Association Between Pain Intensity and Late-Life Suicide in Rural China: A Case-Control Psychological Autopsy Study.

Background: Few studies have investigated the roles of psychosocial factors such as depressive symptoms and hopelessness on the relationship between pain and suicide with inconsistent results. The study aimed to analyze the impact of pain intensity on suicide death and to estimate the degree to which depressive symptoms, hopelessness, and perceived burden may explain the association in Chinese rural elderly.Methods: Using a 1:1 matched case–control design, we collected data from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including sociodemographic characteristics, pain intensity, depression, hopelessness, perceived burden, physical diseases, and social support. Conditional logistic regression was employed to assess the association between pain intensity and completed suicide. Mediation analysis using the KHB method was applied to explore the mediation effects from depressive symptoms, hopelessness, and perceived burden.Results: The result of multivariable logistic regression showed that unemployment [odds ratio (OR) = 5.06, 95% confidence interval (CI): 1.76–14.49], higher levels of hopelessness (OR = 7.72, 95% CI: 3.49–17.10), depressive symptom (OR = 15.82, 95% CI: 4.53–55.25), and severe pain (OR = 3.46, 95% CI: 1.31–9.13) were significantly associated with elevated suicide risk in older adults in rural China. Depressive symptoms, hopelessness, and perceived burden significantly mediated 43.71% of the pain–suicide association (p = 0.020), with 17.39% due to depressive symptoms, 17.63% due to hopelessness, and 8.69% due to perceived burden.Conclusions: Regular screening of pain, depressive symptoms, hopelessness, and perceived burden using simple but sensitive questions or scales for older adults with pain is vital for the prevention and early detection of suicide risk in Chinese rural areas. Moreover, the importance of pain management and psychological interventions targeted on depressive symptoms and hopelessness should be emphasized.