Modifying effects of sociodemographic factors on the relationship between living alone and suicidality in older adults

doi:10.21203/rs.3.rs-4712202/v1

Download PDF

Research Article

Modifying effects of sociodemographic factors on the relationship between living alone and suicidality in older adults

https://doi.org/10.21203/rs.3.rs-4712202/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Purpose

The goal of the current study is to examine how the association between living arrangements and suicidality could be modified by other factors among individuals 50 years of age and older.

Methods

The data from the 2020 and 2022 National Surveys on Drug Use and Health (NSDUH) in the U.S.A. were analyzed to address the research questions. Multiple logistic regression models were used to evaluate the association between living arrangements and suicidality adjusting for gender, age, race, income, depression, and alcohol use. Interaction terms consisting of living arrangements and each of the key sociodemographic factors were added to the logistic regression models to evaluate whether the association between living alone and suicidality varied by any of those sociodemographic factors.

Results

Females living alone had lower odds of suicidality compared to males (adjusted OR = 0.55, p = 0.046), while among Blacks, living alone was associated with higher odds of suicidality (adjusted OR = 2.72, p = 0.035) than Whites. Notably, individuals earning $50,000 - $74,999 annually had lower odds of suicidality when living alone (adjusted OR = 0.26, p = 0.021) compared to those earning less than $20,000 annually.

Conclusions

The association between living alone and suicidality was more pronounced in males compared with females and Blacks versus Whites but attenuated in individuals with a higher annual income. The results provide some clues to the points of targeted suicide prevention.

suicide

living arrangement

gender

race

household income

Suicide poses a pressing threat to public health worldwide. The increase in suicide rates has been found to be more pronounced in older individuals than younger individuals in recent years in the US, with the largest percent increase in suicide rates between 2001 and 2021 among men ages 55–64 and among women ages 65–74 [1]. A recent study of National Center for Health Statistics WONDER data from 2010 to 2020, found that the annual percent change in suicide rate increased for all race, ethnic, and age groups, except for those 65 years and older [2], suggesting a probably unique interplay between risk factors for suicide in this demographic. Factors such as living arrangements, socioeconomic status, and social support have been shown to significantly influence suicide risk among older adults [3, 4].

Accumulating evidence demonstrates that living alone is associated with a higher risk of suicide among older individuals [5–9]. Although living alone does not necessarily equate social isolation, the link between social isolation and suicide risk has been well documented across various populations [10]. A cohort study sheds light on the critical relationship between loneliness and suicide risk among older adults, implying the protective role of living with a partner and the heightened risk of self-harm hospitalization associated with loneliness [11]. Elderly individuals living alone also tend to have higher levels of suicidal ideation, depression, and hopelessness, and lower self-esteem compared to those living with family [12]. However, family connectedness can moderate this risk, with stronger family connections reducing the likelihood of suicide ideation [13]. However, a recent study based on the data from 50-state COVID-19 surveys does not endorse living alone to be associated with suicide ideation among elderly individuals [14]. This study suggests that the association between living alone and suicide risk among elderly individuals may depend on other factors, such as challenges arising from the pandemic, which include increased social isolation, limited access to mental health services, and heightened stress and anxiety due to health concerns. While existing research highlights the multifaceted relationship between living alone and suicide risk among older adults, the intricacies of this association warrant further exploration. Conducting a study that considers the interplay between living arrangement and sociodemographic features is crucial for gaining a comprehensive understanding of the role of living alone in suicidality among older individuals.

Study design and data source

The data were extracted from the National Surveys on Drug Use and Health (NSDUH) data, a nationally representative, annual, cross-sectional survey providing annual population estimates on substance use and health among US residents aged 12 years and above. We combined the data from the three-year period of 2020 to 2022 and evaluated whether there was any significant difference in the proportion of individuals living alone across the three years before we decided if we should merge the data for the analysis.

Ethics statement

The study did not require institutional review board approval or informed consent because it utilized de-identified and publicly available data.

