A Study on Antecedents of Suicidal Ideation among Korean Older Adults: A test of the Stress-diathesis Model

다국어 초록 (Multilingual Abstract)

While late-life suicide has been increasing and become an important issue for public health in Korea, little is known about the phenomenon and its contributing risk factors based on which effective preventive measures can be made. Since suicidal ideation is a major precursor to attempted and completed suicide, the objective of the present study was to reveal primary contributors to suicidal ideation. Data were collected from a cross-sectional survey of 247 community-dwelling Korean older adults (age≧60) in the mid-size city in Korea. The statistical methodology employed a robust hierarchical regression procedure that iteratively downweights outliers. Based on the stress-diathesis model, the study examined major diathesis and stressors directly explaining suicidal ideation. The study also explored the significant interaction among these factors. The findings revealed that living alone and depression were significant main antecedents of suicidal ideation. In addition, neuroticism X life events and neuroticism X depression were significant interaction terms with the strongest explanatory power, which provides an empirical evidence to support the stress-diathesis model in explaining suicidal phenomenon of the Korean elderly. The result demonstrates the theoretical implication as well as the practical implication for developing and implementing late-life suicide prevention strategies. Limitations and directions for future research are discussed.

참고문헌 (Reference)

1 최연희, "재가 노인의 우울에 따른 자살생각과 관련요인" 한국노년학회 28 (28): 345-355, 2008

2 김효창, "성인 자살의 특성과 자살유형에 관한 연구" 한국사회문제심리학회 12 (12): 15-33, 2006

3 양순미, "농촌노인들의 자살생각에 미치는 우울의 효과" 한국노인복지학회 32 (32): 377-396, 2006

4 박봉길, "노인의 우울과 자살생각에 대한 관련요인 연구" 한국정신보건사회복지학회 22 (22): 58-90, 2006

5 정호영, "노인 자살생각에 영향을 미치는 요인에 관한 연구-우울과 스트레스의 매개효과를 중심으로-" 한국노년학회 27 (27): 789-805, 2007

6 McCrae, R. R., "Validation of the five-factor model across instruments and observers" 52 : 81-90, 1987

7 Dixon, W. A., "Use of different sources of stress to predict: hopelessness and suicide ideation in a college Population" 39 : 342-349, 1992

8 Mann, J. J., "Toward a clinical model of suicidal behavior in psychoatric patients" 156 : 181-189, 1999

9 Durkheim, E., "The rules of the sociological Method" Free Press 1982

10 Dorpat, T. L., "The relationship of physical illness to suicide. In: Suicidal behavior: diagnosis and management" Little Brown & Co. 209-219, 1968

11 Goldstein, R. B., "The prediction of suicide" 48 : 418-422, 1991

12 Baumeister, R. F., "The need to belong: desire for interpersonal attachments as a fundamental human motivation" 109 : 186-204, 1995

13 Overholser, J. C., "The course of depressive symptoms in suicidal vs. non-suicidal depressed Inpatients" 175 (175): 50-456, 1987

14 Radloff, L. S., "The CES-D scale: a self-report depression scale for research in the general population" 1 : 385-401, 1977

15 Durkheim, E., "Suicide: A study in sociology" The Free Press 1951

16 Roy, A., "Suicide. In Comprehensive Textbook of Psychiatry (5th ed.)" Williams & Wilkins 1414-1427, 1989

17 Qin, P., "Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case control study based on longitudinal registers" 360 : 1126-1130, 2002

18 Beck, A. T., "Suicide risk assessment and prediction" 11 : 22-30, 1990

19 Carney, S. S., "Suicide over 60: the San Diego study" 42 : 174-180, 1994

20 Hagnell, O., "Suicide in the lund by study: A controlled prospective investigation of stressful life events" 6 : 319-332, 1980

