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Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Protective factors against suicide among young-old Chinese outpatients

Authors: Ying-Jen Chen, Yun-Fang Tsai, Shwu-Hua Lee, Hsiu-Lan Lee

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

Suicide is common among the elderly worldwide. However, no literature could be found on the beliefs/expectations that protect young-old people from attempting suicide. The purpose of this study was to explore young-old outpatients’ reasons for not killing themselves in Taiwan.

Method

Data for this qualitative descriptive study were extracted from a large research series. From the 83 elderly outpatients in the original sample, 31 were chosen for this study because they were young-old (65–74 years old) and from two randomly selected medical centers in northern Taiwan. Data on participants’ reasons for not killing themselves in unhappy situations were collected in individual interviews using a semi-structured guide and analyzed by content analysis.

Results

Analysis of interview data identified six major themes: satisfied with one’s life, suicide cannot resolve problems, fear of humiliating one’s children, religious beliefs, never thought about suicide, and living in harmony with nature.

Conclusion

These identified protective factors (reasons for living) could be added to suicide-prevention programs for the elderly. Our findings may also serve as a reference for geriatric researchers in western countries with increasing numbers of elderly ethnic minority immigrants.
Literature
1.
go back to reference Conwell Y, Thompson C: Suicidal behavior in elders. Psychiatr Clin North Am. 2008, 31: 333-356. 10.1016/j.psc.2008.01.004.CrossRefPubMed Conwell Y, Thompson C: Suicidal behavior in elders. Psychiatr Clin North Am. 2008, 31: 333-356. 10.1016/j.psc.2008.01.004.CrossRefPubMed
4.
go back to reference Conwell Y, Lyness JM, Duberstein P, Cox C, Seidlitz L, DiGiorgio A, Caine ED: Completed suicide among older patients in primary care practices: a controlled study. J Am Geriatr Soc. 2000, 48: 23-29.CrossRefPubMed Conwell Y, Lyness JM, Duberstein P, Cox C, Seidlitz L, DiGiorgio A, Caine ED: Completed suicide among older patients in primary care practices: a controlled study. J Am Geriatr Soc. 2000, 48: 23-29.CrossRefPubMed
5.
go back to reference Luoma JB, Martin CE, Pearson JL: Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002, 159: 909-916. 10.1176/appi.ajp.159.6.909.CrossRefPubMed Luoma JB, Martin CE, Pearson JL: Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002, 159: 909-916. 10.1176/appi.ajp.159.6.909.CrossRefPubMed
6.
go back to reference Pan YJ, Lee MB, Chiang HC, Liao SC: The recognition of diagnosable psychiatric disorders in suicide cases’ last medical contacts. Gen Hosp Psychiatry. 2009, 31: 181-184. 10.1016/j.genhosppsych.2008.12.010.CrossRefPubMed Pan YJ, Lee MB, Chiang HC, Liao SC: The recognition of diagnosable psychiatric disorders in suicide cases’ last medical contacts. Gen Hosp Psychiatry. 2009, 31: 181-184. 10.1016/j.genhosppsych.2008.12.010.CrossRefPubMed
7.
go back to reference Giandrea MD, Cahill KE, Quinn JF: Bridge jobs: a comparison across cohorts. Res Aging. 2009, 31: 549-576. 10.1177/0164027509337195.CrossRef Giandrea MD, Cahill KE, Quinn JF: Bridge jobs: a comparison across cohorts. Res Aging. 2009, 31: 549-576. 10.1177/0164027509337195.CrossRef
8.
go back to reference Wang M, Schultz KS: Employee retirement: a review and recommendations for future investigation. J Manag. 2010, 36: 172-206. Wang M, Schultz KS: Employee retirement: a review and recommendations for future investigation. J Manag. 2010, 36: 172-206.
9.
go back to reference Finney JW, Moos RH: Life stressors and problem drinking among older adults. Recent Dev Alcohol. 1984, 2: 267-288.PubMed Finney JW, Moos RH: Life stressors and problem drinking among older adults. Recent Dev Alcohol. 1984, 2: 267-288.PubMed
