Mediating Effects of Social Support on Depression and Suicidal Ideation in Older Korean Adults With Hypertension Who Live Alone

10.1097/jnr.0000000000000292

Eun Jeong NAM；Jong-Eun LEE

older adult ； living alone ； depression ； suicidal ideation ； social support

The Journal of Nursing Research

27卷3期（2019 / 06 / 01）

1 - 8-002

英文

Background: Older adults who live alone are less physically and emotionally healthy and report higher levels of depression relative to those who do not live alone. Suicide is the most problematic health issue reported by older adults who live alone. In particular, vulnerable older adults who live alone experience difficulty obtaining self-care and medical services; therefore, early detection of depression is difficult, and there are few opportunities to implement suicide prevention strategies in this population. In addition, social support for depression is an important factor affecting illness and economic vulnerability in older adults who live alone. Purpose: This study aimed to examine the relationship between depression and suicidal ideation in vulnerable older Korean adults with hypertension and to explore the mediating effect of social support on this relationship. Methods: The study used a cross-sectional design. Vulnerable older adults who were 65 years old or older with hypertension and who received home visit services from a public health center were invited to participate. The participants completed structured questionnaires, including the 15-item Short-Form Geriatric Depression Scale, 12-item Multidimensional Scale of Perceived Social Support, and 19-item Scale for Suicidal Ideation, and provided information regarding their demographic characteristics, health status, and economic status. Descriptive and correlation analyses were performed to examine the correlations among these variables. The three-step regression analysis method proposed by Baron and Kenny was used to examine the mediating effect of social support. Results: The mean depression, social support, and suicidal ideation scores of participants were 23.64 (± 2.04), 35.94 (± 15.40), and 7.80 (± 7.73), respectively. In addition, depression was negatively correlated with social support (r = -.27) and positively correlated with suicidal ideation (r = .21), whereas social support was negatively correlated with suicidal ideation (r = -.35). Social support mediated the relationship between depression and suicidal ideation (Z = 2.69). Conclusions: Social support was identified as an important variable for older adults with chronic illness who lived alone. Interventions that include social support hold the potential to reduce depression and suicidal ideation in this population.