21 Jarvis, G. K., "Suicide in the later years" 4 : 144-158, 1980

22 Barraclough, B. M., "Suicide in the elderly: recent developments in psychogeriatrics" 6 (6): 87-97, 1971

23 Osgood, N., "Suicide in the elderly: etiology and assessment" 4 : 217-223, 1992

24 Templer, D. I., "Suicide in the elderly: assessment and intervention" 5475-5487, 1986

25 Conwell, Y., "Suicide in later life: psychological autopsy findings" 3 : 59-66, 1991

26 Egeland, J. A., "Suicide and family loading for affective disorders" 254 : 915-918, 1985

27 Conwell, H. D., "Suicide and cancer in later" 41 (41): 43-49, 1990

28 Clark, D. C., "Suicide among the elderly" 1991

29 Fernando, S., "Suicide among psychiatric patients of a district general hospital" 14 : 661-672, 1984

30 Forsell Y., "Suicidal thoughts and associated factors in. an elderly population" 95 : 108-111, 1997

31 Olfson, M., "Suicidal ideation in primary care" 111 : 447-453, 1996

32 Schwab, J., "Suicidal ideation and behavior in a general population" 33 : 745-748, 1972

33 Callahan C. M., "Suicidal ideation among older primary care patients" 44 (44): 1205-1209, 1996

34 Mireault, M., "Suicidal ideation among older adults: personal variables, stress and social support" 24 : 385-392, 1996

35 Patrick, J. R., "Suicidal ideation among Elderly Homecare Patients" 22 (22): 32-37, 2007

36 Paykel, E. S, "Suicidal feelings in the general population: a prevalence study" 124 : 460-469, 1974

37 Skoog, O. Aevarsson, "Suicidal feelings in a population sample of nondemented 85-year-olds" 153 : 1015-1020, 1996

38 Kim, K. W., "Study on teenage suicide" 9 : 127-152, 2000

39 Wasserman, D., "Stress-vulnerability model and development of the suicidal process from suicidal ideation to suicide, In suicide: un unnecessary Death" Martin Dunitz 2001

40 Mui, A. C., "Stress, coping, and depression among elderly Korean immigrants" 3 (3): 281-299, 2001

41 Vanderhosrt, R. K., "Social relationships as predictors of depression and suicidal ideation in older adults" 9 (9): 517-525, 2005

42 Atchley, R. C., "Social forces and aging: An introduction to social gerontology (6th ed.)" Wadsworth 1991

43 Farmer, A. E., "Sensation seeking, life Events and depression: The cardiff depression study" 178 : 549-553, 2001

44 Fillenbaum, G., "Screening the elderly: A brief instrumental activities of daily living measure" 33 : 698-706, 1985

45 Rich, C. L., "San Diego suicide study: young vs old subjects" 43 : 577-582, 1986

46 Conwell, Y, "Risk factors for suicide in later life" 52 : 193-204, 2002

47 Lapierre S, "Risk factors associated with suicide in elderly persons living in the community" 40 (40): 8-11, 1992

48 Kirsling, R. A., "Review of suicide among elderly persons" 59 : 359-366, 1986

49 Conwell, Y., "Relationships of age and axis I diagnoses in victims of competed suicide: a psychological autopsy study" 153 : 1001-1008, 1996

50 Zautra, A. J., "Relationship among physical impairment, distress, and well-being. in older adults" 12 (12): 543-557, 1989

51 Harwood D., "Psychiatric disorder and personality factors assocaited with suicide in older people: a descriptive and case control study" 16 : 155-165, 2001

52 Stensman R., "Physical disease and disability among 416 suicide cases in Sweden" 16 (16): 149-153, 1988

53 Brezo, J., "Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review" 113 : 180-206, 2005

54 Gunderson, J.G., "Personality and vulnerability. In Personality and Psychopathology" American Psychiatric Pub. 3-32, 1999

55 Cloninger, R.C., "Personality and Psychopathology American Psychiatric Pub"

56 Beevers, C. G., "Perfectionism, cognitive bias, and hopelessness as prospective predictors of suicidal ideation" 34 : 126-137, 2004

57 Bisconti, T. L., "Perceived social control as a mediator of the relationships among social support, psychological well-being, and perceived health" 39 : 94-103, 1999

