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Attachment anxiety, depression, and perceived social support: a moderated mediation model of suicide ideation among the elderly

Published online by Cambridge University Press:  07 May 2020

Awirut Oon-arom Open the ORCID record for Awirut Oon-arom [Opens in a new window] ,
Tinakon Wongpakaran ,
Pimolpun Kuntawong  and
Nahathai Wongpakaran Open the ORCID record for Nahathai Wongpakaran [Opens in a new window]
Awirut Oon-arom
Affiliation:
Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Tinakon Wongpakaran*
Affiliation:
Psychotherapy Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Pimolpun Kuntawong
Affiliation:
Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Nahathai Wongpakaran
Affiliation:
Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*
Correspondence should be addressed to: Nahathai Wongpakaran, Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., Tambon Sriphum, Amphoe Muang, Chiang Mai50200, Kingdom of Thailand. Phone: +66 53 935422 ext 320; Fax: +66 53 935426. Email: nahathai.wongpakaran@cmu.ac.th
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Abstract

Objectives:

Issues concerning the association among attachment anxiety, depression and suicidal ideation among the elderly have rarely been explored. The present study investigated the relationship among attachment anxiety, depression and perceived support concerning suicidal ideation among older people.

Design:

Cross-sectional study

Setting:

Tertiary care settings

Participants:

The authors recruited 191 elderly patients from 10 tertiary care settings in Thailand

Measurements:

Participants provided data on their suicidal ideation and suicidal attempt using Module C of the Mini-International Neuropsychiatric Interview. Their attachment anxiety was assessed using the revised Experience of Close Relationship questionnaire (ECR-R-18), while their level of depression was investigated using the Geriatric Depression Scale. In addition, their perception of being supported was ascertained using the Multidimensional Scale of Perceived Social Support. We performed two mediation analyses and moderation analyses separately using the product of coefficients approach. First, we created a mediation model to examine the role of attachment anxiety and depression on suicidal ideation. Second, a moderated mediation model was created to explore the relationship of perceived social support as a moderator of depression.

Results:

We found that depression significantly mediated the association between attachment anxiety and suicidal ideation. The association between depression and suicidal ideation was moderated by the level of perceived social support.

Conclusion:

Findings of this study may broaden our understanding of how suicidal ideation develops among the elderly and further stimulate future research exploring the interaction of positive and negative factors of suicidality among the elderly. Implications of the findings were also discussed.

Keywords

Attachment anxietysuicidal ideationmoderated mediationelderly
Type
Original Research Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 2: Issue Theme: Schizophrenia and Depression in Older Adults , February 2021 , pp. 169 - 178
Copyright
© International Psychogeriatric Association 2020