10.
go back to reference Huffine CL, Folkman S, Lazarus RS: Psychoactive drugs, alcohol, and stress and coping processes in older adults. Am J Drug Alcohol Abuse. 1989, 15: 101-113. 10.3109/00952998908993403.CrossRefPubMed Huffine CL, Folkman S, Lazarus RS: Psychoactive drugs, alcohol, and stress and coping processes in older adults. Am J Drug Alcohol Abuse. 1989, 15: 101-113. 10.3109/00952998908993403.CrossRefPubMed
11.
go back to reference Sjösten N, Nabi H, Westerlund H, Singh-Manoux A, Dartigues JF, Goldberg M, Zins M, Oksanen T, Salo P, Pentti J, Kivimäki M, Vahtera J: Influence of retirement and work stress on headache prevalence: a longitudinal modelling study from the GAZEL Cohort Study. Cephalalgia. 2011, 31: 696-705. 10.1177/0333102410394677.CrossRefPubMedPubMedCentral Sjösten N, Nabi H, Westerlund H, Singh-Manoux A, Dartigues JF, Goldberg M, Zins M, Oksanen T, Salo P, Pentti J, Kivimäki M, Vahtera J: Influence of retirement and work stress on headache prevalence: a longitudinal modelling study from the GAZEL Cohort Study. Cephalalgia. 2011, 31: 696-705. 10.1177/0333102410394677.CrossRefPubMedPubMedCentral
12.
go back to reference Westerlund H, Vahtera J, Ferrie JE, Singh-Manoux A, Pentti J, Melchior M, Leineweber C, Jokela M, Siegrist J, Goldberg M, Zins M, Kivimäki M: Effect of retirement on major chronic conditions and fatigue: French GAZEL occupational cohort study. BMJ. 2010, 341: c6149-10.1136/bmj.c6149.CrossRefPubMedPubMedCentral Westerlund H, Vahtera J, Ferrie JE, Singh-Manoux A, Pentti J, Melchior M, Leineweber C, Jokela M, Siegrist J, Goldberg M, Zins M, Kivimäki M: Effect of retirement on major chronic conditions and fatigue: French GAZEL occupational cohort study. BMJ. 2010, 341: c6149-10.1136/bmj.c6149.CrossRefPubMedPubMedCentral
13.
go back to reference Hsiao WK: Active aging and care services: theory, policy and practice. Community Dev Q. 2010, 132: 41-58. Hsiao WK: Active aging and care services: theory, policy and practice. Community Dev Q. 2010, 132: 41-58.
14.
go back to reference Maris RW: Suicide prevention in adults (age 30–65). Suicide Life Threat Behav. 1995, 25: 171-179.PubMed Maris RW: Suicide prevention in adults (age 30–65). Suicide Life Threat Behav. 1995, 25: 171-179.PubMed
15.
go back to reference Wasserman D: A stress-vulnerability model and the development of the suicidal process. Suicide: An Unnecessary Death. Edited by: Wasserman D. 2001, London: Martin Dunitz, 13-27.CrossRef Wasserman D: A stress-vulnerability model and the development of the suicidal process. Suicide: An Unnecessary Death. Edited by: Wasserman D. 2001, London: Martin Dunitz, 13-27.CrossRef
17.
go back to reference Fässberg MM, van Orden KA, Duberstein P, Erlangsen A, Lapierre S, Bodner E, Canetto SS, De Leo D, Szanto K, Waern M: A systematic review of social factors and suicidal behavior in older adulthood. Int J Environ Res Public Health. 2012, 9: 722-745. 10.3390/ijerph9030722.CrossRefPubMedPubMedCentral Fässberg MM, van Orden KA, Duberstein P, Erlangsen A, Lapierre S, Bodner E, Canetto SS, De Leo D, Szanto K, Waern M: A systematic review of social factors and suicidal behavior in older adulthood. Int J Environ Res Public Health. 2012, 9: 722-745. 10.3390/ijerph9030722.CrossRefPubMedPubMedCentral
18.
go back to reference Bostwick JM, Rackley S: Addressing suicidality in primary care settings. Curr Psychiatry Rep. 2012, 14: 353-359. 10.1007/s11920-012-0286-7.CrossRefPubMed Bostwick JM, Rackley S: Addressing suicidality in primary care settings. Curr Psychiatry Rep. 2012, 14: 353-359. 10.1007/s11920-012-0286-7.CrossRefPubMed
19.
go back to reference Unützer J, Tang L, Oishi S, Katon W, Williams JW, Hunkeler E, Hendrie H, Lin EH, Levine S, Grypma L, Steffens DC, Fields J, Langston C, IMPACT Investigators: Reducing suicidal ideation in depressed older primary care patients. J Am Geriatr Soc. 2006, 54: 1550-1556.CrossRefPubMed Unützer J, Tang L, Oishi S, Katon W, Williams JW, Hunkeler E, Hendrie H, Lin EH, Levine S, Grypma L, Steffens DC, Fields J, Langston C, IMPACT Investigators: Reducing suicidal ideation in depressed older primary care patients. J Am Geriatr Soc. 2006, 54: 1550-1556.CrossRefPubMed
