Gender differences in correlates of mental health among elderly Koreans

Exploring the interplay of living arrangements, social support, and depression among older adults in rural northwest China

BACKGROUND

With the intensification of aging, depression among the older adults has become a significant global health challenge, especially in developing countries where the problem is particularly severe. This study aims to explore the association between living arrangements and depression, with a specific focus on examining the mediating role of social support in rural northwest China.

METHODS

Data were collected from 501 individuals aged 60 and above in rural Shaanxi Province, northwest China. Living arrangements were assessed based on co-residing family members. Depression was measured using the Geriatric Depression Scale-30, and social support was evaluated with the Social Support Rating Scale. Ordinary Least Squares Regression, Quantile Regression, Generalized Linear Regression, and Ordered Regression analyzed the association between living arrangements and depression. Hierarchical multiple linear regression examined the mediating role of social support. A heterogeneity analysis by gender and socio-economic status was also conducted.

RESULTS

The depression rates were 51.84% for non-empty nests, 67.92% for individuals living alone, and 46.80% for individuals only living with a spouse. The regression analysis did not reveal a significant difference in depressive between empty nests compared to non-empty nests. However, older adults living alone exhibited a higher susceptibility to depression symptoms (β = 2.594, P < 0.05). The mediating analysis showed that empty nesters living alone experience higher rates of depression due to receiving less social support compared to those living with a spouse or in non-empty nest arrangements, particularly concerning subjective social support (β = 0.481, P < 0.05). Heterogeneity analysis identified specific vulnerable groups among older adults, emphasizing the higher susceptibility to depressive symptoms among those living alone, especially among male older adults or those from non-poor families.

CONCLUSIONS

Our findings emphasize a significant prevalence of depression among older adults in rural areas, particularly highlighting the vulnerability of those living alone. This underscores the urgent need for government attention to address the mental health challenges faced by the older adults. Future interventions should focus on improving social support networks to mitigate the impact of living alone on depression symptoms among this population.

The association between living alone and depressive symptoms in older adults population: evidence from the China Health and Retirement Longitudinal Study

Objective

The goal of this research was to reveal the association between living alone and depressive symptoms in older adults. It also aims to explore the mediating role of social activity and adult children's relationship satisfaction. Ultimately, the study seeks to add to the body of knowledge for lowering the risk of depression among older people and promoting positive aging.

Methods

Based on information from the 2020 China Health and Retirement Longitudinal Study, the ordinary least square (OLS) regression model and propensity score matching (PSM) were used to investigate the association between living alone and depressive symptoms in older adults and to explore possible heterogeneity in different groups. Utilizing the SPSS PROCESS macro application, the mediation model was constructed. The significance of the mediation effect was investigated using the Bootstrap technique.

Results

The average level of depressive symptoms of older people living alone (10.55 ± 6.962) was higher than that of older people who do not live alone (8.80 ± 6.363). The baseline regression analysis revealed a significant connection between living alone and the depressive symptoms of older people (β = 0.842, p < 0.001). The association between living alone and the level of depressive symptoms was significantly higher in those aged 60-74 years (β = 1.698, p < 0.001) than in those aged 75 and older (β = 0.953, p < 0.05). The association between living alone and depressive symptoms was significantly higher in rural older adults (β = 1.512, p < 0.001) than in urban older adults (β = 1.141, p < 0.001). Between living alone and the level of depressive symptoms experienced by older people, there was a substantial mediation impact on social engagement and adult children's relationship satisfaction, which contributed to 2.91 and 13.62% of the overall effect.

Conclusion

For older age groups, living alone is associated with higher levels of depressive symptoms. This effect is stronger in older adults aged 60-74 or rural areas. In older age groups, the association between living alone and depressive symptoms is mediated by social activity and adult children's relationship satisfaction.

Is living alone beneficial to older adults during the COVID-19 pandemic? Examining associations between living arrangements and life satisfaction by gender in Korea

OBJECTIVES

This study examines associations between living arrangements and life satisfaction and the associated effects of gender among Korean older adults during the pandemic.

METHOD

Data were drawn from the 2020 National Survey of Older Koreans-a nationally representative survey. Living arrangements were categorized into four groups: living alone; living with spouse only; living with family and spouse; and living with family without spouse. Logistic regression analyses were used to examine associations between living arrangements and life satisfaction measured as a binary outcome.

RESULTS

Older adults living alone were more likely to be satisfied with life compared with those who lived with a spouse only. However, living alone became nonsignificant after controlling for social contact with friends or neighbors and social participation. Interestingly, there was a significant interaction between living arrangements and gender, showing that living alone was beneficial to older women but not to men. Subsample analysis by gender confirmed that older women living alone had a greater likelihood of being satisfied with life than those living with a spouse only, whereas men living alone had lower life satisfaction.

CONCLUSION

Findings suggest that living alone is not always deleterious to older adults, particularly women. During the pandemic, older Korean women living with their spouse and/or family might be less satisfied with life due to the dual burden of family care and housework, associated with traditional gendered norms and social context.

Decreasing patterns of depression in living alone across middle-aged and older men and women using a longitudinal mixed-effects model

There is little evidence regarding the association between living arrangement and depression, and no studies have examined the age- and gender-specific differences in this association. The present study sought to examine the longitudinal changes in depression patterns between isolative living versus living in company among middle-aged and older men and women by obtaining data from waves 1-7 of the Korean Longitudinal Study of Aging (KloSA), which comprises a sample of persons at least 45 years of age in the Republic of Korea (2273 middle-aged and 1387 older men, 2805 middle aged and 1862 older women). Depression scores were based on the self-reported Center for Epidemiologic Studies Depression Scale (CES-D-10) short forms. Using mixed-effect linear regression models, we estimated depression patterns by living arrangement across age- and gender groups. Our findings from the mixed-effects model revealed that over a 14-year follow-up period, there were significant decreasing patterns of depression were among middle-aged men and women, and older men living alone compared to living with a spouse and living with others. However, living alone still had the highest depression compared to other living arrangement types. On the other hand, the depression of older women living alone changed to a level similar to those living with others during the follow-up period. In conclusion, these findings indicate that living alone significantly increases the risk of depression, but the risk decreases over time. Additionally, depression patterns by living arrangement proved to differ across age and gender groups.