1. Alexopoulos, G. S.(2005).Depression in the elderly.The Lancet,368(9475),1961-1970.
2. Baek, H. C.,Lee, J.(2014).Factors affecting suicidal ideation of the low-income elderly living alone.Journal of Korean Academy of Community Health Nursing,25(3),180-186.
3. Baron, R. M.,Kenny, D. A.(1986).The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology,51(6),1173-1182.
4. Beck, A. T.,Kovacs, M.,Weissman, A.(1979).Assessment of suicidal intention: The scale for suicide ideation.Journal of Consulting and Clinical Psychology,47(2),343-352.
5. Cha, J. E.,Yun, S. N.(2015).The comparison of health behaviors, use of health services, and health expenditures among diabetic patients according to the practice of exercise.Jounal of the Korean Academy of Community Health Nursing,26(1),31-41.
6. Choi, Y. J.,Won, M. R.(2012).Effects of tailored case management using a gatekeeper for the depressed single-household elderly population: Focusing on the mental health case management.Journal of Korean Academy of Community Health Nursing,23(4),376-385.
7. Faul, F.,Erdfelder, E.,Buchner, A.,Lang, A. -G.(2009).Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses.Behavior Research Methods,41(4),1149-1160.
8. Glanz, K.(Ed.),Rimer, B. K.(Ed.),Viswanath, K.(Ed.)(2008).Health behavior and health education: Theory, research, and practice.San Francisco, CA:Jossey-Bass.
9. Greenglass, E.,Fiksenbaum, L.,Eaton, J.(2006).The relationship between coping, social support, functional disability and depression in the elderly.Anxiety, Stress, and Coping,19(1),15-31.
10. Han, H. R.,Song, Y.,Song, H. J.,Kim, M. T.(2013).Influence of living arrangements on the management and control of hypertension: A mixed-methods study of Korean American elderly.Journal of Immigrant and Minority Health,15(5),944-952.
11. Jang, S. Y.,Choi, B.,Ju, E. Y.,Kim, Y. M.,Kang, S. B.,Park, S.,Kim, I. H.(2014).Association between restriction of activity related to chronic diseases and suicidal ideation in older adults in Korea.Geriatrics & Gerontology International,14(4),983-988.
12. Jeong, K. H.(2015).The present situation and policy implications for the elderly in Korea (Report no. 300[2015-32])The present situation and policy implications for the elderly in Korea (Report no. 300[2015-32]),South Korea:Korea Institute for Health and Social Affairs.
13. Kang, Y. H.,Kim, M. Y.,Lee, G. J.,Jung, D. Y.,Ma, R. W.(2012).A study of social support, loneliness, sleep quality, and perceived health status among community-dwelling older adults.Journal of Korean Public Health Nursing,26(2),303-313.
14. Kee, B. S.(1996).A preliminary study for the standardization of Geriatric Depression Scale Short Form-Korea Version.Journal of the Korean Neuropsychatric Association,35(2),298-307.
15. Kim, S. H.,Choi, Y. H.(2007).The influence of physical health on suicidal ideation in older adults.Journal of the Korean Gerontological Society,27(4),775-788.
16. Kim, Y. J.(2009).Comparison of health habits, perceived stress, depression, and suicidal thinking by gender between elders living alone and those living with others.Journal of the Korean Academy of Fundamentals of Nursing,16(3),333-344.
17. Korea Institute for Health and Social Affairs(2014).,Seoul, South Korea:Ministry of Health & Welfare.
18. Korean Statistical Information Service. (2016). Statistics on the elderly in 2015. Retrieved from http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&bSeq=&aSeq=356426&pageNo=1&rowNum=10&navCount=10&currPg=&sTarget=title&sTxt=%EA%B3%A0%EB%A0%B9%EC%9E%90 (Original work published in Korean)
19. Kwon, J. D.,Um, T. Y.,Kim, Y. J.(2012).A study on factors affecting suicide risk among seniors who live alone: The effect of loneliness and the mediating effect of hopelessness.Health and Social Welfare Review,32(1),89-114.
20. Lee, E. J.,Bae, S. K.,Um, T. Y.(2010).A study on the influence of depression and leisure participation on attempted suicide among the elderly who lives alone.Journal of the Korean Gerontological Society,30(2),615-628.
21. Lee, G. Y.,Choi, E. H.(2013).A study on the effect of main variables to the suicidal ideation among the elderly living alone: Focused on the direct and indirect effects of social support.Health and Social Welfare Review,33(1),162-189.
22. Manthorpe, J.,Iliffe, S.(2010).Suicide in later life: Public health and practitioner perspectives.International Journal of Geriatric Psychiatry,25(12),1230-1238.
23. Oh, Y. H.,Bae, H. O.,Kim, Y. S.(2006).A study on physical and mental function affecting self-perceived health of older persons in Korea.Journal of the Korea Gerontological Society,26(3),461-476.
24. Shin, M. S.,Park, K. B.,Oh, K. J.,Kim, Z. S.(1990).A study of suicidal ideation among high school students: The structural relation among depression, hopelessness, and suicidal ideation.The Korean Journal of Clinical Psychology,9(1),1-19.
25. Sobel, M. E.(1982).Asymptotic confidence intervals for indirect effects in structural equation models.Sociological Methodology,13,290-312.
26. Sohn, J. N.(2012).A study on factors influencing the suicidal ideation in elderly people who live alone or live with family.Journal of Korean Academy of Psychiatric Mental Health Nursing,21(2),118-126.
27. Song, Y. D.,Son, J. A.,Park, S. M.(2010).An analysis of eco-systematic factors influencing suicidal ideation of the elderly who are living alone.Journal of the Korean Gerontological Society,30(2),643-660.
28. Yesavage, J. A.,Brink, T. L.,Rose, T. L.,Lum, O.,Huang, V.,Adey, M.,Leirer, V. O.(1982).Development and validation of a geriatric depression screening scale: A preliminary report.Journal of Psychiatric Research,17(1),37-49.
29. You, K. S.,Park, H. S.(2003).Comparison of health status between senior people living alone and those who live with their families.Journal of the Korean Gerontological Society,23(4),163-179.
30. Zimet, G. D.,Dahlem, N. W.,Zimet, S. G.,Farley, G. K.(1988).The Multidimensional Scale of Perceived Social Support (MSPSS).Journal of Personality Assessment,52(1),30-41.

1. 陳柯玫,許俊才(2022)。獨居老人社會支持之初探－以屏東縣屏東市為例。社會發展研究學刊，29，1-33。
2. 陳柯玫,許俊才,林宏陽,王仕圖(2020)。屏東縣獨居老人生活狀況與長期照顧需求態度之探討。人文社會科學研究，14(3)，1-29。