"Is Life Worth Living?": The Role of Masculinity in the Way Men Aged Over 80 Talk About Living, Dying, and Suicide

Updated information concerning trends in suicide rates in elderly in China, 2002-2020

The aim of this study was to investigate trends in suicide rates (SRs) among the elderly in China. Annual data on SRs among Chinese people ≥ the age of 65 were collected from China's Health Statistics Yearbook from 2002 to 2020. Then, data were stratified by age, region, and sex. Standardized SRs were calculated and analyzed using a conventional joinpoint regression model. Results revealed that overall, SRs among the elderly in China tended to decline from 2002-2020. Fluctuations in SRs, including in 2004-2005 due to the SARS epidemic, in 2009-2010 due to the economic crisis, and in 2019-2020 due to the COVID-19 pandemic, were also observed. Data suggested a relatively greater crude SR among the elderly (vs. young people), in males (vs. females), and in people living in a rural area (vs. those living in an urban area). SRs tended to rise with age. Joinpoint regression analysis identified joinpoints only for males ages 65-69 and over the age of 85 living in a rural area, suggesting that individuals in these groups are more sensitive to negative stimuli and more likely to commit suicide, necessitating closer attention. The findings from this study should help to make policy and devise measures against suicide in the future.

Adherence to Masculinity Norms and Depression Symptoms Among Israeli Men: The Moderating Role of Psychological Flexibility

Being a man has been recognized as a salient risk factor for suicide. Adopting uncompromised masculine perceptions (i.e., conforming to the masculine gender role norms) may restrict emotional expressiveness in men, which, in turn, may contribute to depression and somatization symptoms. We examined the moderating role of psychological flexibility and alexithymia in the relationship of masculinity with depression and somatization symptoms. A sample of 119 men completed measures of masculinity, alexithymia (difficulty identifying and delivering subjective feelings), psychological flexibility, depression, and somatization symptoms in a cross-sectional design study. Psychological flexibility levels moderated the relationship between masculinity and depression symptoms: Masculinity contributed as positively associated with depression symptoms when psychological flexibility was low, but no such association was found at moderate or high levels of psychological flexibility. As a cognitive factor promoting adaptive emotional regulation, psychological flexibility might reduce depression symptoms among inflexible masculine men. Clinical implications relate to diagnosing at-risk subgroups and their treatment.

Is there a role for citizen science in death and dying research?

The COVID-19 pandemic has brought conversations about death and dying to the fore in a way not experienced for generations. This raises questions around perceptions of death and dying; the role of healthcare and the community in care; and the use of digital media for information and support. Public engagement can provoke a two-way conversation between researchers and the public and includes techniques that can engage the community not only with the topic but also in research. This perspective article considers the potential role of citizen science in death and dying research, including considerations around its potential benefits and constraints.

Suicide rates in the Slovak Republic in 2011-2020

PURPOSE

Suicide is a serious public health problem leading to premature mortality. The aim of the present study is to describe and analyze the trends of suicide rates in the Slovak Republic in 2011-2020.

METHODS

Trends of age-standardized suicide rates were described and incidence rate ratios of suicide were analyzed by negative binomial regression. The age-standardized rates of death by the undetermined intent and its ratio to suicide rate were calculated.

RESULTS

The overall suicide rate for the Slovak population was 7.58 per 100,000. Age-standardized suicide rate had a declining trend in the reported period, from 10.24 in 2011 to 6.65 per 100,000 in 2020. The highest suicide rate was in the oldest age groups. The male to female ratio was 6.09. The most common method of suicide in the Slovak population was hanging. The age-standardized rate of deaths by undetermined intent increased from 15.72 in 2011 to 18.46 per 100,000 in 2020.

CONCLUSION

We observed the overall declining annual suicide mortality trends in the Slovak Republic in 2011-2020. Further investigation is necessary to understand the exceptionally high undetermined intent mortality.

The role of perceived social norms in non-suicidal self-injury and suicidality: A systematic scoping review

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for more nuanced, theory-based, investigations of how, when, where, why, and for whom, perceived norms have a causal role in NSSI and suicidality outcomes.

Emotional Universe of Nurse Case Managers Regarding Care for Elderly at Risk in Spain: A Hermeneutical Study

The role of nurse case managers (NCM) involves a rarely visible emotional labor, even more when their role focuses on the care of elders at risk (EAR). Motivated by the lack of qualitative research on the emotional universe of NCM, this study explores the emotional universe (EU) of NCM regarding the care they provide to EAR in primary health care as well as the reasons that generate these emotions. An interpretative-phenomenological approach was implemented in southern Spain, with a purposive sampling that included nurses playing the NCM role for at least three years. Data collection was conducted in two periods (between September 2019 and July 2022). The primary collection tool was the semi-structured individual interview, with starting categories based on Bisquerra's EU taxonomy. The analysis followed Ricoeur's considerations, using the Nvivo software. In the NCM's EU, the recognition of the social phenomena stands out, with an open feeling of empathy regarding the desire of the EAR to continue living at home. However, there was also helplessness, resignation, disappointment, and frustration when EAR rejected their proposals. Furthermore, the system's limitations aroused compassion in the NCM and made them go beyond the limits of their role. This EU requires that their role be valued more, and higher responsiveness must be enforced to improve EAR care.