Gender differences in the modifying effect of living arrangements on the association of sleep quality with cognitive function among community-dwelling older adults: a cross-sectional study

Background

Sleep quality is considered to be associated with cognitive function for older adults, but little is known about whether living with others can buffer mild cognitive impairment in older adults with poor sleep quality. The objective of this study was to examine the role of living arrangements in sleep quality and cognitive function among older adults aged 65 and over.

Methods

2,859 older adults over 65 years old were selected by using multi-stage stratified sampling method. Cognitive function and sleep quality were measured using Mini-Mental State Examination (MMSE) and Pittsburgh Sleep Quality Index (PSQI). Binary logistic regression was performed to examine the relationship between sleep quality and mild cognitive impairment, and the interaction effects of sleep quality and living arrangements on mild cognitive impairment stratified by gender.

Results

Poor sleep quality was associated with mild cognitive impairment among men and women regardless of living arrangements. The significantly protective role of living with others in reducing the incidence of mild cognitive impairment was found in men with poor sleep quality, but not in women.

Conclusion

Targeted support for older adults with poor sleep quality may be effective in preventing mild cognitive impairment, and gender differences should be taken into account when promoting cohabitations.

[A Longitudinal Study of the Reciprocal Relationship between Depression and Income among Korean Older Men and Women]

PURPOSE

This study examined the reciprocal relationships between depression and income, and gender differences in these relationships among older adults in South Korea.

METHODS

Using 2015 to 2019 of the Korea Welfare Panel Study (KoWePS), we studied 6,070 older adults (2,394 men and 3,676 women) aged 60 years over in 2015. The generalized estimating equation was employed to explore the effect of an individual income on depression and the reverse causal link-that of depression on income.

RESULTS

The study found the reciprocal relationships between income and depression. Income has a significant impact on depression. Higher-income was linked to decreased risks of the Center for Epidemiologic Studies Depression (CES-D) scores among older adults (B = -0.121, p < 0.001). Estimates of the reverse causal link show that higher CES-D scores were also linked to income reduction among Korean older adults (B = -0.007, p < 0.001). In addition, we also observed gender differences in the impact of income on depression but not in the reverse causal link. Income has more detrimental to psychological consequence for older men (B = -0.108, p < 0.001) than older women (B = -0.057, p < 0.001).

CONCLUSION

The finding implies that both psychological and social protection policies for the elderly are needed in view of gender perspective.

Future expectations of receiving care and all-cause mortality among older adults in Korea

While demand for care-giving is increasing rapidly among older adults in Korea, there are large unmet care needs. In the face of an elder care crisis, older adults feel uncertain about how and by whom they will be cared for. This study examines the relationship between expectations of receiving care in the future and all-cause mortality among Korean older adults. We explore whether mortality risk differs by sources of care (non-family vs. family caregivers), and further disaggregate different sources of care by family member type (spouse, sons and daughters). Using data from the Korean Longitudinal Study of Ageing (N = 3,111 participants aged 65 or older), we estimate Cox proportional hazards regression models predicting all-cause mortality. Expecting to receive care from either non-family or family members is significantly associated with lower mortality risk. Expecting care from a spouse and/or daughter was associated with lower mortality risk, but expecting care from sons was not. After adjusting for covariates, expecting future care from a spouse and/or daughter predicted lower mortality risk (HR = 0.83; 95% CI = 0.71-0.97 [spouse], HR = 0.79; 95% CI = 0.67-0.94 [daughter]), and the coefficient for expectations of formal care from non-family members became statistically insignificant. After controlling for family structure, only the association between expecting care from daughters and mortality remained statistically significant (HR = 0.78; 95% CI = 0.66-0.94). These effects are more pronounced among women than men. Initiatives to support and maintain high-quality family relationships across the life course and remove barriers that obstruct family members from providing care to their elders would improve older adults' longevity.

Depression Risk Factors for Knowledge Workers in the Post-Capitalist Society of Taiwan

This study aimed to examine the depression risk factors for knowledge workers aged 20–64 in the post-capitalist society of Taiwan. Interview data from 2014 and 2019 were adopted for quantitative analysis of the depression risk by demographic and individual characteristics. The results showed that the depression risks of knowledge workers were not affected by demographic variables in a single period. From 2014 to 2019, the prevalence of high depression risk in knowledge workers aged 20–64 years increased over time. The more attention is paid to gender equality in society, the less the change in the gender depression index gap may be seen. Positive psychological state and family relationships are both depression risk factors and depression protective factors. Being male, married, religious, and aged 45–49 years old were found to be critical risk factors. Variables of individual characteristics could effectively predict depression risk.

Does gender matter to promote mental health through community engagement among older adults?

Objectives: Community engagement is critical for healthy aging. However, how gender plays a role in mental health promotion of late life is less understood. The study objectives were to examine the association between community engagement and mental health and the effect of gender on this association in older adults.Methods: A door-to-door interviewer-administered survey was conducted with 497 older adults in a public housing town in Singapore. The survey used measures of General Health Questionnaire (GHQ-12), Community Integration Measure (CIM), FRAIL Index, Lubben Social Network, and community participation. Multiple regressions were conducted for psychological distress and social dysfunction, assessed by GHQ-12. After testing the main effects, the moderating effects of gender were explored in the regression models.Results: None of the demographic characteristics, except gender, was associated with psychological distress; men reported poorer mental health than women. In regressions, female, community attachment (assessed by CIM), and participation were associated with decreased psychological distress; social networks and community participation were associated with decreased social dysfunction. Interaction effects of gender and community participation were found in psychological distress, not social dysfunction. The reduction of psychological distress by community engagement was higher among males than females.Conclusions: The findings suggest that, besides the importance of community engagement on mental health among older adults, greater efforts should be placed on the development of gender-tailored community interventions for older adults to maximize its benefits.