Key variables

The outcome variables of interest comprised of three measures related to suicide and self-harm which included suicidal ideation (yes/no), suicide plan (yes/no), and suicide attempt (yes/no) in the past 12 months. The primary exposure in this study was the living arrangement at the time of reporting which was dichotomized as living alone versus living with others. We also included other key covariates such as age, gender, race, annual income, depression in the past 12 months (yes, no), and alcohol use in the past 12 months. The proportion of individuals living alone exceeded 10% for individuals in the age group of 50 years and above. Similarly, Whites, Blacks, and Hispanics are the three racial groups with at least 10% of the respondents living alone. Therefore, the subsequent analyses are focused on individuals aged 50 and above in these three racial groups.

Statistical analysis

Sampling weights were applied for all analyses to manage sampling error and for non-responses. Further details on sample weights can be found in the Substance Abuse and Mental Health Services Administration (SAMHSA) report. 79.4% of the participants had non-missing data on suicidality. Listwise deletion was adopted to main the integrity of the dataset.

We utilized descriptive statistics to identify significant differences in the sociodemographic characteristics and the self-reports of suicidal/self-harm behaviors of the sample using Pearson’s chi-squared tests. Following this, a multivariable logistic regression analysis was conducted to determine the significant predictors of suicidal/self-harm behaviors in the past 12 months whilst adjusting for key covariates. Additionally, to examine possible modifying effect of sociodemographic effects, additional models, where the interaction between living alone and three sociodemographic factors such as gender, race, and income, respectively, were added to the original models, were used to evaluate modifying effects. All statistical analyses were performed using the software STATA 18 [15].

The weighted sample size was 76,620,911. The sample characteristics stratified by living arrangements, as presented in Table 1, reveal notable distinctions among individuals living alone and those living with others, with significant variations observed across demographics (p < 0.001). There was no statistically significant difference in the proportion of individuals living alone across the three consecutive years, and hence we merged the data from these three years’ surveys. In terms of age, those aged 50–64 years constituted a larger proportion of individuals living alone, while those aged 65 years and older were more prevalent among those living with others (p < 0.001). Gender distribution also differed significantly, with a higher percentage of females living alone compared to males, while males were more common among those living with others (p < 0.001). Regarding race, a higher percentage of Black individuals resided alone compared to those living with others, whereas White individuals were more evenly distributed across living arrangements (p < 0.001). Income disparities were evident (p < 0.001), with a larger proportion of individuals earning less than $20,000 per year living alone, whereas those with higher incomes were more likely to live with others. Concerning mental health indicators, higher rates of suicidal ideation, suicidal plan, suicidality, and depression were observed among individuals living alone, while alcohol use was slightly higher among those living with others (p < 0.010).

Table 1

Characteristics of the sample stratified by living arrangements. The percentage within each subgroup (i.e., living alone and living with others, separately) is presented.
Characteristics	Total (N = 27818) Weighted sample (N = 352798004) %	Living alone (N = 6535) Weighted sample (N = 76620911) %	Living with others (N = 21283) Weighted sample (N = 276177093) %	p-value
Time period				0.154
2020	32.9	31.7	33.3
2021	33.5	35.1	33.0
2022	33.6	33.2	33.8
Age				< 0.001
50–64 years	52.5	42.7	55.3
65 years and older	47.5	57.3	44.7
Gender				< 0.001
Male	47.3	43.2	48.6
Female	52.6	56.8	51.4
Race				< 0.001
White	61.2	69.0	60.0
Black	12.2	14.9	11.8
Hispanic	17.8	19.0	9.8
Native American/Islander origin	1.0	1.0	1.0
Asian	6.0	3.5	6.3
Mixed/Others	2.0	1.9	2.0
Income				< 0.001
Less than $20,000	12.8	29.1	7.8
$20,000 - $49,999	26.8	36.2	23.9
$50,000 - $74,999	16.4	15.1	16.8
$75,000 and above	44.0	19.5	51.6
Suicidality* – past 12 months				< 0.001
No	95.0	96.8	98.0
Yes	2.2	3.2	2.0
Missing/Undisclosed	2.8
Depression – past 12 months				< 0.001
No	85.6	85.3	89.4
Yes	11.2	14.7	10.6
Missing/Undisclosed	3.2
Alcohol use – past 12 months				0.010
No	92.0	92.2	93.2
Yes	7.0	7.8	6.8
Missing/Undisclosed	1.0
* Suicidality is defined as the presence of suicidal ideation, suicide plan, or suicide attempt