Boys Do Cry: Age and Gender Differences in Psycho-Physiological Distress during the COVID-19 Pandemic in Italy

This article contributes to the quality of life literature by investigating gender and age gaps in psycho-physiological distress during the COVID-19 pandemic in Italy. Specifically, we investigate whether women experienced higher levels of distress than men, and if such gap can be explained by a greater negative reaction of women in the experience of a negative COVID-19 related event, such as the illness or death of a relative. Moreover, we explore whether age moderated or amplified the effect of a negative event on distress among women and men. To do so we rely on an ad hoc survey carried out between April 2020 and June 2021 in Italy, the first European country to be hit by the pandemic. Our results indicate that subjects who experienced the hospitalization or, more so, the death of a family member during the pandemic were more exposed to psycho-psychological distress compared to subjects who were not directly touched by COVID-19. Moreover, our results show that while women were on average more likely to express feelings of distress than men in absence of evident stressors, this gap disappeared among subjects who experience the death of a relative. Furthermore, our results indicate that experiencing a negative COVID-19 related event led to an increase in distress among all respondents except older men, who appeared to be the most resilient to the manifestation of any sign of distress. These results speak to important age and gender differences in the feelings and externalization of grief in the Italian context.

Sheds for life: health and wellbeing outcomes of a tailored community-based health promotion initiative for men's sheds in Ireland

BACKGROUND

Gender is increasingly recognised as a critical factor in designing community-based health promotion programmes. Men's Sheds ('Sheds') are community-based informal environments that represent a safe space in which to engage cohorts of hard-to-reach (HTR) men in health promotion. Sheds for Life (SFL), the first structured health promotion initiative evaluated globally in Sheds, is a 10-week initiative co-designed with Shed Members (Shedders) and delivered directly in the Shed setting in Ireland. This research describes the health and wellbeing outcomes experienced by SFL participants.

METHODS

Purposive sampling was used to recruit a diverse representation of Shedders (n = 421) participating in SFL alongside a wait list control (n = 86). Questionnaires assessing constructs of health and wellbeing were administered one-to-one in Sheds at baseline, 3, 6 and 12 months. Descriptive data for health outcomes were generated for each time point and assessed for significant changes using inferential testing, while considering COVID-19 impact.

RESULTS

Outcomes related to subjective wellbeing, mental wellbeing, physical activity, social capital and healthy eating significantly increased post SFL (p < 0.05). Mental wellbeing scores (SWEMWBS) post SFL remained significantly higher than baseline despite COVID-19 impact (p < 0.05). Binary logistic regression indicated that the odds of a meaningful SWEMWBS change was significantly higher for shedders that had lower SWEMWBS (OR 0.804), less loneliness (OR 0.638) and lived alone (OR 0.456) at baseline. Shedders with lower SWEMBWS had higher odds of experiencing positive changes in life satisfaction (OR 0.911) and trust (OR 0.928), while Shedders who lived alone had also higher odds of experience positive changes in healthy eating (OR 0.481). Finally, inactive Shedders at baseline had higher odds of experiencing increased levels of physical activity (OR 0.582).

CONCLUSIONS

Findings suggest that the inclusive, community-based SFL model is effective in engaging Shedders and facilitating positive and sustained changes in health and wellbeing outcomes. Using gender-specific approaches in the informal and safe environment of the Shed are effective in engaging men in structured health and wellbeing initiatives, particularly those who may be more vulnerable, isolated or lonely.

TRIAL REGISTRATION

This study has been retrospectively registered with the 'International Standard Randomised Controlled Trial Number' registry (ISRCTN79921361) as of 05/03/2021.

The views of Aotearoa/New Zealand adults over 60 years regarding the End of Life Choice Act 2019

This study described the views of older New Zealand adults toward assisted dying and specifically the End of Life Choice Act (2019), an Act making assisted dying legal. An anonymous postal and online survey of 636 adults 60 years and older was conducted. The majority of respondents did not support legalization (85.7%), while 8.8% were in favor (5.5% did not specify a view). Weighted binary logistic regression indicated that the odds of support for legalization were lower in those respondents with a religious affiliation (OR = .020, S.E. = 0.60, p = .00), and there were 2.66 times greater odds in those identifying as male (S.E. = 0.34, p = .005). On the other hand, those respondents under 65 years had increased odds of supporting legalization (OR = 1.89, S.E. = .029, p = .045). Results indicate that most participants were concerned about potential abuses and coercive practices if assisted dying became legally available in New Zealand.