Social Network Types and Depressive Symptoms among Older Korean Men and Women

This study explores the social network types of older Korean men and women, and the relationship of those networks to depressive symptoms. A population of 4608 older adults who participated in the Living Profiles of Older People Survey (LPOPS) were included in the study. Seven criterion variables-marital status, living arrangements, frequency of contact with children, close friends, and close relatives, participation in social activities, and total network size-were included in a K-means cluster analysis. Multivariable logistic regression analysis of the impact of social network type on depressive symptoms was conducted. We identified two "diverse type" social networks (diverse-married and diverse-unmarried) in women, and one diverse type and one "social-activity-focused type" network in men. Family focused type and two "restricted type" social networks (restricted-couple-focused, and restricted-unmarried) were identified in both men and women. The restricted-unmarried and restricted-couple-focused networks were associated with more depressive symptoms in both men and women. However, the family focused type was associated with more depressive symptoms only in women. The results indicated that social network types, and their impact on depressive symptoms, differ by gender. There is a need for further research on gender differences in the social network types of older adults across diverse cultures.

Increased income over time predicts better self-perceived mental health only at a population level but not for individual changes: An analysis of a longitudinal cohort using cross-lagged models

BACKGROUND

The literature identifies a strong relationship between mental health and income, but there is little research that clarifies the directional association between household income and self-perceived mental health (SPMH) overtime either at between-perso+n or within-person levels. This study investigates whether higher income predicts better SPMH overtime and poor SPMH predicts lower income overtime both at between-person or within-person levels.

METHODS

Data analyzed was from the Montreal Southwest Social and Psychiatric Epidemiology Catchment Area study (ZEPSOM), a longitudinal community-based cohort. The baseline survey was conducted in 2007/8 with follow-up every two years. We traced a total of 3464 participants over a period of 8 years. To examine the associations between income and SPMH at both between-person or within-person levels, cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs) were used. Gender and age effects were examined using multiple group analyses. Complete case analyses evaluated the findings' robustness.

RESULTS

At between-person levels, higher household income predicted higher SPMH, but not vice versa. These associations were stronger among men and older adults. At within-person levels, higher income did not predict higher SPMH. No significant gender- or age- group differences were observed. Complete case analyses supported the findings.

LIMITATIONS

Loss to follow-up may affect the generalizability of the research findings.

CONCLUSIONS

This study suggests that higher household income predicts higher SPMH at between-person levels. Policy and programs aiming at promoting mental health should focus on low-income individuals, especially men and older adults.

Precarious Employment as Compared With Unemployment Reduces the Risk of Depression in the Elderly in Korea

OBJECTIVE

To compare how depression develops in precarious employment and in unemployment, as how precarious jobs impact unemployment-related depression is relatively unknown.

METHODS

Using the 1st to 4th Korean Longitudinal Study of Aging survey data, 5638 older people were analyzed to measure depression incidence in relation to employment status. A Center for Epidemiological Studies-Depression Scale form was chosen to identify depression. Hazard ratios (HRs) and 95% confidence intervals (CIs) were derived from Cox proportional hazards models adjusted for a number of variables.

RESULTS

Unemployment-related depression risk was significantly higher than for precarious employment. Depression risk was significantly lower for male full-time permanent workers than precarious workers, but was not significantly different in women.

CONCLUSIONS

To prevent the deterioration of mental health in the elderly, an extensive job promotion campaign including precarious work is required.

Association of self-perceived income status with psychological distress and subjective well-being: a cross-sectional study among older adults in India

BACKGROUND

As the older population aged 65 and over worldwide, is estimated to increase from 9% in 2019 to 16% in 2050, rapid aging will transform the aspects such as economic security, employment status, and family structure. The effects of lower levels of perceived income and poor socioeconomic status on the mental health of older adults appear to be large and enduring. Therefore, the present study contributes to the literature on understanding the association of socioeconomic conditions and self-perceived income status in particular, with self-assessed mental health outcomes (psychological distress and subjective well-being) among older adults in India.

METHODS

Data for the present study was derived from the Building Knowledge Base on Population Ageing (BKPAI) in India. Bivariate and binary logistic regression analyses were conducted to understand the relationship between socioeconomic status and outcome variables.

RESULTS

About 43% of older adults had no income whereas 7% had income but perceived as not sufficient to fulfil their basic needs. Nearly, 9% of older adults were retired from regular employment. Almost 70% older adults had received no pension and nearly 18% of older adults had no asset ownership. It is revealed that older adults with income that is partially sufficient to fulfil their basic needs were 2.23 times [OR: 2.23, CI: 1.75-2.84] and 1.96 times [OR: 1.96, CI: 1.55-2.47] significantly more likely to suffer from psychological distress and low subjective well-being than those who had income which was sufficient to fulfil their basic needs.

CONCLUSIONS

By focusing on four target areas such as the income support, education, family oriented initiatives and local or regional policies, the current framework for assessing the mental health among older adults in India can be modified. A move towards a guaranteed pension for eligible older individuals by which they do not have to remain as a financial burden on their children, may reduce their self-perceived economic distress and result in higher levels of wellbeing in older ages. Also, strategies to address socioeconomic disadvantages and gender differentials related to mental health status among older population are urgently needed.

The Impact of Work Hours on Depressive Symptoms among Koreans Aged 45 and over

Background: Given the documented importance of employment for middle-aged and older adults' mental health, studies of the association between their number of work hours and depressive symptoms are needed. Objectives: To examine the association between the number of work hours and depressive symptoms in Korean aged 45 and over. Methods: We used data from the first wave to fourth wave of the Korea Longitudinal Study of Aging. Using the first wave at baseline, data included 9845 individuals. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale. We performed a longitudinal analysis to estimate the prevalence of depressive symptoms by work hours. Results: Both unemployed males and females aged 45-65 years were associated with higher depressive symptoms (β = 0.59, p < 0.001; β = 0.32, p < 0.001). Females working ≥ 69 h were associated with higher depressive symptoms compared to those working 41-68 h (β = 0.25, p = 0.013). Among those both middle-aged and older adults, both males and females unemployed were associated with higher depressive symptoms. Those middle-aged female working ≥69 h were associated with higher depressive symptoms. Conclusions: An increase in depressive symptoms was associated with unemployed males and females working ≥69 h compared to those working 41-68 h. Although this association was found among middle-aged individuals, a decrease in depressive symptoms in both sexes was associated with working 1-40 h. Depressive symptoms should decrease by implementing employment policies and social services to encourage employers to support middle-aged and older adults in the workforce considering their sex and age differences.

