Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation? A Cross-Sectional Study in China
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection and Participants
2.2. Measures
2.2.1. Demographic Information
2.2.2. Psychological Pain
2.2.3. Suicidal Ideation
2.3. Statistical Analysis
2.4. Ethical Statements
3. Results
3.1. General Information
3.2. Psychological Pain and Suicidal Ideation
3.3. Factors Associated with Psychological Pain and Suicidal Ideation
3.4. Association between Psychological Pain and Suicidal Ideation
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- United Nations. Ageing. Available online: https://www.un.org/en/sections/issues-depth/ageing/index.html (accessed on 25 March 2020).
- People’s Republic of China. National Economy Press Conference 2018. Available online: http://www.scio.gov.cn/xwfbh/xwbfbh/wqfbh/39595/39709/ (accessed on 25 March 2020).
- Chen, H.; Levkoff, S. Assessing Needs among Elders in Urban China: Interview and Limitations. Ageing Int. 2017, 42, 159–168. [Google Scholar] [CrossRef]
- Fang, E.F.; Scheibye-Knudsen, M.; Jahn, H.J.; Li, J.; Ling, L.; Guo, H.; Zhu, X.; Preedy, V.; Lu, H.; Bohr, V.A.; et al. A research agenda for aging in China in the 21st century. Ageing Res. Rev. 2015, 24, 197–205. [Google Scholar] [CrossRef] [Green Version]
- Problems and Countermeasures in China’s Pension. Available online: https://kns.cnki.net/KCMS/detail/detail.aspx?FileName=NJCM201911198&DbName=CJFQ2019. (accessed on 2 September 2020).
- Yu, H.; Wu, L.; Chen, S.; Wu, Q.; Yang, Y.; Edwards, H. Caregiving burden and gain among adult-child caregivers caring for parents with dementia in China: The partial mediating role of reciprocal filial piety. Int. Psychogeriatr. 2016, 28, 1845–1855. [Google Scholar] [CrossRef]
- Bozkurt Zincir, S.; Sunbul, M.; Zincir, S.; Aydin Sunbul, E.; Oguz, M.; Feriha Cengiz, F.; Durmus, E.; Kivrak, T.; Sari, I. Burden and Depressive Symptoms Associated with Adult-Child Caregiving for Individuals with Heart Failure. Sci. World J. 2014, 2014, 1–6. [Google Scholar] [CrossRef] [PubMed]
- Liu, J.; Guo, M.; Bern-Klug, M. Economic Stress among Adult-Child Caregivers of the Oldest Old in China: The Importance of Contextual Factors. J. Cross Cult. Psychol. 2013, 28, 465–479. [Google Scholar] [CrossRef] [PubMed]
- Lou, V.W.Q.; Kwan, C.W.; Leung, A.Y.M.; Chi, I. Psychological Distress among Chinese Adult-Child Caregivers: The Effects of Behavioral and Cognitive Components of Care. Home Health Care Serv. Q. 2011, 30, 133–146. [Google Scholar] [CrossRef] [PubMed]
- Savundranayagam, M.Y.; Montgomery, R.J.V.; Kosloski, K. A Dimensional Analysis of Caregiver Burden among Spouses and Adult Children. Gerontologist 2011, 51, 321–331. [Google Scholar] [CrossRef] [Green Version]
- Yeh, K.; Bedford, O. A test of the Dual Filial Piety model. Asian. J. Soc. Psychol. 2003, 6, 215–228. [Google Scholar] [CrossRef] [Green Version]
- Guo, J. The Rural Genarelational Relationships and “Raise Children for Retirement Safeguard”. Master’s Thesis, Huazhong University of Science & Technology, Wuhan, China, 1 May 2008. [Google Scholar]
- Simon, M.A.; Chen, R.; Chang, E.S.; Dong, X. The Association Between Filial Piety and Suicidal Ideation: Findings From a Community-Dwelling Chinese Aging Population. J. Gerontol. A Biol. Sci. Med. Sci. 2014, 69, S90–S97. [Google Scholar] [CrossRef] [Green Version]
- Sun, F.; Ong, R.; Burnette, D. The influence of ethnicity and culture on dementia caregiving: A review of empirical studies on Chinese Americans. Am. J. Alzheimers Dis. Other Demen. 2012, 27, 13–22. [Google Scholar] [CrossRef]
- Analysis on the Anomie of Filial Piety Culture and the Dilemma of Family Supporting for Elderly under the Change of Rural Social Structure. Available online: https://kns.cnki.net/KCMS/detail/detail.aspx?FileName=SHGC201804019&DbName=CJFQ2018 (accessed on 2 September 2020).