[Insert Table 1 here]

Table 2 presents the results of multivariable logistic regression models without interaction, examining the association between various characteristics and suicidal behavior in the past 12 months, along with adjusted odds ratios (AORs), t-values, and corresponding p-values. Without taking modifying effects of sociodemographic features into account, living alone was not found to exert a statistically significant association with suicidal behavior (AOR = 1.22, 95% CI: 0.89–1.66, t = 1.23, p = 0.219). Regarding age, individuals aged 65 years and older had lower odds of suicidal behavior compared to those aged 50 years and older (AOR = 0.79, 95% CI: 0.47–0.86, t = -3.20, p = 0.001). Gender did not exhibit a significant association, although females tended to have lower odds of suicidal behavior compared to males (AOR = 0.79, 95% CI: 0.60–1.05, t = -1.64, p = 0.101). Similarly, race did not show significant associations with suicidal behavior. Among income categories, individuals earning $75,000 and above annually had substantially lower odds of suicidal behavior compared to those earning less than $20,000 (AOR = 0.37, 95% CI: 0.25–0.56, t = -4.66, p < 0.001). The presence of depression in the past 12 months was strongly associated with suicidal behavior (AOR = 14.30, 95% CI: 10.75–19.02, t = 18.28, p < 0.001). Similarly, alcohol use in the past 12 months showed a significant association, with individuals reporting alcohol use having higher odds of suicidal behavior compared to those who did not (AOR = 1.78, 95% CI: 1.19–2.65, t = 2.82, p = 0.005). These findings underscore the importance of considering mental health indicators in understanding and preventing suicidal behavior.

Table 2

Multivariable logistic regression models (no interaction)
Characteristics	Suicidality in the past 12 months
Characteristics	AOR (95% CI)	t-value	p-value
Living alone
No	Reference
Yes	1.22 (0.89, 1.66)	1.23	0.219
Age
50 years and older	Reference
65 years and older	0.79 (0.47, 0.86)	-3.20	0.001
Gender
Male	Reference
Female	0.79 (0.60, 1.05)	-1.64	0.101
Race
White	Reference
Black	0.74 (0.45, 1.22)	-1.17	0.240
Hispanic	0.74 (0.43, 1.26)	-1.12	0.263
Income
Less than $20,000	Reference
$20,000 - $49,999	0.84 (0.57, 1.25)	-0.85	0.396
$50,000 - $74,999	0.82 (0.81, 1.30)	-0.85	0.393
$75,000 and above	0.37 (0.25, 0.56)	-4.66	< 0.001
Depression
No	Reference
Yes	14.30 (10.75, 19.02)	18.28	< 0.001
Alcohol use
No	Reference
Yes	1.78 (1.19, 2.65)	2.82	0.005

[Insert Table 2 here]

Table 3 presents the results of multivariable logistic regression models, focusing on the interaction between living arrangement and gender concerning their association with suicidality in the past 12 months. For individuals living alone, the odds of experiencing suicidality in the past 12 months were significantly higher (AOR = 1.68, p = 0.019). Age was associated with lower odds of suicidality, particularly among those aged 65 years and older (AOR = 0.63, p = 0.003). Gender alone did not show a significant association with suicidality. However, a significant interaction effect between living alone and gender was observed. The odds of experiencing suicidality associated with living alone were significantly lower in females than males (AOR = 0.55, p = 0.046). Furthermore, depression in the past 12 months showed a strong association with suicidality (AOR = 14.32, 95% CI: 10.78–18.89, t = 19.03, p < 0.001), as did alcohol use during the same period (AOR = 1.78, p = 0.005).