Living alone, loneliness, and depressive symptoms among Indonesian older women

In this study, the researchers aimed to investigate the factors associated with loneliness and depressive symptoms among Indonesian older women. A secondary data analysis of the Indonesian Family Life Survey-5 was conducted. Data from 1233 women aged 60 years or above were analyzed using logistic regression. Results indicated fewer than one in five older women lived alone, half reported loneliness, and 16% reported depressive symptoms. Living alone was significantly associated with loneliness and depressive symptoms. Different factors were associated with loneliness and depressive symptoms. Loneliness and depression were found to be independent constructs of older women living alone in Indonesia.

Work-related physical activity and psychological distress among women in different occupations: a cross-sectional study

BACKGROUND

Recent evidence suggests that work-related physical activity may not have the same mental health benefits as leisure-time physical activity. Further, work-related physical activity is likely to include a variety of different behaviours for people with different occupations. As such, the aim of this study was to determine if occupation type moderated the association between work-related physical activity and psychological distress.

METHODS

A randomly selected sample of 1080 women from Melbourne, Australia completed the International Physical Activity Questionnaire (IPAQ) and General Health Questionnaire (GHQ-30), and reported their current occupation.

RESULTS

Linear regression analyses indicated that occupation significantly moderated the association between work-related walking and psychological distress (F [8, 55] = 2.26, p = .036). Given evidence of moderation, we fitted linear regression models to test the associations between work-related physical activity and psychological distress for three separate groups; professionals, sales and services workers, and tradespersons. Female tradespersons who engaged in a low (B = - 3.81, p = .006) or high amount of work-related walking (B = - 3.23, p = .029), had significantly lower psychological distress symptoms than those who engaged in no work-related walking. There were no significant associations between work-related physical activity of any intensity and psychological distress for professionals, or sales and service workers.

CONCLUSIONS

Given the relationship does not exist across all occupations, work-related physical activity should not be promoted above and beyond leisure-time physical activity. However, walking at work may be important in reducing psychological distress for some people and should therefore, not be discounted.

Mediators and Moderators of the Influences of Living Alone on Psychological Distress Among Japanese Older Adults

This study explored gender differences in mediators and moderators of the association between living alone and psychological distress among 2556 Japanese older adults aged 65 years and older. Putative mediators and moderators were physical health, income, informal networks, and social support. Living alone was significantly related to psychological distress only in men. Significant mediators were income in both genders and social support only in men. Living alone in women was related to having more informal networks, which reduced psychological distress. This contributed to mitigating the effect of living alone on psychological distress among women. Effective moderators were not discovered.

Socio-Medical Aspects of Depression Among Elderly Adults in Serbia

Depression is the most frequent mental health problem in older age with serious consequences on personal, interpersonal and social level. The aim of this study was to determine the association of demographic factors, socio-economic factors and health status characteristics, with the presence of depressive symptoms in the elderly persons. The survey was conducted as a part of the national study “Health Survey of the Serbian population” in 2013. Data on the population aged 65 years and over were used for the purposes of this study (3540 respondents). PHQ-8 questionnaire was used to assess the presence of symptoms of depression. The relations between the presence of depressive symptoms, as a dependent variable, and a set of independent variables was examined by univariate and multivariate logistic regressions. Depression (PHQ-8 score≥10) was registered in 10% of the population aged 65 and above, wherein it was statistically significantly higher in women (12.7%) than in men (6.5%). Limitations in performing of daily activities showed to be the strongest predictor of depression in the elderly, while respondents who have had serious limitations had even six times more chanse to develop depression (OR=6.84). Respondents who rated their health as “bad or very bad” for 49.5% more frequently manifested depressive symptoms compared to those who evaluated their health as “very good or good” (OR=3.49). Respondents who have had two or more chronic diseases were three times more likely to have depression (OR=3.1) compared to people without chronic disease.

Posttraumatic Stress and Depression Among Syrian Refugees Living in Turkey: Findings From an Urban Sample

Although most of the 3.6 million Syrian refugees in Turkey live outside refugee camps, most mental health research is on camp residents and few are on those living in cities. We aimed to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and depression in Syrian refugees living in an urban area in Turkey. A total of 420 adult Syrians living in Ankara were assessed using the Harvard Trauma Questionnaire and the Beck Depression Inventory. Probable PTSD and depression rates were 36.5% and 47.7%, respectively. Female sex, physical illness, and greater number of potentially traumatic events predicted both PTSD and depression. PTSD was additionally predicted by past psychiatric illness, and depression was predicted by lower economic status. Interestingly, lower economic status predicted depression among men, but not among women. Studies on refugees should be sensitive to factors that could have a significant effect on mental health such as sex or residence.

Subjective wellbeing of Chinese elderly: a comparative analysis among Hong Kong, Urban China and Taiwan

This study investigates the relative importance of living with adult children and social participation for the elderly's subjective wellbeing (happiness) in three Chinese societies (Hong Kong, urban China and Taiwan). We use data from the 2011 wave of the Hong Kong Panel Study of Social Dynamics (N = 1,658), the 2010 China Family Panel Studies in mainland China (N = 3,198) and the 2010 wave of the Taiwan Social Change Survey (N = 790). The ordinary least squares regression shows that, as the family value of society moves forward on a traditional–modern continuum, the elderly benefit more psychologically from social participation and less from living with children. The older people in Hong Kong who live independently with a spouse are in a significantly better emotional state than those living with adult children. Social participation is positively associated with subjective wellbeing among the aged in Hong Kong but not among those in urban China and Taiwan. The findings suggest that encouraging social involvement is important for effective public policy to tackle rapid population ageing in Chinese societies.

Cross-cultural comparative study of psychological distress between older Korean immigrants in the United States and older Koreans in South Korea

Objective: This study aims to answer questions about the similarities and differences in the prevalence and distribution of psychological distress across these populations. Methods: Survey data from older Koreans between the ages 60 and 79 from the two countries (n = 480) was analyzed descriptively and in hierarchical multiple regressions. The stress coping framework was used as a conceptual model Results: This study found significantly different prevalence of psychological distress in both countries. About 13% of older Korean immigrants(US) experienced 'severe' psychological distress versus 21% of their counterparts ( Korea). Health status and overall financial status were significantly associated with the experience of psychological distress in both countries, while income was not significantly associated with psychological distress. Hierarchical multiple regression revealed significant associations between family relationships and help-seeking behavior among older Korean immigrants in the United States while there were significant associations between social support, social networks and psychological distress among older Koreans in South Korea. Conclusion: This is the first time that a comparative study has been used to understand psychological distress among older Koreans in both countries. The findings build on prior research on social support and social networks as stress coping buffers, adding a much-needed understanding of how stressors and different types of resources influence psychological distress outcomes.