- Jin, Y. A Research on the Problem of Care for the Aged as Caregivers in Rural Areas: A Case Study of F Village in Hubei Province. Value Eng. 2017, 36, 243–246. [Google Scholar]
- Tatangelo, G.; McCabe, M.; Macleod, A.; You, E. “I just don’t focus on my needs.” The unmet health needs of partner and offspring caregivers of people with dementia: A qualitative study. Int. J. Nurs. Stud. 2018, 77, 8–14. [Google Scholar] [CrossRef] [PubMed]
- Zhan, H.J.; Montgomery, R.J.V. Gender and Elder Care in China: The Influence of Filial Piety and Structural Constraints. Gend. Soc. 2003, 17, 209–229. [Google Scholar] [CrossRef]
- Cook, S.K.; Snellings, L.; Cohen, S.A. Socioeconomic and demographic factors modify observed relationship between caregiving intensity and three dimensions of quality of life in informal adult children caregivers. Health Qual. Life Outcomes 2018, 16. [Google Scholar] [CrossRef]
- Chinese Government Website. Healthy China Action (2019–2030). Available online: http://www.gov.cn/xinwen/2019-07/15/content_5409694.htm (accessed on 15 March 2020).
- Holden, R.R.; Mehta, K.; Jane Cunningham, E.; Mcleod, L.D. Development and Preliminary Validation of a Scale of Psychache. Can. J. Behav. Sci. 2001, 33, 224–232. [Google Scholar] [CrossRef]
- Yang, L.; Chen, W. Reliability and Validity of the Psychache Scale in Chinese Undergraduates. J. Clin. Psychol. 2017, 25, 475–478, 583. [Google Scholar] [CrossRef]
- Gomes, G.; Luchesi, B.M.; Gratao, A.; Orlandi, F.S.; Say, K.G.; Inouye, K.; Alexandre, T.; Brigola, A.G.; Pavarini, S. Prevalence of Physical Inactivity and Associated Factors among Older Caregivers of Older Adults. J. Aging Health 2019, 31, 793–813. [Google Scholar] [CrossRef] [PubMed]
- Posner, K.; Brown, G.K.; Stanley, B.; Brent, D.A.; Yershova, K.V.; Oquendo, M.A.; Currier, G.W.; Melvin, G.A.; Greenhill, L.; Shen, S.; et al. The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am. J. Psychiatry 2011, 168, 1266–1277. [Google Scholar] [CrossRef] [Green Version]
- Sheehan, D.V.; Lecrubier, Y.; Sheehan, K.H.; Amorim, P.; Janavs, J.; Weiller, E.; Hergueta, T.; Baker, R.; Dunbar, G.C. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J. Clin. Psychiatry 1998, 59 (Suppl. 20), 22–57. [Google Scholar]
- Meerwijk, E.L.; Weiss, S.J. Toward a unifying definition: Response to ‘The concept of mental pain’. Psychother. Psychosom. 2014, 83, 62–63. [Google Scholar] [CrossRef]
- Meerwijk, E.L.; Weiss, S.J. Utility of a time frame in assessing psychological pain and suicide ideation. Peer J. 2017, 5, e3491. [Google Scholar] [CrossRef]
- Campos, R.C.; Simoes, A.; Costa, S.; Pio, A.S.; Holden, R.R. Psychological pain and suicidal ideation in undergraduates: The role of pain avoidance. Death Stud. 2019, 1–4. [Google Scholar] [CrossRef] [PubMed]
- Jeong, S.H.; Chun, B.C. Individual and regional factors associated with suicidal ideation among Korean elderly: A multilevel analysis of the Korea Community Health Survey. Epidemiol. Health 2019, 41, e2019022. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Liao, S.; Wu, B.; Liu, T.; Chou, C.; Rong, J. Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan. BMC Psychiatry 2018, 18. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wei, J.; Zhang, J.; Deng, Y.; Sun, L.; Guo, P. Suicidal Ideation among the Chinese Elderly and Its Correlates: A Comparison between the Rural and Urban Populations. Int. J. Environ. Health Res. 2018, 15, 422. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Yu, Z.; Xu, L.; Sun, L.; Zhang, J.; Qin, W.; Li, J.; Ding, G.; Wang, Q.; Zhu, J.; Xie, S. Association between interpersonal trust and suicidal ideation in older adults: A cross-sectional analysis of 7070 subjects in Shandong, China. BMC Psychiatry 2019, 19. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zhang, L.; Sun, L.; Zhou, C.; Ge, D.; Qian, Y. The Relationship Between Difficulties in Daily Living and Suicidal Ideation among Older Adults: Results From a Population-Based Survey in Shandong. J. Nerv. Ment. Dis. 2018, 206, 1. [Google Scholar] [CrossRef] [PubMed]
- Informal Social Support and Mental Health of Chinese Elderly. Available online: https://kns.cnki.net/KCMS/detail/detail.aspx?FileName=GZSK201604015&DbName=CJFQ2016 (accessed on 2 September 2020).