Table 3

Multivariable logistic regression models (interaction of living arrangement and gender only)
Characteristics	Suicidality in the past 12 months
Characteristics	AOR (95% CI)	t-value	p-value
Living alone
No	Reference
Yes	1.68 (1.10, 2.58)	2.35	0.019
Age
50–64 years	Reference
65 years and older	0.63 (0.47, 0.85)	-3.02	0.003
Gender
Male	Reference
Female	0.96 (0.69, 1.35)	-0.23	0.818
Race
White	Reference
Black	0.75 (0.45, 1.24)	-1.13	0.257
Hispanic	0.73 (0.43, 1.25)	-1.14	0.255
Income
Less than $20,000	Reference
$20,000 - $49,999	0.83 (0.56, 1.23)	-0.92	0.357
$50,000 - $74,999	0.80 (0.50, 1.28)	-0.93	0.351
$75,000 and above	0.37 (0.24, 0.56)	-4.70	< 0.001
Depression
No	Reference
Yes	14.32 (10.78, 18.89)	19.03	< 0.001
Alcohol use
No	Reference
Yes	1.78 (1.19, 2.66)	2.88	0.005
Interaction effect
Living alone x Male	Reference
Living alone x Female	0.55 (0.30, 0.99)	-1.99	0.046

[Insert Table 3 here]

Table 4 illustrates the results of multivariable logistic regression models, focusing on the interaction between living arrangement and race concerning their association with suicidality in the past 12 months. Living alone did not exhibit a significant association with suicidality. However, an interaction effect was observed between living alone and race. The association between living alone and increased odds of suicidality was significantly greater in Blacks than Whites (AOR = 2.72, p = 0.035). Other significant associations included age (AOR = 0.61, p = 0.001), with individuals aged 65 years and older, compared to those 50 to 64 years, having lower odds of suicidality, and income (AOR = 0.37, p < 0.001), with higher income associated with lower odds of suicidality. Depression (AOR = 14.33, p < 0.001) and alcohol use (AOR = 1.77, p = 0.004) were strongly associated with suicidality.

Table 4

Multivariable logistic regression models (interaction of living arrangement and race only)
Characteristics	Suicidality in the past 12 months
Characteristics	AOR (95% CI)	t-value	p-value
Living alone
No	Reference
Yes	1.09 (0.78, 1.53)	0.48	0.604
Age
50–64 years	Reference
65 years and older	0.61 (0.45, 0.82)	-3.25	0.001
Gender
Male	Reference
Female	0.78 (0.59, 1.04)	-1.73	0.084
Race
White	Reference
Black	0.46 (0.26, 0.82)	-2.63	0.009
Hispanic	0.74 (0.41, 1.34)	-1.00	0.319
Income
Less than $20,000	Reference
$20,000 - $49,999	0.85 (0.57, 1.26)	-0.82	0.414
$50,000 - $74,999	0.83 (0.51, 1.31)	-0.83	0.405
$75,000 and above	0.37 (0.24, 0.55)	-4.75	< 0.001
Depression
No	Reference
Yes	14.33 (10.77, 19.08)	18.32	< 0.001
Alcohol use
No	Reference
Yes	1.77 (1.20, 2.61)	2.86	0.004
Interaction effect
Living alone x White	Reference
Living alone x Black	2.72 (1.07, 6.90)	2.11	0.035
Living alone x Hispanic	0.91 (0.24, 3.37)	-0.15	0.882

[Insert Table 4 here]

Table 5 presents the results of multivariable logistic regression models, focusing on the interaction between living arrangement and income concerning their association with suicidality in the past 12 months. Living alone was significantly associated with higher odds of suicidality (AOR = 1.84, p = 0.047). An interaction effect was observed between living alone and income. Among individuals earning $50,000 - $74,999 annually, living alone was significantly associated with lower odds of suicidality individuals with an annual income less than $20,000 did (AOR = 0.26, p = 0.021), indicating that the association between living alone and suicidality was less pronounced in this income bracket compared with individuals with an annual income less than $20,000. Other significant associations included age (AOR = 0.61, p = 0.001), with individuals aged 65 years and older having lower odds of suicidality, and race (AOR = 0.74, p = 0.015 for Black individuals), with Black individuals having lower odds of suicidality compared to White individuals. Depression (AOR = 14.37, p < 0.001) and alcohol use (AOR = 1.83, p = 0.003) were strongly associated with suicidality. These findings highlight the nuanced relationship between living arrangement, income, and mental health outcomes.

