A study on household headship, living arrangement, and recipient of pension among the older adults in association with suicidal risks

Background: This study aims to examine whether variation in socioeconomic factors indicative of lower status within families in later life, such as the elderly losing their household headship, living with descendants, and having no pension are associated with suicidal risks among the older adults aged 60 years and above in the world. Methods: Using the data from the Global Burden of Disease Study in 2015, the suicide age ratios (i.e., suicide rate ratios between older adults aged >=60 years versus the younger groups aged <60 years) for the 173 regions were computed and compared. The suicide age ratio rather than the actual rate is used to adjust the difference in base rates among different countries. Forest plots were performed to assess whether late-life status within families moderated the worldwide patterns of suicide age ratios. Regression analyses were used to estimate the extent to which the factors reflecting family status affect suicide age ratios. Gender-specific analyses were also performed. Results: The results showed that higher suicide age ratios were significantly found in regions with lower percentages of the elderly being heads of households (ratios=1.69 vs 2.73, P<0.01), higher percentages of co-residence of the elderly with their descendants (ratios=2.72 vs 1.39, P<0.01), and lower percentages of the elderly receiving a pension (ratios=1.42 vs 2.76, P<0.01). In the adjusted regression, having no pension remained to be a significant determinant for both overall population (P = 0.01) and men (P<0.01) but not for women (P = 0.29), and loss of household headship was only significant for men (P = 0.05) but not for either overall population (P = 0.22) or women (P = 0.55), whereas the elderly living with their descendants was no longer significant for either overall population (P = 0.60) or both genders (men: P = 0.72; women P = 0.11). Limitations: The cross-sectional data do not allow to explore causal effect analyses. Conclusions: This is the first global study to reveal associations between lower socioeconomic status within families and higher rates of suicide among older adults aged 60 years and above compared with the younger population. Thus, the present ecological findings suggest that strategies to enhance the socioeconomic status of older adults may be important to prevent suicides in later life both within and across countries.