58 Montgomery S. A., "New psychotropic drugs for the acute treatment of depressive disorders. In International Review of Psychiatry" American Psychiatric Press 139-160, 1993

59 Henriksson, M. M., "Mental disorders in elderly suicide" 7 : 275-286, 1995

60 Kim, O., "Medication effect of social support between ethnic attachment and loneliness in older Korean Immigrants" 22 : 169-175, 1999

61 Yeh, S. C. J., "Living alone, social support, and feeling lonely among the elderly" 2004

62 Rubenowitz, E., "Life events and psychosocial factors in elderly suicides - a case-control study" 31 : 1193-1202, 2001

63 Koh J., "Korean elders in the United States: inter-generational eelations and living arrangements" 27 : 66-76, 1987

64 Lynch, T. R., "Journal of Affective" 56 : 9-15, 1999

65 Uncapher, H., "Hopelessness and suicidal ideation in older adults" 38 (38): 62-70, 1998

66 Blumenthal, S. J., "Generalisable treatment strategies for suicidal behaviour" 327-340, 1986

67 Awata, S., "Factors associated with suicidal ideation in an elderly urban Japanese population: A community-based cross-sectional study" 59 : 327-336, 2005

68 Eysenck, H. J., "Eysenck personality questionnaire, educational and industrial testing service" San Diego 1975

69 Giles-Sims, J., "Explaining cross-state differences in elderly suicide rates and identifying state-level public policy responses that reduce rates" 36 (36): 694-708, 2006

70 Barnow, S., "Epidemiology and psychiatric morbidity of suicidal ideation among the elderly" 21 (21): 171-180, 2000

71 McDaniel, S. A., "Emotional support and family contacts of older canadians" 28 : 30-33, 1993

72 Heikkinen, M. E., "Differences in recent life events between alcoholic and depressive nonalcoholic suicides: alcoholism" 18 : 1143-1149, 1994

73 Eysenck, S. B. G., "Data: cross-cultural study on the characteristics of personality dimensions : Korean & English" 5 (5): 51-66, 1985

74 Luona, J.B., "Contact with mental health and primary care providers before suicide: A review of the evidence" 159 (159): 909-916, 2002

75 Park, G. B, "College goal and suicidal ideation among high school students" 9 (9): 20-32, 1990

76 Teri, L., "Cognitive/behavior therapywith depressed older adults. In Diagnosis and Treatment of depression in the elderly: Proceedings of the N\IH Consensus Development Conference" American Psychiatric Association Press 279-291, 1994

77 Alexopoulos G. S., "Clinical determinants of suicidal ideation and behavior in geriatric depression" 56 : 1048-1053, 1999

78 Victor, C., "Being alone in later life: loneliness, social isolation and living alone" 10 (10): 407-417, 2000

79 Beck A. T., "Assessment of suicidal intention: the scale for suicide ideation" 47 (47): 343-352, 1979

80 Sarason, I. G., "Assessing social support: The social support questionnaire" 44 : 127-139, 1983

81 Fawcett J., "Assessing and treating the patient at risk for suicide" 25 : 244-254, 1993

82 Gallagher-Thompson, D., "Applying cognitive behavior therapy to the common psychological problems of later life. In Psychotherapy and aging: Effective interventions with older adults" American Psychological Association Press 61-82, 1996

83 Charron M. F., "Annexe statistique au rapport du comite de sante mentale sur la prevention du suicide" Ministere des Affaires sociales 1981

84 Park, S. C., "A study of factors influencing suicidal ideation of dlders" Ewha Womans University 2005

85 Pokorny, A. D., "A scheme for classifying suicidal behaviors. In The prediction of suicide" Charles Press 29-44, 1974

86 Yip, P. S. F, "A prevalence study of suicide ideation among older adults in Hong Kong SAR" 18 (18): 1056-1062, 2003

87 Mann, J., "A current perspective of suicide and attempted suicide" 136 (136): 302-311, 2002