Table 5

Multivariable logistic regression models (interaction of living arrangement and income only)
Characteristics	Suicidality in the past 12 months
Characteristics	AOR (95% CI)	t-value	p-value
Living alone
No	Reference
Yes	1.84 (1.01, 3.35)	1.99	0.047
Age
50–64 years	Reference
65 years and older	0.61 (0.45, 0.82)	-3.25	0.001
Gender
Male	Reference
Female	0.78 (0.59, 1.04)	-1.70	0.084
Race
White	Reference
Black	0.74 (0.28, 0.87)	-2.44	0.015
Hispanic	0.75 (0.43, 1.41)	-0.82	0.414
Income
Less than $20,000	Reference
$20,000 - $49,999	1.07 (0.61, 1.86)	0.22	0.823
$50,000 - $74,999	1.27 (0.69, 2.37)	0.77	0.405
$75,000 and above	0.48 (0.27, 0.84)	-2.58	0.010
Depression – past 12 months
No	Reference
Yes	14.37 (10.80, 19.13)	18.27	< 0.001
Alcohol use – past 12 months
No	Reference
Yes	1.83 (1.23, 2.71)	3.01	0.003
Interaction effect
Living alone x income less than $20,000	Reference
Living alone x income: $20,000 - $49,999	0.70 (0.32, 1.54)	-0.89	0.375
Living alone x income: $50,000 - $74,999	0.26 (0.08, 0.81)	-2.30	0.021
Living alone x Hispanic: $75,000 and above	0.65 (0.24, 1.70)	-0.88	0.376

[Insert Table 5 here]

Supplementary Table 1 presents the findings from multivariable logistic regression models with a focus on three interactions: living arrangement with gender, race, and income concerning their association with suicidality in the past 12 months. Living alone was significantly associated with higher odds of suicidality (AOR = 2.33, p = 0.036). Interaction effects were observed between living alone and gender, race, and income. Compared with males, females living alone was significantly associated with lower odds of suicidality (AOR = 0.52, p = 0.033). Additionally, compared with the Whites, living alone was marginally associated with higher odds of suicidality among the Blacks (AOR = 2.40, p = 0.078). Furthermore, among individuals earning $50,000 - $74,999 annually, living alone was significantly associated with lower odds of suicidality than the individuals with an annual income less than $20,000 did (AOR = 0.26, p = 0.029). Other significant associations included age (AOR = 0.63, p = 0.002), with individuals aged 65 years and older having lower odds of suicidality, and race (AOR = 0.49, p = 0.015 for Black individuals), with Black individuals having lower odds of suicidality compared to White individuals. Depression (AOR = 14.45, p < 0.001) and alcohol use (AOR = 1.82, p = 0.002) were strongly associated with suicidality. How the association between living alone and suicidality varies by these three interactions are shown in Supplementary Fig. 1.

The current findings suggest while living alone may not independently predict the risk of suicidality when sociodemographic factors were not considered, it played a significant role when interactions with gender, race, and income were examined. Among the older individuals, living alone was associated with higher odds of suicidality, particularly among males, Blacks, and individuals with lower incomes. These results hence highlight the nuanced relationship between living arrangements and suicidal behavior, indicating that sociodemographic factors may modulate this association. The effort to implement suicide prevention programs targeting social disconnection may need to take these sociodemographic factors into account to optimize the efficacy.