- Fang, Y.; Liu, L. Analysis of psychological distress and influencing factors in patients with chronic obstructive pulmonary disease. China J. Lat. Psychol. 2019, 27, 1370–1373. [Google Scholar]
- Chang, Q.; Chan, C.H.; Yip, P.S.F. A meta-analytic review on social relationships and suicidal ideation among older adults. Soc. Sci. Med. 2017, 191, 65–76. [Google Scholar] [CrossRef]
- Mizuno, Y.; Hikichi, H.; Noguchi, M.; Kawachi, I.; Takao, S. Reciprocity of social support is associated with psychological distress and suicidal ideation in older Japanese people: A population-based study. Soc. Sci. Med. 2019, 230, 131–137. [Google Scholar] [CrossRef]
- Pompili, M.; Vichi, M.; Qin, P.; Innamorati, M.; De Leo, D.; Girardi, P. Does the level of education influence completed suicide? A nationwide register study. J. Affect Disord. 2013, 147, 437–440. [Google Scholar] [CrossRef]
- Belo, P.; Navarro-Pardo, E.; Pocinho, R.; Carrana, P.; Margarido, C. Relationship Between Mental Health and the Education Level in Elderly People: Mediation of Leisure Attitude. Front. Psychol. 2020, 11, 573. [Google Scholar] [CrossRef] [Green Version]
- Oh, D.J.; Park, J.Y.; Oh, M.; Kim, K.; Hong, J.; Kim, T.; Han, J.W.; Kim, T.H.; Kim, K.W. Suicidality-based prediction of suicide attempts in a community-dwelling elderly population: Results from the Osan Mental Health Survey. J. Affect Disord. 2015, 184, 286–292. [Google Scholar] [CrossRef]
- Yen, Y.; Yang, M.; Yang, M.; Lung, F.; Shih, C.; Hahn, C.; Lo, H. Suicidal ideation and associated factors among community-dwelling elders in Taiwan. Psychiatry Clin. Neurosci. 2005, 59, 365–371. [Google Scholar] [CrossRef]
- Conejero, I.; Olie, E.; Calati, R.; Ducasse, D.; Courtet, P. Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions. Curr. Psychiatry Rep. 2018, 20, 33. [Google Scholar] [CrossRef]
- Ducasse, D.; Holden, R.R.; Boyer, L.; Artero, S.; Calati, R.; Guillaume, S.; Courtet, P.; Olie, E. Psychological Pain in Suicidality: A Meta-Analysis. J. Clin. Psychiatry 2018, 79. [Google Scholar] [CrossRef]
- Li, H.; Xie, W.; Luo, X.; Fu, R.; Shi, C.; Ying, X.; Wang, N.; Yin, Q.; Wang, X. Clarifying the role of psychological pain in the risks of suicidal ideation and suicidal acts among patients with major depressive episodes. Suicide Life Threat. Behav. 2014, 44, 78–88. [Google Scholar] [CrossRef]
- Shneidman, E.S. Suicide as psychache. J. Nerv. Ment. Dis. 1993, 181, 145–147. [Google Scholar] [CrossRef]
Variables | Categories | N = 4622 |
---|---|---|
Parental state | Neither alive | 3414 (73.9) |
One alive | 788 (17.0) | |
Both alive | 420 (9.1) | |
Age, mean ± SD | 71.2 ± 7.8 | |
Gender | Male | 2284 (49.4) |
Female | 2338 (50.6) | |