Incidence and predictors of mild cognitive impairment (MCI) within a multi-ethnic Asian populace: a community-based longitudinal study

BACKGROUND

Limited information is available from longitudinal studies regarding the predictors and incidence of MCI in older Asian adults. Thus, a community-based longitudinal study was conducted to determine the incidence of MCI among multi-ethnic older adults in Malaysia. The role of health and lifestyle as predictors of MCI was also examined.

METHODS

Analysis of data obtained from the Towards Useful Aging (TUA) study (2014-2016), wave 1 (baseline) and wave 2 (1½ years of follow-up) was conducted. For the baseline, comprehensive, interview-based questionnaires were administered to 1227 subjects who were 60 years old and above. MCI is a unique transitional state between normal ageing and dementia. MCI characteristics include a decline and disturbance of cognition, minimal impairment of complex activities, ability to perform regular daily functions, and absence of dementia. The incidence of MCI was assessed using comprehensive neuropsychological batteries. The study then performed a logistic regression analysis to examine the effect of each possible predictor of MCI. This analysis began with univariate analyses and a separate review of the effect of every variable. Binary logistic analyses followed hereafter.

RESULTS

During the follow-up after 1½ years, 179 (14.6%) of the participants who did not exhibit MCI at baseline were observed to have developed MCI. Among the participants who did not exhibit MCI at baseline, the incidence rate was 10.5 per 100 person-years. Male sex and lack of engagement in mental activities were predictors of MCI among participants without MCI at baseline.

CONCLUSION

After the 1½-year follow-up, the incidence rate for MCI was considerably high among the respondents. Being male and being less engaged in mental activities were predictors of the occurrence of MCI. Mental activities need to be promoted for the prevention of MCI incidence among older adults.

Care inequality: care received according to gender, marital status, and socioeconomic status among Korean older adults with disability

Background

We sought to identify the types of care and care resources available to older Korean adults with disabilities, and document the inequality in care received according to gender, marital status, and socioeconomic status.

Method

Data were derived from the sixth wave of the Korean Longitudinal Study of Ageing. The sample consisted of 946 men and women who were disabled in ADL and IADL. Generalized linear models and analyses of covariance were used to evaluate group differences in types of care received and care resources. The outcome variables were main primary caregivers, the total number of available caregivers, hours of care received per day, number of days of care, and fees paid to caregivers.

Results

In total, 41.7% of men with ADL/IADL disabilities reported that they did not receive formal or informal care from any source, compared with 30.7% of women. Almost half (49.2%) of men without a spouse were in a state of care deficit (vs. 30.8% in women without a spouse, P < 0.001). Among care recipients, men reported receiving higher average days of care per month than women (25.6 vs. 21.2 days, P < 0.01). Both men and women received care primarily from their spouse, but adult children were more frequently care providers for older women than men. A combination of care from spouse and paid caregiver was more frequent among women. Dependent older people with high household incomes had a higher likelihood of receiving care There was the clear gradient in rate of paid formal caregivers use by household income (higher income = higher use) among women but not men.

Conclusions

Care types and resources among disabled older adults appeared to be different by gender, marital status and socioeconomic status under the cultural phenomenon and contextual circumstances in the aging Korean population.

Health Literacy, Depression Literacy, and Depression among Older Korean Americans

The purpose of this study was to explore depression and its relationship with background characteristics, health literacy, and depression literacy among Korean Americans (KAs). A cross-sectional survey was conducted among 178 older KAs (age 60≥) in the Washington D.C. metro area in 2016. Three open-ended questions were included to obtain narrative responses for thoughts about depression and its symptoms, and the living situation that might be related to depression. Depression was measured on the Patient Health Questionnaire-9 translated into Korean. The rate of depression was 22.5% among older KAs. No relationship between health literacy and depression was shown. In the regression analysis with covariates, limited English proficiency, less family support, shorter length of U.S. residency, male, and higher depression literacy were significantly associated with higher odds of depression. On narrative questions, only 35% among respondents believed that depression was a mental status. The others described it as environmental or attitude problems such as stress or goals being set too high. Education about depression engaging older KAs immigrants with limited English, and their families are the important health issue in the Korean community.

The Impact of Living Alone and Intergenerational Support on Depressive Symptoms Among Older Mexican Americans: Does Gender Matter?

The study examined gender differences in the impact of living alone and intergenerational support on depressive symptoms among Mexican American older adults. The sample included 335 parent-adult child pairs which are nested within 92 Mexican American respondents, because each respondent reported their specific relationships with each child. Clustered regression analysis showed gender differences in the impact of living alone and intergenerational support on depressive symptoms among Mexican American older adults. In general, older men provided and received less intergenerational support than older women, but their depressive symptoms were more susceptible to living alone and different types of intergenerational support. Factors such as living alone, receiving instrumental support were associated with more depressive symptoms in older men than inolder women, whereas older men benefited more from the emotional closeness with children than older women. The findings highlight the need for a gender-specific approach to future research on this topic.

The Prevalence of Chronic Physical Diseases Comorbid with Depression among Different Sex and Age Groups in South Korea: A Population-Based Study, 2007-2014

OBJECTIVE

People with depression often suffer from comorbid, chronic physical diseases. Little is known about how demographic characteristics such as age and sex influence the prevalence of chronic physical diseases comorbid with depression. Therefore, this study aimed to explore the age and sex differences in the prevalence of diverse, chronic physical diseases comorbid with depression.

METHODS

This cross-sectional survey were conducted with the participants (n=45,598) of the Korean National Health and Nutrition Examination Survey (KNHANES). Using log-binomial regression, age adjusted prevalence ratios (APR) of chronic physical diseases of participants with depression and those without depression were estimated for each sex and age group.

RESULTS

The APR of most chronic physical diseases were significantly higher among respondents with depression than those without depression. Chronic physical diseases that showed the highest APR were asthma in adult male respondents (APR=3.46) and adult female respondents (APR=2.19) and chronic renal failure in elderly male respondents (APR=8.36) and elderly female respondents (APR=1.94).