The current study expands upon prior research by delving into the inter-relationships between living arrangements, sociodemographic factors, and suicidal behavior among older adults. Contrary to some earlier findings that suggest living alone as a standalone predictor of suicidal behavior regardless of demographic variables,[1, 4] our investigation, in line with some other studies, emphasizes that interplay between living alone and other sociodemographic factors such as gender, race, and income, demands more attention in the context of suicide prevention [16–18]. Note that some inconsistent findings may stem from heterogeneity in study designs. Despite the strong correlation between suicidality such as suicidal ideation and suicide mortality, the two behaviors may be attributable to the same risk factors to various degrees. For example, alcohol use was found to be associated with suicidality in older individuals in the current study, but it did not contribute to suicide deaths in some other studies [19]. Further, patterns for gender bias may also differ between non-fatal suicidality such as suicidal ideation and suicide deaths, with former and latter being more prevalent in females and males in adolescents and young adults [20]. However, such a difference between non-fatal suicidality and suicide deaths in terms of gender bias appears to be attenuated in older individuals, and hence both our study focused on non-fatal suicidality and previous research focused on suicide deaths agree that female gender is a protective factor among older individuals. Older women generally have stronger social networks, which can help mitigate the effects of depression over the long term [21].

Our study's findings also shed novel insights into the relationship between living alone and suicidality among older adults, with a particular focus on racial differences. While the overall risk of suicidality is lower in Black older individuals compared to their White counterparts, the impact of living alone appears significantly more pronounced in Black older individuals. This suggests that living alone may exacerbate feelings of isolation or lack of support in this demographic, leading to increased vulnerability to suicidal ideation or behavior. This finding has lent some support to previous research indicating that Blacks with mental health issues are more likely to experience more debilitating distress than other races [22]. A growing body of research indicates that Black individuals experience elevated levels of stigma and discrimination, which significantly affect their psychological well-being [23–25]. Our findings hence underscore the necessity for tailored interventions that not only address mental health concerns but also consider the contextual influence of living arrangements and racial factors. Such a perspective shifts the narrative from viewing living alone as a universal risk factor for suicidality to recognizing its differential impact based on individual characteristics and avoiding oversimplification for suicide prevention in older individuals [26].

Similarly, socioeconomic status shapes vulnerability, with lower-income individuals facing increased risk due to stressors like housing instability and limited support [27], moderating depression following widowhood leading to living alone [28]. This underscores the need for comprehensive interventions addressing structural inequities, advocating for inclusive environments that support individuals living alone, especially those from marginalized backgrounds. The current study shows that a clear gradient for the inverse association between the income level and suicidality, albeit, notably, the moderating effect of income on the association between living alone and suicidality did not exhibit a dose-response relationship. One meta-analysis of 27 studies found mixed results for the relationship between income inequality and psychological wellbeing across various populations [29]. Previous evidence also suggests that the relationship between the income level and psychological well-being varies in different demographic subgroups [30].

Strengths and Limitations:

The study draws data from the NSDUH, ensuring a nationally representative sample of US residents. By combining data from three consecutive years, the study enhances statistical power and sample size, thereby improving the robustness of the analysis. Comprehensive adjustment for key covariates in the multivariable logistic regression analysis enhances the validity of results by minimizing confounding effects. Additionally, the utilization of sampling weights and consideration of non-responses in the statistical analysis improve the accuracy of estimates, reducing biases associated with survey data.

This study faces several methodological limitations. First, its cross-sectional design limits causal inference between living arrangements and suicidality. Second, reliance on self-reported measures may introduce bias, and unmeasured confounders like social support and physical health status could affect results. Third, interaction terms were included but may not fully capture the complexity of sociodemographic factors, and potential mediating pathways were not explored. Fourth, generalizability is limited to the US context, and broad racial and income categorizations may obscure important variations. Additionally, the age groupings used might not capture the full diversity of experiences within the older adult population. Addressing these limitations in future research could enhance understanding and inform targeted interventions.

In summary, by elucidating how factors such as age, gender, ethnicity, and income, intersect with living arrangements to influence suicide risk, we can develop targeted interventions and support systems to effectively address the unique needs of vulnerable populations. Such research endeavors not only enhance our understanding of suicidality in older adults but also pave the way for tailored strategies aimed at preventing tragic outcomes and promoting mental well-being in this demographic.