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References

Alexopoulos, G. S. et al. (2009). Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. American Journal of Psychiatry, 166(8), 882–890. doi: 10.1176/appi.ajp.2009.08121779.CrossRefGoogle ScholarPubMed
Almeida, O. P. et al. (2012). Factors associated with suicidal thoughts in a large community study of older adults. British Journal of Psychiatry, 201, 466–472. doi: 10.1192/bjp.bp.112.110130.CrossRefGoogle Scholar
Bartholomew, K. and Perlman, D. (1994). Attachment Processes in Adulthood. Advances in Personal Relationships. London: J. Kingsley Publishers.Google Scholar
Bernier, S., Lapierre, S. and Desjardins, S. (2020). Social interactions among older adults who wish for death. Clinical Gerontologist, 43, 4–16. doi: 10.1080/07317115.2019.1672846.CrossRefGoogle ScholarPubMed
Brausch, A. M. and Decker, K. M. (2014). Self-esteem and social support as moderators of depression, body image, and disordered eating for suicidal ideation in adolescents. Journal of Abnormal Child Psychology, 42(5), 779–789. doi: 10.1007/s10802-013-9822-0.CrossRefGoogle ScholarPubMed
Calati, R., Olié, E., Ritchie, K., Artero, S. and Courtet, P. (2017). Suicidal ideation and suicide attempts in the elderly associated with opioid use and pain sensitivity. Psychotherapy and Psychosomatics, 86(6), 373–375. doi: 10.1159/000478021.CrossRefGoogle ScholarPubMed
Casale, M., Boyes, M., Pantelic, M., Toska, E. and Cluver, L. (2018). Suicidal thoughts and behaviour among South African adolescents living with HIV: can social support buffer the impact of stigma? Journal of Affective Disorders, 245, 82–90. doi: 10.1016/j.jad.2018.10.102.CrossRefGoogle ScholarPubMed
Choi, N.G., DiNitto, D.M., Marti, C.N. and Kaplan, M. S. (2017). Older suicide decedents: intent disclosure, mental and physical health, and suicide means. American Journal of Preventive Medicine, 53(6), 772–780. doi: 10.1016/j.amepre.2017.07.021.CrossRefGoogle ScholarPubMed
Cohen, A. N., Hammen, C., Henry, R. M. and Daley, S. E. (2004). Effects of stress and social support on recurrence in bipolar disorder. Journal of Affective Disorders, 82(1), 143–147. doi: 10.1016/j.jad.2003.10.008.CrossRefGoogle ScholarPubMed
Conradi, H. J., Kamphuis, J. H. and de Jonge, P. (2018). Adult attachment predicts the seven-year course of recurrent depression in primary care. Journal of Affective Disorders, 225, 160–166. doi: 10.1016/j.jad.2017.08.009.CrossRefGoogle ScholarPubMed
Diamond, G. S. et al. (2019). A randomized controlled trial: attachment-based family and nondirective supportive treatments for youth who are suicidal. Journal of American Academy of Child and Adolescence Psychiatry, 58, 721–731. doi: 10.1016/j.jaac.2018.10.006.CrossRefGoogle ScholarPubMed
Falgares, G. et al. (2017). Attachment styles and suicide-related behaviors in adolescence: the mediating role of self-criticism and dependency. Frontiers in Psychiatry, 8, 36. doi: 10.3389/fpsyt.2017.00036.CrossRefGoogle ScholarPubMed
Fässberg, M. et al. (2016). A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging and Mental Health, 20(2), 166–194. doi: 10.1080/13607863.2015.1083945.CrossRefGoogle ScholarPubMed
Findlay, L. (2017). Depression and suicidal ideation among Canadians aged 15 to 24. Health Reports, 28(1), 3–11.Google ScholarPubMed
Gujral, S., Dombrovski, A. Y., Butters, M., Clark, L., Reynolds, C. F. and Szanto, K. (2014). Impaired executive function in contemplated and attempted suicide in late life. The American Journal of Geriatric Psychiatry, 22(8), 811–819. doi: 10.1016/j.jagp.2013.01.025.CrossRefGoogle ScholarPubMed
Gutierrez, D. M. D., Sousa, A. B. L. and Grubits, S. (2015). Suicidal ideation and attempted suicide in elderly people - subjective experiences. Ciencia and Saude Coletiva, 20(6), 1731–1740. doi: 10.1590/1413-81232015206.02242015.CrossRefGoogle ScholarPubMed
Harrison, K. E. et al. (2010). Alone? Percieved social support and chronic interpersonal difficulties in suicidal elders. International Psychogeriatrics, 22(3), 445–454. doi: 10.1017/S1041610209991463.CrossRefGoogle Scholar
