The Mediating Role of Depressive Symptoms, Hopelessness, and Perceived Burden on the Association Between Pain Intensity and Late-Life Suicide in Rural China

A Case–Control Psychological Autopsy Study

Bibliographic Data

ID15526745
AuthorsJiali Wang (0000-0002-0781-8177, Central South University), Jiahuan Xu (0000-0002-8215-1747, Guangzhou Medical University), Zhenyu Ma (0000-0002-7984-1827, Guangxi Medical University), Cun-Xian Jia (0000-0002-2651-147X, Shandong University), Guojun Wang (0000-0002-0236-7047, Jinzhou Kangning Hospital), Liang Zhou (0000-0003-4374-2242, Guangzhou Medical University, corresponding author)
Year2021
Volume12
Pages779178-779178
Publication date2021-12-13
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Psychiatry (JOURNAL)
Journal identifiersISSN: 1664-0640 • E-ISSN: 1664-0640
PublisherFrontiers Media (PUBLISHER • CH)
DOI10.3389/fpsyt.2021.779178
PMID34966310
OpenAlexW4226241047
LanguageEN
Citations received1
References cited43

Background: Few studies have investigated the roles of psychosocial factors such as depressive symptoms and hopelessness on the relationship between pain and suicide with inconsistent results. The study aimed to analyze the impact of pain intensity on suicide death and to estimate the degree to which depressive symptoms, hopelessness, and perceived burden may explain the association in Chinese rural elderly. Methods: Using a 1:1 matched case-control design, we collected data from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including sociodemographic characteristics, pain intensity, depression, hopelessness, perceived burden, physical diseases, and social support. Conditional logistic regression was employed to assess the association between pain intensity and completed suicide. Mediation analysis using the KHB method was applied to explore the mediation effects from depressive symptoms, hopelessness, and perceived burden. Results: The result of multivariable logistic regression showed that unemployment [odds ratio (OR) = 5.06, 95% confidence interval (CI): 1.76-14.49], higher levels of hopelessness (OR = 7.72, 95% CI: 3.49-17.10), depressive symptom (OR = 15.82, 95% CI: 4.53-55.25), and severe pain (OR = 3.46, 95% CI: 1.31-9.13) were significantly associated with elevated suicide risk in older adults in rural China. Depressive symptoms, hopelessness, and perceived burden significantly mediated 43.71% of the pain-suicide association ( p = 0.020), with 17.39% due to depressive symptoms, 17.63% due to hopelessness, and 8.69% due to perceived burden. Conclusions: Regular screening of pain, depressive symptoms, hopelessness, and perceived burden using simple but sensitive questions or scales for older adults with pain is vital for the prevention and early detection of suicide risk in Chinese rural areas. Moreover, the importance of pain management and psychological interventions targeted on depressive symptoms and hopelessness should be emphasized

Confidence interval · Depression (economics · Injury prevention · Logistic regression · Mediation · Medical emergency · Odds ratio · Poison control · Psychiatry · Psychosocial · Suicidal ideation · Cardiac Arrest and Resuscitation · Clinical Psychology · Medicine · Mental Health Treatment and Access · Psychology · Suicide and Self-Harm Studies · Internal Medicine

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