Author Contributing Statement

P.L. conceptualized the study. J.J. and P.L. curated and analyzed the data. P.L. prepared the supplementary figure 1. P.L. and E.A. wrote the main manuscript text. All authors reviewed and edited the manuscript.

Competing Interest: None to declare.

Garnett MF, Spencer MR, Weeks JD. Suicide Among Adults Age 55 and Older, 2021. NCHS Data Brief. 2023.
Messias E, Salas J, Wilson L, Scherrer JF. Temporal Location of Changes in the US Suicide Rate by Age, Ethnicity, and Race: A Joinpoint Analysis 1999-2020. Journal of Nervous and Mental Disease. 2023;211. doi:10.1097/NMD.0000000000001653
Shah A, Bhat R, Zarate-Escudero S, Deleo D, Erlangsen A. Suicide rates in five-year age-bands after the age of 60 years: The international landscape. Aging Ment Health. 2016;20. doi:10.1080/13607863.2015.1055552
Beghi M, Butera E, Cerri CG, Cornaggia CM, Febbo F, Mollica A, et al. Suicidal behaviour in older age: A systematic review of risk factors associated to suicide attempts and completed suicides. Neuroscience and Biobehavioral Reviews. 2021. doi:10.1016/j.neubiorev.2021.04.011
Olfson M, Cosgrove CM, Altekruse SF, Wall MM, Blanco C. Living Alone and Suicide Risk in the United States, 2008–2019. Am J Public Health. 2023;113. doi:10.2105/AJPH.2022.307080E
Obuobi-Donkor G, Nkire N, Agyapong VIO. Prevalence of major depressive disorder and correlates of thoughts of death, suicidal behaviour, and death by suicide in the geriatric population—a general review of literature. Behavioral Sciences. 2021. doi:10.3390/bs11110142
De Leo D, Draper BM, Snowdon J, Kõlves K. Suicides in older adults: A case-control psychological autopsy study in Australia. J Psychiatr Res. 2013;47. doi:10.1016/j.jpsychires.2013.02.009
Avci D, Selcuk KT, Dogan S. Suicide Risk in the Hospitalized Elderly in Turkey and Affecting Factors. Arch Psychiatr Nurs. 2017;31. doi:10.1016/j.apnu.2016.08.002
Sinyor M, Tan LPL, Schaffer A, Gallagher D, Shulman K. Suicide in the oldest old: An observational study and cluster analysis. Int J Geriatr Psychiatry. 2016;31. doi:10.1002/gps.4286
Motillon-Toudic C, Walter M, Séguin M, Carrier J-D, Berrouiguet S, Lemey C. Social isolation and suicide risk: Literature review and perspectives. European Psychiatry. 2022;65. doi:10.1192/j.eurpsy.2022.2320
Shaw RJ, Cullen B, Graham N, Lyall DM, Mackay D, Okolie C, et al. Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: A nine-year follow up of the UK Biobank cohort. J Affect Disord. 2021;279. doi:10.1016/j.jad.2020.10.026
Sohn JN. A Study on Factors Influencing the Suicidal Ideation in Elderly People who Live Alone or Live with Family. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2012;21. doi:10.12934/jkpmhn.2012.21.2.118
Purcell B, Heisel MJ, Speice J, Franus N, Conwell Y, Duberstein PR. Family connectedness moderates the association between living alone and suicide ideation in a clinical sample of adults 50 years and older. American Journal of Geriatric Psychiatry. 2012;20. doi:10.1097/JGP.0b013e31822ccd79
Solomonov N, Green J, Quintana A, Lin J, Ognyanova K, Santillana M, et al. A 50-state survey study of thoughts of suicide and social isolation among older adults in the United States. J Affect Disord. 2023;334. doi:10.1016/j.jad.2023.04.038
StataCorp. Stata Statistical Software: Release 18. College Station. TX: StataCorp LLC. 2023.
Tseng HY, Lee CY, Wu CS, Wu IC, Chang HY, Hsu CC, et al. Examining the role of living alone and loneliness in predicting health-related quality of life: results from the Healthy Aging Longitudinal Study in Taiwan (HALST). Quality of Life Research. 2024;33. doi:10.1007/s11136-023-03581-0