Heisel, M. J., Neufeld, E. and Flett, G. L. (2016). Reasons for living, meaning in life, and suicide ideation: investigating the roles of key positive psychological factors in reducing suicide risk in community-residing older adults. Aging and Mental Health, 20, 195–207. doi: 10.1080/13607863.2015.1078279.CrossRefGoogle ScholarPubMed
Hobbs, M. J., Joubert, A. E., Mahoney, A. E. J. and Andrews, G. (2018). Treating late-life depression: comparing the effects of internet-delivered cognitive behavior therapy across the adult lifespan. Journal of Affective Disorders, 226, 58–65. doi: 10.1016/j.jad.2017.09.026.CrossRefGoogle ScholarPubMed
Hooper, L. M., Tomek, S. and Newman, C. R. (2012). Using attachment theory in medical settings: implications for primary care physicians. Journal of Mental Health, 21, 23–37. doi: 10.3109/09638237.2011.613955.CrossRefGoogle ScholarPubMed
Hsu, L. R., Hailey, B. J. and Range, L. M. (1987). Cultural and emotional components of loneliness and depression. Journal of Psychology, 121(1), 61–70. doi: 10.1080/00223980.1987.9712644.CrossRefGoogle ScholarPubMed
Hu, L. and Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. doi: 10.1080/10705519909540118.CrossRefGoogle Scholar
Jahn, D. R., Poindexter, E. K. and Cukrowicz, K. C. (2015). Personality disorder traits, risk factors, and suicide ideation among older adults. International Psychogeriatrics, 27(11), 1785–1794. doi: 10.1017/S1041610215000174.CrossRefGoogle ScholarPubMed
Jané-Llopis, E., Hosman, C., Jenkins, R. and Anderson, P. (2003) Predictors of efficacy in depression prevention programmes. Meta-analysis. British Journal of Psychiatry, 183, 384–397. doi: 10.1192/bjp.183.5.384.CrossRefGoogle ScholarPubMed
Jensen, M. P., Smith, A. E., Bombardier, C. H., Yorkston, K. M., Miró, J. and Molton, I. R. (2014). Social support, depression, and physical disability: age and diagnostic group effects. Disabily and Health Journal, 7(2), 164–172. doi: 10.1016/j.dhjo.2013.11.001.CrossRefGoogle ScholarPubMed
Jokinen, J., Mattsson, P., Nordström, P. and Samuelsson, M. (2016). High early suicide risk in elderly patients after self-poisoning. Archives of Suicide Research, 20(4), 683–688. doi: 10.1080/13811118.2016.1162239.CrossRefGoogle ScholarPubMed
Ju, Y. J. et al. (2016). Low socioeconomic status and suicidal ideation among elderly individuals. International Psychogeriatrics, 28(12), 2055–2066. doi: 10.1017/S1041610216001149.CrossRefGoogle ScholarPubMed
Kenny, D. A. and McCoach, D. B. (2003). Effect of the number of variables on measures of fit in structural equation modeling. Structural Equation Modeling, 10(3), 333–351. doi: 10.1207/S15328007SEM1003_1.CrossRefGoogle Scholar
Kidd, T., Poole, L., Ronaldson, A., Leigh, E., Jahangiri, M. and Steptoe, A. (2016). Attachment anxiety predicts depression and anxiety symptoms following coronary artery bypass graft surgery. British Journal of Health Psychology, 21(4), 796–811. doi: 10.1111/bjhp.12191.CrossRefGoogle ScholarPubMed
Kiosses, D. N., Gross, J. J., Banerjee, S., Duberstein, P. R., Putrino, D. and Alexopoulos, G. S. (2017). Negative emotions and suicidal ideation during psychosocial treatments in older adults with major depression and cognitive impairment. The American Journal of Geriatric Psychiatry, 25(6), 620–629. doi: 10.1016/j.jagp.2017.01.011.CrossRefGoogle ScholarPubMed
Kittirattanapaiboon, P. and Khamwongpin, M. (2005). The validity of the mini international neuropsychiatric interview (MINI)-Thai version. Journal of Mental Health of Thailand, 13(3), 125–135.Google Scholar
Kono, A. et al. (2012) Effects of a preventive home visit program in ambulatory frail older people: a randomized controlled trial. Journal of Gerontology. Series A Biological Science and Medical Science, 67, 302–309. doi: 10.1093/gerona/glr176.CrossRefGoogle ScholarPubMed
Lee, M. -A. (2016). Social relationships, depressive symptoms and suicidality in Korea: Examining mediating and moderating effects in men and women. The International Journal of Social Psychiatry, 62(1), 67–75. doi: 10.1177/0020764015592434.CrossRefGoogle ScholarPubMed
