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. 2023 Jan;38(1):e5873.
doi: 10.1002/gps.5873.

Physical multimorbidity, suicidal ideation, and suicide attempts among adults aged ≥50 years from low- and middle-income countries

Lee Smith  1 , Jae Il Shin  2 , Guillermo F López Sánchez  3 , Karel Kostev  4 , Louis Jacob  5   6 , Mark A Tully  7 , Laurie Butler  1 , Yvonne Barnett  1 , Nicola Veronese  8 , Pinar Soysal  9 , Adel S Abduljabbar  10 , Josep Maria Haro  5   10 , Ai Koyanagi  5   11
Affiliations

Physical multimorbidity, suicidal ideation, and suicide attempts among adults aged ≥50 years from low- and middle-income countries

Lee Smith et al. Int J Geriatr Psychiatry. 2023 Jan.

Abstract

Objectives: The association between physical multimorbidity and suicidal ideation or suicide attempts among older adults from low- and middle-income countries (LMICs) is largely unknown. We aimed to assess this association as well as its mediators using nationally representative data from six LMICs.

Methods: Cross-sectional, community-based data from the Study on Global Aging and Adult Health were analyzed. A total of 11 chronic physical conditions were assessed. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analyses were conducted.

Results: The final sample consisted of 34,129 adults aged ≥50 years (mean [SD] age 62.4 (16.0) years; maximum age 114 years; 52.1% females). In the overall sample, physical multimorbidity was associated with increased odds for suicidal ideation (OR = 2.99; 95% CI = 2.06-4.34) and suicide attempts (OR = 2.79; 95% CI = 1.58-4.95), with the association being stronger in males than females. The association between multimorbidity and suicidal ideation or suicide attempts was largely mediated by pain/discomfort (mediated% 33.3%-44.2%), sleep/energy (28.2%-33.8%), and mobility limitations (26.6%-34.8%).

Conclusions: Physical multimorbidity among older adults in LMICs was associated with a substantially increased risk for suicidal ideation and suicide attempts. Addressing the identified mediators in people with physical multimorbidity may aid in the prevention of suicidal ideation and suicide attempts.

Keywords: adults; epidemiology; low- and middle-income countries; multimorbidity; suicidal ideation; suicide attempts.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Prevalence of suicidal ideation and suicide attempts by number of chronic conditions (overall and by sex).
FIGURE 2
FIGURE 2
Association between individual chronic conditions and (A) suicidal ideation or (B) suicide attempts estimated by multivariable logistic regression. Models are mutually adjusted for all individual chronic conditions and age, sex, education, wealth, alcohol consumption, smoking, and country. Abbreviations: CI, Confidence interval; OR, Odds ratio
FIGURE 3
FIGURE 3
Country‐wise association between physical multimorbidity (i.e., ≥2 chronic conditions) and suicidal ideation (outcome) estimated by multivariable logistic regression. Models are adjusted for age, sex, education, wealth, alcohol consumption, and smoking. Overall estimate was obtained by meta‐analysis with fixed effects. Abbreviations: CI, Confidence interval; OR, Odds ratio
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