Social effects on suicide risks among older adults

Abstract

Suicide in older adults has been a serious public health problem globally. Social factors, including ecological social influences and individual characteristics of social relationships, exert important impacts on suicide risks. However, contemporary efforts in articulating the social effects on late-life suicide is far from sufficient. At the ecological level, few studies that have explored the global variations of suicide gender/age ratios and their associated social factors. At the individual level, no meta-analysis has been made to examine which aspects of social relationships are more predictive of suicidality in later life than others. Moreover, it is still unknown whether many well-identified social factors from western studies could be applied to the Chinese older adults. My thesis aims to address these knowledge gaps and solicit public health awareness. Analytical approaches employed in this thesis were meta-analysis, confirmatory factor analysis, and regression analysis.

The first investigation shows that gender inequalities contributed to global variations in suicide gender ratios among older population, lower male-to-female suicide rate ratios were found in countries where gender-based discrimination was more prominent. Moreover, cultural-based indicator of gender inequality was more sensitive than economic-based indicator. Thus, strategies to eliminate culturally embedded gender discrimination have the potentials to prevent suicides.

The second investigation illustrates that household headship, residential independency, and pension receipt may be associated with suicide age ratios, i.e., suicide rate ratios between older adults versus younger population. This ecological investigation suggests that strategies to enhance the socioeconomic status of older adults may be important to prevent suicides in later life both within and across countries on a grand scale.

In the third investigation, the meta-analysis indicates a 57% likelihood increase of suicidal ideation for elderly participants with discordant social relationships. Moreover, the functional measures of social relationships are more predictive than structural measures. Among all the measures, elderly mistreatment has the strongest effect size, followed by perceived loneliness and poorly perceived social support. The associations are moderated by country income levels, social-cultural context, and study types. This meta-analysis provides significant evidence for improving social relationships, especially in perceived bonds, is a promising strategy in decreasing late-life suicide risks.

In the fourth investigation, the abbreviated version of the Lubben Social Network Scale (“LSNS-6”) has been well validated and could be a useful tool for assessing social network support among older adults in mainland China. Interestingly, late-life suicidality is highly associated with the LSNS-6 family subscale, rather than the friends subscale. Strategies to improve family support could be effective in reducing late-life suicide risks in mainland China.

The fifth investigation shows that the effects of family relationships are robust and deserve continuing clinical attention among the Chinese elderly patients with mental disorders. Early interventions designed to decrease hopelessness, control negative symptoms, and improve social connectedness may result in decreased risks of suicide among elderly Chinese patients with schizophrenia.

This thesis highlights the social effects on suicide risks among older adults at both ecological and individual levels, which has significantly theoretical, psychometric, and empirical contributions to the existing knowledge in suicidology.