Marital status | Married | 3129 (67.7) |
Others (single, divorced, and widowed) | 1493 (32.3) | |
Place of residence | rural areas | 2805 (60.7) |
main urban or urban-rural areas | 1817 (39.3) | |
Education level | <Primary school | 1942 (42.0) |
Primary school | 1136 (24.6) | |
Middle/high school | 1192 (25.8) | |
≥College | 352 (7.6) | |
Family per-capita annual income (CHY) | ≤15,000 | 1639 (35.5) |
15,000–30,000 | 1162 (25.1) | |
30,000–45,000 | 883 (19.1) | |
>45,000 | 938 (20.3) | |
Occupation before retirement | Farmer, worker, etc. | 2657 (57.5) |
Self-employed | 585 (12.7) | |
Company employee | 424 (9.2) | |
Government employee | 766 (16.6) | |
Others | 190 (4.1) | |
Number of chronic diseases | 0 | 2219 (48.0) |
1 | 1252 (27.1) | |
≥2 | 1151 (24.9) | |
Fully self-care ability | Yes | 3265 (70.6) |
No | 1357 (29.4) |
Variables | All Participants | Parental State | F/χ2 | Pairwise Comparison | ||
---|---|---|---|---|---|---|
Neither Alive (g1) | One Alive (g2) | Both Alive (g3) | ||||
Psychological pain | ||||||
PSA sum-score | 22.1 ± 9.5 | 22.5 ± 9.6 | 19.7 ± 7.6 | 23.3 ± 11.0 | 33.27 *** | g2 < g1 & g3 |
PSA-frequency | 14.8 ± 6.6 | 15.0 ± 6.7 | 13.2 ± 5.2 | 15.7 ± 7.8 | 28.71 *** | g2 < g1 < g3 |
PSA-intensity | 7.3 ± 3.4 | 7.5 ± 3.5 | 6.4 ± 2.8 | 7.6 ± 3.7 | 34.18 *** | g2 < g1 & g3 |
Suicidal ideation | ||||||
Wish to die | 98.82 *** | g2 < g1 & g3 | ||||
Moderate to severe | 134 (2.9) | 112 (3.3) | 7 (0.9) | 15 (3.6) | ||
Mild | 1450 (31.4) | 1164 (34.1) | 147 (18.7) | 139 (33.1) | ||
None | 3038 (65.7) | 2138 (62.6) | 634 (80.5) | 266 (63.3) | ||
Wish to live | 64.65 *** | g2 < g1 & g3 | ||||
None | 152 (3.3) | 117 (3.4) | 11 (1.4) | 24 (5.7) | ||
Mild | 943 (20.4) | 759 (22.2) | 93 (11.8) | 91 (21.7) | ||
Moderate to severe | 3527 (76.3) | 2538 (74.3) | 684 (86.8) | 305 (72.6) | ||
Reasons to live/die | 47.26 *** | g2 < g1 & g3 | ||||
More for dying | 111 (2.4) | 89 (2.6) | 9 (1.1) | 13 (3.1) | ||
Equal | 1319 (28.5) | 1042 (30.5) | 155 (19.7) | 122 (29.0) | ||
More for living | 3192 (69.1) | 2283 (66.9) | 624 (79.2) | 285 (67.9) | ||
Overall suicidal ideation | 95.80 *** | g2 < g1 & g3 | ||||
Yes | 2061 (44.6) | 1634 (47.9) | 227 (28.8) | 200 (47.6) | ||
No | 2561 (55.4) | 1780 (52.1) | 561 (71.2) | 220 (52.4) |
Variables | B | S.E. | 95% CI for B | T | p-Value | |
---|---|---|---|---|---|---|
Lower | Upper | |||||
Parental state (vs. Neither alive) | ||||||
One alive | −0.95 | 0.38 | −1.69 | −0.20 | 6.18 | 0.013 |
Both alive | 1.47 | 0.47 | 0.54 | 2.40 | 9.64 | 0.002 |
Age | −0.06 | 0.02 | −0.09 | −0.02 | 8.57 | 0.003 |
Gender (vs. Female) | ||||||
Male | −0.82 | 0.28 | −1.36 | −0.28 | 8.71 | 0.003 |