Levi-Belz, Y., Gvion, Y., Horesh, N. and Apter, A. (2013). Attachment patterns in medically serious suicide attempts: the mediating role of self-disclosure and loneliness. Suicide and Life-Threatening Behavior, 43(5), 511–522. doi: 10.1111/sltb.12035.Google ScholarPubMed
Li, S. et al. (2017). Attachment style and suicide behaviors in high risk psychiatric inpatients following hospital discharge: the mediating role of entrapment. Psychiatry Research, 257, 309–314. doi: 10.1016/j.psychres.2017.07.072.CrossRefGoogle ScholarPubMed
Lien, Y. J., Hu, J. N. and Chen, C. Y. (2016). The influences of perceived social support and personality on trajectories of subsequent depressive symptoms in Taiwanese youth. Social Science and Medicine, 153, 148–55. doi: 10.1016/j.socscimed.2016.02.015.CrossRefGoogle ScholarPubMed
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G. and Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7(1), 83–104.CrossRefGoogle ScholarPubMed
MacKinnon, D. P., Lockwood, C. M. and Williams, J. (2004). Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behavioral Research, 39(1), 99. doi: 10.1207/s15327906mbr3901_4.CrossRefGoogle ScholarPubMed
McLaren, S., Gomez, R., Gill, P. and Chesler, J. (2015). Marital status and suicidal ideation among Australian older adults: the mediating role of sense of belonging. International Psychogeriatrics, 27(1), 145–154. doi: 10.1017/S1041610214001501.CrossRefGoogle ScholarPubMed
Miniati, M., Callari, A. and Pini, S. (2017). Adult attachment style and suicidality. Psychiatria Danubina, 29(3), 250–259. doi: 10.24869/psyd.2017.250.CrossRefGoogle ScholarPubMed
Muthén, L. K. and Muthén, B. O. (2012). Muthén: 1998–2015 Mplus user’s guide (seventh.). Los Angeles, CA. Retrieved from https://www.statmodel.com/download/usersguide/MplusUserGuideVer_7.pdf Google Scholar
Nam, E. J. and Lee, J.-E. (2019). Mediating effects of social support on depression and suicidal ideation in older Korean adults with hypertension who live alone. Journal of Nursing Research, 27, e20. doi: 10.1097/jnr.0000000000000292.CrossRefGoogle ScholarPubMed
Okolie, C., Dennis, M., Simon Thomas, E. and John, A. (2017). A systematic review of interventions to prevent suicidal behaviors and reduce suicidal ideation in older people. International Psychogeriatrics, 29(11), 1801–1824. doi: 10.1017/S1041610217001430.CrossRefGoogle ScholarPubMed
O’Riley, A., Nadorff, M. R., Conwell, Y. and Edelstein, B. (2013). Challenges associated with managing suicide risk in long-term care facilities. The Annals of Long-term Care, 21, 28–34.Google ScholarPubMed
Ozer, U., Yildirim, E. A. and Erkoc, S. N. (2015). Relationship of suicidal ideation and behavior to attachment style in patients with major depression. Noro Psikiyatr Ars, 52(3), 283–288. doi: 10.5152/npa.2015.7459.CrossRefGoogle ScholarPubMed
Palitsky, D., Mota, N., Afifi, T. O., Downs, A. C. and Sareen, J. (2013). The association between adult attachment style, mental disorders, and suicidality: findings from a population-based study. The Journal of nervous and mental disease, 201(7), 579–586. doi: 10.1097/NMD.0b013e31829829ab.CrossRefGoogle ScholarPubMed
Park, S. et al. (2015). The association of suicide risk with negative life events and social support according to gender in Asian patients with major depressive disorder. Psychiatry Research, 228(3), 277–282. doi: 10.1016/j.psychres.2015.06.032.CrossRefGoogle ScholarPubMed
Perlick, D. A. et al. (2016) Caregiver burden as a predictor of depression among family and friends who provide care for persons with bipolar disorder. Bipolar Disorder 18, 183–191. doi: 10.1111/bdi.12379.CrossRefGoogle ScholarPubMed
Sheehan, D. V. et al. (1998). The validity of Mini International Neuropsychiatric Interview (MINI). The development and validation of a structured diagnostic interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 211–232.Google Scholar
Shin, K. M. et al. (2013). Suicide among the elderly and associated factors in South Korea. Aging & Mental Health, 17(1), 109–114. doi: 10.1080/13607863.2012.702732.CrossRefGoogle ScholarPubMed