Conejero I, Olié E, Courtet P, Calati R. Suicide in older adults: Current perspectives. Clinical Interventions in Aging. 2018. doi:10.2147/CIA.S130670
National Institute on Aging. Social isolation, loneliness in older people pose health risks. National Institute on Aging Research Highlights. 2019.
Turvey CL, Conwell Y, Jones MP, Phillips C, Simonsick E, Pearson JL, et al. Risk factors for late-life suicide: A prospective, community-based study. American Journal of Geriatric Psychiatry. 2002;10. doi:10.1097/00019442-200207000-00006
Miranda-Mendizabal A, Castellví P, Parés-Badell O, Alayo I, Almenara J, Alonso I, et al. Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. International Journal of Public Health. 2019. pp. 265–283. doi:10.1007/s00038-018-1196-1
Lee GR, DeMaris A. Widowhood, gender, and depression: A longitudinal analysis. Res Aging. 2007;29. doi:10.1177/0164027506294098
Brody GH, Yu T, Chen E, Miller GE, Kogan SM, Beach SRH. Is Resilience Only Skin Deep?: Rural African Americans’ Socioeconomic Status-Related Risk and Competence in Preadolescence and Psychological Adjustment and Allostatic Load at Age 19. Psychol Sci. 2013;24. doi:10.1177/0956797612471954
Zoubaa S, Dial B, Ryan-Jones L, Shah V, Yanos PT. On the relationship between experienced microaggressions and mental health stigma among members of marginalized groups. Couns Psychol Q. 2022;35. doi:10.1080/09515070.2021.1968795
Quinn DM, Camacho G, Pan-Weisz B, Williams MK. Visible and concealable stigmatized identities and mental health: Experiences of racial discrimination and anticipated stigma. Stigma Health. 2020;5. doi:10.1037/sah0000210
Gaston GB, Earl TR, Nisanci A, Glomb B. Perception of mental health services among Black Americans. Social Work in Mental Health. 2016. doi:10.1080/15332985.2015.1137257
De Leo D. Late-life suicide in an aging world. Nat Aging. 2022;2. doi:10.1038/s43587-021-00160-1
Burgard SA, Seefeldt KS, Zelner S. Housing instability and health: Findings from the Michigan recession and recovery study. Soc Sci Med. 2012;75. doi:10.1016/j.socscimed.2012.08.020
Sasson I, Umberson DJ. Widowhood and depression: New light on gender differences, selection, and psychological adjustment. Journals of Gerontology - Series B Psychological Sciences and Social Sciences. 2014;69. doi:10.1093/geronb/gbt058
Ribeiro WS, Bauer A, Andrade MCR, York-Smith M, Pan PM, Pingani L, et al. Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis. Lancet Psychiatry. 2017;4. doi:10.1016/S2215-0366(17)30159-1
McMillan KA, Enns MW, Asmundson GJG, Sareen J. The association between income and distress, mental disorders, and suicidal ideation and attempts: Findings from the collaborative psychiatric epidemiology surveys. Journal of Clinical Psychiatry. 2010;71. doi:10.4088/JCP.08m04986gry

No competing interests reported.

Supplementarydata.docx

Download PDF

Reviews received at journal
07 Sep, 2024
Reviewers agreed at journal
23 Aug, 2024
Reviewers invited by journal
06 Aug, 2024
Editor assigned by journal
10 Jul, 2024
Submission checks completed at journal
10 Jul, 2024
First submitted to journal
09 Jul, 2024

You are reading this latest preprint version

Modifying effects of sociodemographic factors on the relationship between living alone and suicidality in older adults

Status:

Version 1

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Methods

Study design and data source

Key variables

Statistical analysis

Results

Discussion

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1