CONCLUSION

Prevalence ratios of the chronic physical diseases comorbid with depression differed according to sex and age groups. Collaborative care strategies should be designed according to demographic characteristics of the population.

Contrasting Effects of Spousal Education on Depressive Symptoms Among Korean Middle-Aged and Older Adults

Background

Within marital dyads, we focused on the so-called positive spillover effects of one spousal partner’s educational attainment on the health of the other partner. This study examined the relationship between spousal educational attainment and depressive symptoms in Korean older adults.

Methods

Data were obtained from a sample of marital dyads aged 45 or older (total 6,824 husbands and wives) from the baseline survey of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured by the 10-item Center for Epidemiological Studies Depression scale (CES-D 10). A stepwise actor-partner interdependence model was used to examine the association between own and spousal educational attainment and depressive symptoms, conditioning for covariates.

Results

Among men, we found that their wives’ educational attainment did not influence their mental health, whereas, among women, their depressive symptoms were inversely related to their husbands’ level of schooling. With regard to own education, more-educated men reported lower psychological distress, whereas, among women, there was no overall association. However, in a subset of Korean women with the highest level of household income, higher educational attainment was associated with more depressive symptoms.

Conclusion

Our findings underscore the need to incorporate the cultural context in examining the spillover effects of education on health within marriage.

The Gender Difference in Depression: Are Elderly Women at Greater Risk for Depression Than Elderly Men?

Numerous epidemiological reports have found that adolescent, young adult, and middle-aged adult girls and women are more likely to be diagnosed with unipolar depression and report greater symptoms of depression when compared to boys and men of similar ages. What is less well-known is whether this gender difference persists into late life. This literature review examines whether the well-known gender difference in unipolar depression continues into old age, and, if it does, whether the variables that are known to contribute to the gender difference in unipolar depression from adolescence through adulthood continue to contribute to the gender difference in the elderly, and/or whether there are new variables that arise in old age and contribute to the gender difference in the elderly. In this review of 85 empirical studies from every continent except for Antarctica, we find substantial support for the gender difference in depression in individuals who are 60 and older. More research is necessary to determine which factors are the strongest predictors of the gender difference in depression in late life, and particularly whether the factors that seem to be responsible for the gender difference in depression in earlier life stages continue to predict the gender difference in the elderly, and/or whether new factors come into play in late life. Longitudinal research, meta-analyses, and model-based investigations of predictors of the gender difference in depression are needed to provide insights into how and why the gender difference in depression persists in older age.

Elder abuse as a risk factor for psychological distress among older adults in India: a cross-sectional study

OBJECTIVES

This study examines the association between elder abuse and psychological distress among older adults in India and explores whether this association varies by the level of psychosocial and material resources.

DESIGN

The study uses a cross-sectional survey design.

SETTING

The data are drawn from a representative sample of 9589 adults aged 60 and above in seven Indian states-Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala and Tamil Nadu-in 2011.

STATISTICAL ANALYSES

Secondary analysis, using bivariate and multivariate logistic regression models, is conducted using the United Nations Population Fund project Building Knowledge Base on Ageing in India survey. Elder abuse (physical and/or emotional) emanating from family members in the previous month before the survey is examined. Multivariate models are run on the total analytical sample and for men and women separately.

RESULTS

The overall prevalence of psychological distress among persons aged 60 and over living in the seven Indian States is 40.6%. Among those older persons who experienced some form of physical or emotional abuse or violence in the last month, the prevalence of psychological distress is much higher than that in the general older population, at 61.6% (p<0.001). The results show that the experience of abuse is negatively associated with the mental health of older adults, and this relationship persists even after controlling for demographic and socioeconomic factors (OR=1.60, 95% CI 1.22 to 2.09). The findings also suggest that household wealth has an inverse relationship with mental health, with the association between experiencing elder abuse and reporting poor mental health being strongest among older people in wealthy households.

CONCLUSIONS

Elder abuse in India is currently a neglected phenomenon, and greater recognition of the link between abuse and mental health is critical to improve the well-being of vulnerable older adults, some of whom may be 'hidden' within well-off households.

Physical inactivity and cognitive impairment in Korean older adults: gender differences in potential covariates

BACKGROUND

Physical inactivity is one major lifestyle risk factor of mild cognitive impairment with ageing.

AIM

To investigate whether or not potential covariates modulate the association between physical activity (PA) and cognitive impairment in older adults.

SUBJECTS AND METHODS

Data from 10 245 Korean older adults (5817 women) were used.

RESULTS

High PA older adults were younger and longer educated and had lower comorbidity and depression than low PA older adults. Compared with low PA men, moderate PA men only had a significantly lower odds-ratio (OR) and 95% confidence interval (95% CI) (OR = 0.795, 95% CI = 0.654 ∼ 0.965, p = 0.021) for having cognitive impairment, even after adjusting for measured covariates, which was no longer significant when additionally adjusted for comorbidity (OR = 0.862, 95% CI = 0.707 ∼ 1.051, p = 0.143). Compared with low PA women, moderate and high PA women had significantly lower risks of cognitive impairment (OR = 0.830, 95% CI = 0.712 ∼ 0.969, p = 0.018 and OR = 0.784, 95% CI = 0.651 ∼ 0.943, p = 0.010, respectively), even after adjusting for the measured covariates including comorbidity, which was no longer significant when additionally adjusted for depression (OR = 0.897, 95% CI = 0.776 ∼ 1.049, p = 0.173 and OR = 0.919, 95% CI = 0.761 ∼ 1.111, p = 0.385, respectively).

CONCLUSION

These findings suggest that gender differences in the covariates modulate the relationship between physical activity and cognitive decline in older Korean adults.

Impact of Living Alone on Depressive Symptoms in Older Korean Widows

We examined the relationship between living alone and the prevalence of depressive symptoms in older Korean widows and assessed the individual contributions of health, social ties, and socioeconomic factors to the development of depressive symptoms. The study was a secondary analysis using data from widows, 65 years of age and older, who participated in the Living Profiles of Older People Survey (LPOPS). A logistic regression analysis was used to evaluate the contributions of health, social ties, and socioeconomic factors to the development of depressive symptoms. Working status and equivalent household income were significantly associated with depressive symptoms in both those living with others and those living alone. Adjustment for health status and social ties did not change the impact of living alone on the prevalence of depressive symptoms. However, adjustment for equivalent household income eliminated the negative association between living alone and depressive symptoms. Our findings indicate that economic resources are more important than health and social ties for alleviating the negative impact of living alone on the development of depressive symptoms in older widows.