Marital status (vs. Others) | ||||||
Married | −1.02 | 0.30 | −1.62 | −0.43 | 11.30 | 0.001 |
Place of residence (vs. Main urban or urban-rural areas) | ||||||
Rural | 1.30 | 0.34 | 0.63 | 1.97 | 14.56 | 0.000 |
Education level | 0.55 | 0.16 | 0.22 | 0.87 | 11.03 | 0.001 |
Family income | −1.68 | 0.14 | −1.94 | −1.41 | 152.35 | 0.000 |
Occupation before retirement | 0.17 | 0.13 | −0.08 | 0.43 | 1.80 | 0.180 |
Number of chronic diseases (vs. 0) | ||||||
1 | 0.13 | 0.32 | −0.49 | 0.75 | 0.17 | 0.681 |
≥2 | 2.35 | 0.33 | 1.71 | 3.00 | 50.83 | 0.000 |
Fully self-care ability (vs. No) | ||||||
Yes | −3.73 | 0.31 | −4.34 | −3.13 | 146.00 | 0.000 |
Variables | OR | 95% CI for OR | p-Value | |
---|---|---|---|---|
Lower | Upper | |||
Parental state (vs. Neither alive) | ||||
One alive | 0.72 | 0.59 | 0.87 | 0.001 |
Both alive | 1.25 | 1.00 | 1.56 | 0.053 |
Age | 1.00 | 0.99 | 1.01 | 0.838 |
Gender (vs. Female) | ||||
Male | 0.90 | 0.79 | 1.02 | 0.104 |
Marital status (vs. Others) | ||||
Married | 0.57 | 0.49 | 0.66 | 0.000 |
Place of residence (vs. Main urban or urban-rural areas) | ||||
Rural | 1.17 | 1.00 | 1.38 | 0.055 |
Education level | 1.28 | 1.18 | 1.38 | 0.000 |
Family income | 0.69 | 0.64 | 0.73 | 0.000 |
Occupation before retirement | 0.98 | 0.92 | 1.05 | 0.568 |
Number of chronic diseases (vs. 0) | ||||
1 | 1.36 | 1.17 | 1.59 | 0.000 |
≥2 | 1.92 | 1.65 | 2.25 | 0.000 |
Fully self-care ability (vs. No) | ||||
Yes | 0.50 | 0.43 | 0.58 | 0.000 |
Variables | Overall Suicidal Ideation | r | OR (95% CI) | |
---|---|---|---|---|
Yes | No | |||
Psychological pain | 27.7 ± 10.4 | 17.7 ± 5.5 | 0.44 *** | 1.16 (1.14–1.17) *** |
Pain frequency | 18.4 ± 7.4 | 11.8 ± 3.8 | 0.42 *** | 1.22 (1.20–1.24) *** |
Pain intensity | 9.2 ± 3.5 | 5.8 ± 2.4 | 0.43 *** | 1.40 (1.37–1.44) *** |
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Yang, Y.; Wang, S.; Hu, B.; Hao, J.; Hu, R.; Zhou, Y.; Mao, Z. Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation? A Cross-Sectional Study in China. Int. J. Environ. Res. Public Health 2020, 17, 6399. https://doi.org/10.3390/ijerph17176399
Yang Y, Wang S, Hu B, Hao J, Hu R, Zhou Y, Mao Z. Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation? A Cross-Sectional Study in China. International Journal of Environmental Research and Public Health. 2020; 17(17):6399. https://doi.org/10.3390/ijerph17176399
Chicago/Turabian StyleYang, Ying, Shizhen Wang, Borui Hu, Jinwei Hao, Runhu Hu, Yinling Zhou, and Zongfu Mao. 2020. "Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation? A Cross-Sectional Study in China" International Journal of Environmental Research and Public Health 17, no. 17: 6399. https://doi.org/10.3390/ijerph17176399