20.
go back to reference Alexopoulos GS, Reynolds CF, Bruce ML, Katz IR, Raue PJ, Mulsant BH, Oslin DW, Ten Have T, PROSPECT Group: Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatry. 2009, 166: 882-890. 10.1176/appi.ajp.2009.08121779.CrossRefPubMedPubMedCentral Alexopoulos GS, Reynolds CF, Bruce ML, Katz IR, Raue PJ, Mulsant BH, Oslin DW, Ten Have T, PROSPECT Group: Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatry. 2009, 166: 882-890. 10.1176/appi.ajp.2009.08121779.CrossRefPubMedPubMedCentral
21.
go back to reference Lauber C, Rössler W: Stigma towards people with mental illness in developing countries in Asia. Int Rev Psychiatry. 2007, 19: 157-178. 10.1080/09540260701278903.CrossRefPubMed Lauber C, Rössler W: Stigma towards people with mental illness in developing countries in Asia. Int Rev Psychiatry. 2007, 19: 157-178. 10.1080/09540260701278903.CrossRefPubMed
22.
go back to reference Bedrosian RC, Beck AT: Cognitive aspects of suicidal behavior. Suicide Life Threat Behav. 1979, 9: 87-96.PubMed Bedrosian RC, Beck AT: Cognitive aspects of suicidal behavior. Suicide Life Threat Behav. 1979, 9: 87-96.PubMed
23.
go back to reference Kissane M, McLaren S: Sense of belonging as a predictor of reasons for living in older adults. Death Stud. 2006, 30: 243-258. 10.1080/07481180500493401.CrossRefPubMed Kissane M, McLaren S: Sense of belonging as a predictor of reasons for living in older adults. Death Stud. 2006, 30: 243-258. 10.1080/07481180500493401.CrossRefPubMed
24.
go back to reference McLaren S, Gomez R, Bailey M, Van Der Horst RK: The association of depression and sense of belonging with suicidal ideation among older adults: applicability of resiliency models. Suicide Life Threat Behav. 2007, 37: 89-102. 10.1521/suli.2007.37.1.89.CrossRefPubMed McLaren S, Gomez R, Bailey M, Van Der Horst RK: The association of depression and sense of belonging with suicidal ideation among older adults: applicability of resiliency models. Suicide Life Threat Behav. 2007, 37: 89-102. 10.1521/suli.2007.37.1.89.CrossRefPubMed
25.
go back to reference Marty MA, Segal DL, Coolidge FL: Relationships among dispositional coping strategies, suicidal ideation, and protective factors against suicide in older adults. Aging Ment Health. 2010, 14: 1015-1023. 10.1080/13607863.2010.501068.CrossRefPubMed Marty MA, Segal DL, Coolidge FL: Relationships among dispositional coping strategies, suicidal ideation, and protective factors against suicide in older adults. Aging Ment Health. 2010, 14: 1015-1023. 10.1080/13607863.2010.501068.CrossRefPubMed
26.
go back to reference Rowe JL, Conwell Y, Schulberg HC, Bruce ML: Social support and suicidal ideation in older adults using home healthcare services. Am J Geriatr Psychiatry. 2006, 14: 758-766. 10.1097/01.JGP.0000218324.78202.25.CrossRefPubMed Rowe JL, Conwell Y, Schulberg HC, Bruce ML: Social support and suicidal ideation in older adults using home healthcare services. Am J Geriatr Psychiatry. 2006, 14: 758-766. 10.1097/01.JGP.0000218324.78202.25.CrossRefPubMed
27.
go back to reference Chen YJ, Tsai YF, Ku YC, Lee SH, Lee HL: Perceived reasons for, opinions about, and suggestions for elders considering suicide: elderly outpatients’ perspectives. Aging Ment Health. 2013,  -[Epub ahead of print] Chen YJ, Tsai YF, Ku YC, Lee SH, Lee HL: Perceived reasons for, opinions about, and suggestions for elders considering suicide: elderly outpatients’ perspectives. Aging Ment Health. 2013,  -[Epub ahead of print]
28.