Impact of family characteristics by marital status of cohabitating adult children on depression among Korean older adults

AIM

To identify the association between different living arrangements of intergenerational household composition and depression in older adults.

METHODS

Data from the Korea Longitudinal Study of Aging, the first to fourth waves, were used. Using the first wave as baseline, our analysis included 5046 participants aged ≥60 years with at least one living child. Depression was measured using the 10-item Center for Epidemiological Studies Depression scale. Factors investigated included living arrangements according to household composition and the marital status of a cohabiting adult child. A generalized estimating equation with the logit link for binary outcomes was used to examine the association between living arrangements and depression.

RESULTS

Compared with the older adults living with a married child and grandchildren, those living alone, those living with an unmarried child, and those living with an unmarried child and grandchildren were more likely to have depression (OR 1.41, 95% CI 1.13-1.75; OR 1.40, 95% CI 1.18-1.66; OR 1.60, 95% CI 1.27-2.01). In particular, women were more likely to have depression than men in the association between living arrangements and depression.

CONCLUSIONS

Efforts should be made to provide social services for older adults living alone and those living with an unmarried child in a two-/three-generation family, in particular, for those who are female. Geriatr Gerontol Int 2017; 17: 2527-2536.

Do Factors Associated Self-rated Good Health and Their Influences Differ between Males and Females across Different Age Groups in Korean and Australia?

OBJECTIVES

This was a comparative study between Australia and Korea that investigated whether and to what extent factors related to self-rated good health (SRGH) differ by gender among age groups.

METHODS

This study was a secondary analysis of data that were collected in nationally representative, cross-sectional, and population-based surveys. We analyzed Australian and Korean participants > 20 years of age using 2011 data from the Australian National Nutritional Physical Activity Survey (n = 9,276) and the Korean National Health and Nutritional Examination Survey (n = 5,915). Analyses were based on multiple logistic regression after controlling for covariates.

RESULTS

Factors associated with SRGH and the extent of their influence differed by gender among age groups within each nation. Australian SRGH was associated with more factors than Korean SRGH, except in participants > 65 years old. Many differences among adults aged 20-44 years were observed, particularly with regard to the influence of socioeconomic factors. Living with a spouse only influenced SRGH in men 20-44 years old in both countries, negatively for Korean men and positively for Australian men. In this same age group, SRGH was positively influenced by employment and attainment of a higher education level in Australian men but not among Korean men; among women, income, but not education, affected SRGH in Korea, whereas in Australia, women were more influenced by education than by income. Lack of chronic disease had a strong influence on SRGH in both countries and was influential in all Australians and Koreans except those ≥ 65 years old.

CONCLUSION

Broad features of society should be considered when discussing health and differences in associated factors and their influences. For focused public health interventions of population groups, it is also necessary to consider gender and age groups within social environments.

Household Food Insecurity Is Associated with Adverse Mental Health Indicators and Lower Quality of Life among Koreans: Results from the Korea National Health and Nutrition Examination Survey 2012-2013

Food insecurity is an ongoing public health issue and contributes to mental health status. We investigated whether food insecurity is associated with inadequate nutrient intake and whether it affects mental health indicators (perceived stress/experience of depressive symptom/suicidal ideation) and quality of life (QOL) among Koreans (n = 5862, 20-64 years) using data from the Korea National Health and Nutritional Examination Survey (2012-2013). Household food security status was categorized as "food-secure household", "food-insecure household without hunger", and "food-insecure household with hunger". Data on food insecurity, sociodemographic factors, nutrient intake, mental health indicators, and QOL were used. A logistic regression model was conducted to determine odds ratios (ORs) for psychological health. A greater proportion of food-insecure participants were nutritionally deficient compared with expectations of the 2015 Korean Dietary Reference Intakes. These deficiencies were generally higher in both "food-insecure household" groups. Both "food-insecure household" groups, particularly the "food-insecure household with hunger" group showed significantly adverse mental health status (ORs: 1.52-3.83) and lower QOL (ORs: 1.49-3.92) than did the "food-secure household" group before and after adjusting for sex, age, education, household income, smoking/alcohol consumption, physical activity, marital status, and receiving food assistance. In conclusion, food insecurity may be significantly associated with adverse mental health indicators and decreased QOL in young/middle-aged Koreans.

Living arrangements and suicidal ideation among the Korean older adults

OBJECTIVES

This study examines how living arrangements are associated with suicidal ideation for older adults in South Korea, which has the highest suicide rate among OECD countries, and a particularly high suicide rate for older persons.

METHODS

Analyzing a sample of 5795 women and 3758 men aged 65 and older from a nationwide representative cross-sectional data-set, we examined how many older adults think about suicide over a one-year period, why they think about suicide, and whether living arrangements are associated with suicidal ideation.

RESULTS

About 1 out of 12 respondents in our sample reported suicidal ideation. While women and men did not differ in the prevalence of suicidal ideation, women attributed their suicidal feelings to health problems, while men attributed theirs to economic difficulties. Logistic regression results indicated that living arrangements are associated with suicidal ideation for men but not women. Older men living with a spouse were less likely to have suicidal ideation than older men with other living arrangements (i.e., living alone, living with children without spouse, living with spouse, and others).

CONCLUSIONS

Our results highlight the importance of living arrangements to older men's suicidal ideation. We discuss gender differences in the implications of living arrangements to suicidal ideation within the context of Confucian culture.

Low socioeconomic status and suicidal ideation among elderly individuals

BACKGROUND

Suicide rates are high among elderly individuals experiencing socioeconomic insecurity. Socioeconomic security is of critical importance for elderly individuals and directly affects mental health, including suicidal behavior. Thus, we investigated the relationship between socioeconomic status and suicidal ideation in elderly individuals.

METHOD

We conducted a cross-sectional study using data on 58,590 individuals 65 years of age or older from the Korean Community Health Survey 2013. Logistic regression analysis was used to identify relationships between socioeconomic factors (food insecurity, household income, and living arrangement) and suicidal ideation in the elderly population.