Siegmann, P. et al. (2018). Resilience to suicide ideation: a cross-cultural test of the buffering hypothesis. Clinical Psychology and Psychotherapy, 25(1), e1–e9. doi: 10.1002/cpp.2118.CrossRefGoogle ScholarPubMed
Suradom, C. et al. (2019). Prevalence and associated factors of comorbid anxiety disorders in late-life depression: findings from geriatric tertiary outpatient settings. Neuropsychiatric Disease and Treatment, 15, 199–204. doi: 10.2147/NDT.S184585.CrossRefGoogle ScholarPubMed
Szücs, A., Szanto, K., Aubry, J. -M. and Dombrovski, A. Y. (2018). Personality and suicidal behavior in old age: a systematic literature review. Frontiers in Psychiatry, 9, 128. doi: 10.3389/fpsyt.2018.00128.CrossRefGoogle ScholarPubMed
Tan, L. L. and Wong, H. B. (2008). Severity of depression and suicidal ideations among elderly people in Singapore. International Psychogeriatrics, 20(2), 338–346. doi: 10.1017/S1041610207005789.CrossRefGoogle Scholar
Troya, M. I. et al. (2019). Self-harm in older adults: systematic review. British Journal of Psychiatry, 214, 186–200. doi: 10.1192/bjp.2019.11.CrossRefGoogle ScholarPubMed
Vancampfort, D. et al. (2018). Physical activity and suicidal ideation: a systematic review and meta-analysis. Journal of Affective Disorders, 225, 438–448. doi: 10.1016/j.jad.2017.08.070.CrossRefGoogle ScholarPubMed
Wang, J. -Y., Chu, J., Sun, S. -H., Zhang, J., Guo, X. -L. and Jia, C. -X. (2017). Social psychological factors and suicidal intent among suicide attempters in rural china: a path analysis. The Journal of Nervous and Mental Disease, 205(1), 48–53. doi: 10.1097/NMD.0000000000000628.CrossRefGoogle ScholarPubMed
Wongpakaran, N., Wongpakaran, T. and Van Reekum, R. (2013). The use of GDS-15 in detecting MDD: a comparison between residents in a Thai Long-Term care home and geriatric outpatients. Journal of Clinical Medicine Research, 5(2), 101–111. doi: 10.4021/jocmr1239w.Google Scholar
Wongpakaran, N. et al. (2019) Prevalence, clinical and psychosocial variables of depression, anxiety and suicidality in geriatric tertiary care settings. Asian Journal of Psychiatry 41, 38–44. doi: 10.1016/j.ajp.2018.10.007.CrossRefGoogle ScholarPubMed
Wongpakaran, T., Wongpakaran, N. and Wannarit, K. (2011). Validity and reliability of the Thai version of the Experiences of Close Relationships-Revised questionnaire. Singapore Medical Journal, 52(2), 100–106.Google ScholarPubMed
Wongpakaran, T. et al. (2014) Baseline characteristics of depressive disorders in Thai outpatients: findings from the Thai Study of Affective Disorders. Neuropsychiatric Disease and Treatment 10, 217–223. doi: 10.2147/NDT.S56680.CrossRefGoogle ScholarPubMed
Wongpakaran, T., Wongpakaran, N., Sirirak, T., Arunpongpaisal, S. and Zimet, G. (2018). Confirmatory factor analysis of the revised version of the Thai multidimensional scale of perceived social support among the elderly with depression. Aging and Mental Health, 22(9), 1143–1148. doi: 10.1080/13607863.2017.1339778.CrossRefGoogle ScholarPubMed
Woosley, J. A., Lichstein, K. L., Taylor, D. J., Riedel, B. W. and Bush, A. J. (2014). Hopelessness mediates the relation between insomnia and suicidal ideation. Journal Of Clinical Sleep Medicine, 10(11), 1223–1230. doi: 10.5664/jcsm.4208.CrossRefGoogle ScholarPubMed
Zhu, W., Wang, C. D. and Chong, C. C. (2016). Adult attachment, perceived social support, cultural orientation, and depressive symptoms: a moderated mediation model. Journal of Counseling Psychology, 63(6), 645–655. doi: 10.1037/cou0000161.CrossRefGoogle ScholarPubMed
Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S. and Berkoff, K. A. (1990). Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment, 55(3–4), 610–617. doi: 10.1080/00223891.1990.9674095.CrossRefGoogle ScholarPubMed
Zisk, A., Abbott, C. H., Ewing, S. K., Diamond, G. S. and Kobak, R. (2017). The Suicide Narrative Interview: adolescents’ attachment expectancies and symptom severity in a clinical sample. Attachment & Human Development, 19, 447–462. doi: 10.1080/14616734.2016.1269234.CrossRefGoogle Scholar