go back to reference Yip PK, Shyu YI, Lin SI, Lee JY, Chou CF, Chen RC: An epidemiological survey of dementia among elderly in an urban district of Taipei. Acta Neurol Sin. 1992, 1: 347-354. Yip PK, Shyu YI, Lin SI, Lee JY, Chou CF, Chen RC: An epidemiological survey of dementia among elderly in an urban district of Taipei. Acta Neurol Sin. 1992, 1: 347-354.
30.
go back to reference Miles MB, Huberman AM: Qualitative Data Analysis: An Expanded Sourcebook. 1994, Thousand Oaks, CA: Sage Miles MB, Huberman AM: Qualitative Data Analysis: An Expanded Sourcebook. 1994, Thousand Oaks, CA: Sage
31.
go back to reference Lincoln YS, Guba EG: Naturalistic inquiry. 1985, Beverly Hills, CA: Sage Lincoln YS, Guba EG: Naturalistic inquiry. 1985, Beverly Hills, CA: Sage
32.
go back to reference Ku YC, Tsai YF, Lin YC, Lin YP: Suicide experiences among institutionalised older veterans in Taiwan. Gerontologist. 2009, 49: 746-754. 10.1093/geront/gnp114.CrossRefPubMed Ku YC, Tsai YF, Lin YC, Lin YP: Suicide experiences among institutionalised older veterans in Taiwan. Gerontologist. 2009, 49: 746-754. 10.1093/geront/gnp114.CrossRefPubMed
33.
go back to reference Tsai HH, Chen MH, Tsai YF: Perceptions of filial piety among Taiwanese university students. J Adv Nurs. 2008, 63: 284-290. 10.1111/j.1365-2648.2008.04711.x.CrossRefPubMed Tsai HH, Chen MH, Tsai YF: Perceptions of filial piety among Taiwanese university students. J Adv Nurs. 2008, 63: 284-290. 10.1111/j.1365-2648.2008.04711.x.CrossRefPubMed
34.
go back to reference Wang SY: Nursing home placement of older parents: an exploration of adult children’s role and responsibilities. Contemp Nurse. 2011, 37: 197-203. 10.5172/conu.2011.37.2.197.CrossRefPubMed Wang SY: Nursing home placement of older parents: an exploration of adult children’s role and responsibilities. Contemp Nurse. 2011, 37: 197-203. 10.5172/conu.2011.37.2.197.CrossRefPubMed
35.
go back to reference Liu Y: Complexity science and participation in decision making among Taiwanese nurses. J Nurs Manag. 2008, 16: 291-297. 10.1111/j.1365-2834.2007.00792.x.CrossRefPubMed Liu Y: Complexity science and participation in decision making among Taiwanese nurses. J Nurs Manag. 2008, 16: 291-297. 10.1111/j.1365-2834.2007.00792.x.CrossRefPubMed
36.
go back to reference Padesky CA, Mooney KA: Strengths-based cognitive-behavioural therapy: a four-step model to build resilience. Clin Psychol Psychother. 2012, 19: 283-290. 10.1002/cpp.1795.CrossRefPubMed Padesky CA, Mooney KA: Strengths-based cognitive-behavioural therapy: a four-step model to build resilience. Clin Psychol Psychother. 2012, 19: 283-290. 10.1002/cpp.1795.CrossRefPubMed
37.
go back to reference Linehan MM, Goodstein JL, Nielsen SL, Chiles JA: Reasons for staying alive when you are thinking of killing yourself: the reasons for living inventory. J Consult Clin Psychol. 1983, 51: 276-286.CrossRefPubMed Linehan MM, Goodstein JL, Nielsen SL, Chiles JA: Reasons for staying alive when you are thinking of killing yourself: the reasons for living inventory. J Consult Clin Psychol. 1983, 51: 276-286.CrossRefPubMed
38.
go back to reference Edelstein BA, Heisel MJ, McKee DR, Martin RR, Koven LP, Duberstein PR, Britton PC: Development and psychometric evaluation of the reasons for living - older adults scale: a suicide risk assessment inventory. Gerontologist. 2009, 49: 736-745. 10.1093/geront/gnp052.CrossRefPubMedPubMedCentral Edelstein BA, Heisel MJ, McKee DR, Martin RR, Koven LP, Duberstein PR, Britton PC: Development and psychometric evaluation of the reasons for living - older adults scale: a suicide risk assessment inventory. Gerontologist. 2009, 49: 736-745. 10.1093/geront/gnp052.CrossRefPubMedPubMedCentral
39.
go back to reference Chen YY, Wu KC, Yousuf S, Yip PS: Suicide in Asia: opportunities and challenges. Epidemiol Rev. 2012, 34: 129-144. 10.1093/epirev/mxr025.CrossRefPubMed Chen YY, Wu KC, Yousuf S, Yip PS: Suicide in Asia: opportunities and challenges. Epidemiol Rev. 2012, 34: 129-144. 10.1093/epirev/mxr025.CrossRefPubMed
40.