RESULTS

The study included 58,590 participants (24,246 males and 34,344 females). Of those, 2,847 males and 6,418 females experienced suicidal ideation. Participants with food insecure were more likely to experience suicidal ideation than were those who were food secure (males: OR = 1.60; 95% CI, 1.34-1.90; females: OR = 1.54; 95% CI, 1.38-1.72). We found a similar pattern among participants with a low household income and those living alone. Additionally, male and female subjects who were food insecure and living alone or food insecure and had a low household income showed a marked increase in suicidal ideation.

CONCLUSION

Our findings suggest that low socioeconomic status is associated with an increased risk of suicidal ideation among the elderly. Furthermore, intervention programs that address the prevalence of elderly suicide, particularly among those who are socioeconomically disadvantaged, are needed.

Sleep disorders and risk of hospitalization in patients with mood disorders: Analysis of the National Sample Cohort over 10 years

Medical utilization due to organic sleep disorders has increased remarkably in South Korea, which may contribute to the deterioration of mental health in the population. We analyzed the relationship between organic sleep disorders and risk of hospitalization due to mood disorder. We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2002-2013, which included medical claims filed for the 15,537 patients who were newly diagnosed with a mood disorder in a metropolitan region, and employed Poisson regression analysis using generalized estimating equation (GEE) models. By the results, there was a 0.53% hospital admission rate among 244,257 patients with outpatient care visits. Patients previously diagnosed with an organic sleep disorder before specific outpatient care had a higher risk for hospitalization. Such associations were significant in females, patients with a longer duration of disease, or those who lived in the largest cities. In conclusion, considering that experiencing a sleep disorder by a patient with an existing mood disorder was associated with deterioration of their status, health policy makers need to consider insurance coverage for all types of sleep disorders in patients with psychological conditions.

The impact of living arrangements on quality of life among Korean elderly: findings from the Korean Longitudinal Study of Aging (2006-2012)

PURPOSE

To investigate the impact of different living arrangements on quality of life (QoL) and health-related quality of life (HRQoL) in the elderly.

METHODS

We used data from the first to fourth wave of the Korean Longitudinal Study of Aging. Using the first wave as a baseline, the data included 5050 individuals aged 60 years and older with at least one living child. QoL and HRQoL were measured using a visual analogue scale developed by the Korean Labor Institute that bears similarity to the EQ-VAS. Living arrangements were categorized based on household composition (single household, one-generation household, two-generation household, and three-generation household) and the marital status of a cohabiting adult child. A generalized estimating equation was used to examine the association between living arrangements and QoL/HRQoL.

RESULTS

Compared to elderly individuals living in three-generation families with a married child, those in a single household (QoL: β = -2.67 [P = 0.001]; HRQoL: β = -2.24 [P = 0.007]), those living in a three-generation family with an unmarried adult child (QoL: β = -5.19 [P < 0.0001]; HRQoL: β = -3.41 [P < 0.0001]), and those living in a two-generation family with an unmarried adult child (QoL: β = -2.88 [P < 0.0001]; HRQoL: β = -2.80 [P < 0.0001]) were more likely to have lower QoL and HRQoL. These associations were particularly strong for women and individuals in the lowest equivalent household income group.

CONCLUSION

It is necessary to devise government programs not only for elderly individuals living alone, but also for those living with an unmarried adult child; elderly persons who are female and part of the lowest equivalent household income group must receive particular attention.

Association between weight control failure and suicidal ideation in overweight and obese adults: a cross-sectional study

Background

Korea has the highest suicide rate in the OECD and is one of the few OECD countries whose suicide rates have not decreased in recent years. To address these issues, we investigated the effects of weight control failure on suicidal ideation in the overweight and obese populations.

Methods

We performed a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (2008–2012) consisting of 6621 individuals 40 years of age or older. Logistic regression analysis was used to identify the relationship between weight control failure and suicidal ideation in the overweight and obese populations.

Results

A total of 6621 participants were analyzed in this study (overweight group: 2439; obese group: 4182). Among them, weight control failure (weight gain with weight loss efforts) was experienced in 962 obese (males 16.3 %, females 29.6 %) and 412 overweight individuals (males 9.1 %, females 23.4 %). Weight control failure was significantly associated with suicidal ideation in obese females (OR = 1.70, 95 % CI 1.21–2.39), but this association was not significant in obese males or in either sex of the overweight group.

Conclusions

Findings from this study suggest that weight control failure is associated with an increased risk of suicidal ideation among obese women. Furthermore, intervention programs that aim to address the prevalence of suicide, especially for obese women, are needed.

Association between employment status change and depression in Korean adults

OBJECTIVES

This study investigated the association between employment status and depression.

METHODS

Data from the Korea Welfare Panel Study (KOWEPS) collected from 2008 to 2011 were used. A total of 7368 subjects were included in this study after exclusion of subjects with missing data and those who were self-employed or could not work. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Employment status, age, sex, region, education, marital status, income, head of household, self-rated health, smoking status, drinking habits, and the current year's and the previous year's CES-D scores were included in the model as independent variables. A generalised linear mixed-effects model for longitudinal binary data was used.

RESULTS

Compared with those who were permanently employed, individuals who moved from permanent to precarious employment (OR 1.45, 95% CI 1.23 to 1.70) or to unemployment (OR 1.78, 95% CI 1.30 to 2.43) and from precarious employment to unemployment (OR 1.65, 95% CI 1.32 to 2.06) showed a significantly increased the odds of having depression. Continuing precarious employment (OR 1.54, 95% CI 1.30 to 1.83) or unemployment (OR 1.45, 95% CI 1.23 to 1.70) also significantly increased the odds of having depression. These results were particularly identified in men and head of household women. The effects were not significant among non-head of household women.

CONCLUSIONS

Precarious employment and unemployment were clearly associated with having depression. In addition, in view of our findings, policy makers should consider sex and head of household status when developing welfare policies. The inequity between precarious jobs and permanent jobs should be tackled.

A systematic review of physical illness, functional disability, and suicidal behaviour among older adults

OBJECTIVES

To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older.

METHOD

Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review.

RESULTS

Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed.

CONCLUSION

Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.