go back to reference Sisask M, Varnik A, Kolves K, Bertolote JM, Bolhari J, Botega NJ, Fleischmann A, Vijayakumar L, Wasserman D: Is religiosity a protective factor against attempted suicide: a cross-cultural case–control study. Arch Suicide Res. 2010, 14: 44-55. 10.1080/13811110903479052.CrossRefPubMed Sisask M, Varnik A, Kolves K, Bertolote JM, Bolhari J, Botega NJ, Fleischmann A, Vijayakumar L, Wasserman D: Is religiosity a protective factor against attempted suicide: a cross-cultural case–control study. Arch Suicide Res. 2010, 14: 44-55. 10.1080/13811110903479052.CrossRefPubMed
41.
go back to reference Chen LM, Miaskowski C, Dodd M, Pantilat S: Concepts within the Chinese culture that influence the cancer pain experience. Cancer Nurs. 2008, 31: 103-108. 10.1097/01.NCC.0000305702.07035.4d.CrossRefPubMed Chen LM, Miaskowski C, Dodd M, Pantilat S: Concepts within the Chinese culture that influence the cancer pain experience. Cancer Nurs. 2008, 31: 103-108. 10.1097/01.NCC.0000305702.07035.4d.CrossRefPubMed
42.
go back to reference Tsai YF, Wong TK, Ku YC, Liu WC: Reasons for living among older male Chinese residents of veterans’ homes. J Adv Nurs. 2012, 68: 1978-1987. 10.1111/j.1365-2648.2011.05884.x.CrossRefPubMed Tsai YF, Wong TK, Ku YC, Liu WC: Reasons for living among older male Chinese residents of veterans’ homes. J Adv Nurs. 2012, 68: 1978-1987. 10.1111/j.1365-2648.2011.05884.x.CrossRefPubMed
43.
go back to reference Wang YW, Tsai YF, Wong TK, Ku YC: Development and psychometric testing of a Chinese-language instrument for assessing institutionalised older males’ motivations for living. J Clin Nurs. 2013, doi:10.1111/jocn.12089 Wang YW, Tsai YF, Wong TK, Ku YC: Development and psychometric testing of a Chinese-language instrument for assessing institutionalised older males’ motivations for living. J Clin Nurs. 2013, doi:10.1111/jocn.12089
44.
go back to reference Miller JS, Segal DL, Coolidge FL: A comparison of suicidal thinking and reasons for living among younger and older adults. Death Stud. 2001, 25: 357-365. 10.1080/07481180126250.CrossRefPubMed Miller JS, Segal DL, Coolidge FL: A comparison of suicidal thinking and reasons for living among younger and older adults. Death Stud. 2001, 25: 357-365. 10.1080/07481180126250.CrossRefPubMed
45.
go back to reference Liu LF, Tinker A: Factors associated with nursing home entry for older people in Taiwan, Republic of China. J Interprof Care. 2001, 15: 245-255. 10.1080/13561820120063138.CrossRefPubMed Liu LF, Tinker A: Factors associated with nursing home entry for older people in Taiwan, Republic of China. J Interprof Care. 2001, 15: 245-255. 10.1080/13561820120063138.CrossRefPubMed
46.
go back to reference Tsai HH, Tsai YF: A temporary home to nurture health: lived experiences of older nursing home residents in Taiwan. J Clin Nurs. 2008, 17: 1915-1922. 10.1111/j.1365-2702.2007.02240.x.CrossRefPubMed Tsai HH, Tsai YF: A temporary home to nurture health: lived experiences of older nursing home residents in Taiwan. J Clin Nurs. 2008, 17: 1915-1922. 10.1111/j.1365-2702.2007.02240.x.CrossRefPubMed
47.
go back to reference World Health Organization: Public Health Action for the Prevention of Suicide: A Framework. 2012, Geneva: World Health Organization World Health Organization: Public Health Action for the Prevention of Suicide: A Framework. 2012, Geneva: World Health Organization
49.
go back to reference Mold F, Fitzpatrick JM, Roberts JD: Minority ethnic elders in care homes: a review of the literature. Age Ageing. 2005, 34: 107-113. 10.1093/ageing/afi009.CrossRefPubMed Mold F, Fitzpatrick JM, Roberts JD: Minority ethnic elders in care homes: a review of the literature. Age Ageing. 2005, 34: 107-113. 10.1093/ageing/afi009.CrossRefPubMed
Metadata
Title
Protective factors against suicide among young-old Chinese outpatients
Authors
Ying-Jen Chen
Yun-Fang Tsai
Shwu-Hua Lee
Hsiu-Lan Lee
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-372

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