Changes in depression and suicidal thoughts in bereaved older men: insights from a Korean study

The escalating elderly population has highlighted mental health concerns, especially the impacts post-bereavement. This study investigated depression trajectories post-bereavement and their relation to suicidal thoughts among elderly South Korean males, considering demographic variables. Using data from the 7th to 16th Korea Welfare Panel Study (2012–2021), depression was measured via the CES-D (Center for Epidemiological Studies-Depression) scale, and suicidal thoughts were annually identified. Results revealed two post-bereavement depression trajectories: a predominant “Maintenance Type” (79.4%), showing persistent depression, and a “Decreasing Type” (20.6%), where depression reduced over time. Individuals in the “Maintenance Type”, often living alone, exhibited a higher risk of suicidal ideation. These findings emphasize the need for tailored interventions addressing social isolation and enhanced community support for the elderly to improve mental well-being.

Bereavement; Depression; Older male adults; Suicidal thoughts

[1] World Health Organisation (WHO). Mental health and substance use: Suicide data. 2019. Available at https://www.who.int/teams/mental-health-and-substance-use/data-research/suicide-data (Accessed: 14 October 2023).

[2] Barak Y, Cheung G, Fortune S, Glue P. No country for older men: ageing male suicide in New Zealand. Australasian Psychiatry. 2020; 28: 383–385.

[3] Korea Institute for Health and Social Affairs. The living conditions and policy tasks of the elderly living alone. Health and Welfare Issue & Focus. 2011; 72: 1–8.

[4] Lee HK. A study on the relationship between grief level and suicidal ideation among the bereaved elderly who are living alone focusing on the mediating effects of depression. Mental Health and Social Work. 2016; 44: 24–47.

[5] Cattell H. Suicide in the elderly. Advances in Psychiatric Treatment. 2000; 6: 102–108.

[6] Shah A, De T. Suicide and the elderly. International Journal of Psychiatry in Clinical Practice. 1998; 2: 3–17.

[7] De Leo D, Ormskerk SC. Suicide in the elderly: general characteristics. Crisis. 1991; 12: 3–17.

[8] McIntosh JL. Suicide prevention in the elderly (age 65–99). Suicide and Life‐Threatening Behavior. 1995; 25: 180–192.

[9] Blazer·Koening DG, Koening HG. Suicide. In: Birren JE. et al. (eds). Encyclopedia of Gerontology (pp. 529–538). Academic Press: New York. 1996.

[10] Lee GR, DeMaris A, Bavin S, Sullivan R. Gender differences in the depressive effect of widowhood in later life. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2001; 56: S56–S61.

[11] Moyers W. Healing and the mind. 1st edn. Bantam: New York. 1993.

[12] Umberson D, Wortman CB, Kessler RC. Widowhood and depression: explaining long-term gender differences in vulnerability. Journal of Health and Social Behavior. 1992; 33: 10–24.

[13] Williams K. The transition to widowhood and the social regulation of health: consequences for health and health risk behavior. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2004; 59: S343–S349.

[14] Park BG, Chun SK. Effects of mid-life crisis on suicidal ideation: moderating effects of social support and spiritual support. Korean Journal of Social Welfare Research. 2013; 38: 149–179.

[15] Lund DA, Caserta MS, Dimond MF. Gender differences through two years of bereavement among the elderly. The Gerontologist. 1986; 26: 314–320.

[16] Lee M. A longitudinal data analysis on depressive symptoms of Korean older adults: examining the differential effects of spousal loss and marital satisfaction across men and women. Journal of the Korea gerontology Society. 2014; 37: 109–130.

[17] Jadhav A, Weir D. Widowhood and depression in a cross-national perspective: evidence from the United States, Europe, Korea, and China. The Journals of Gerontology: Series B. 2018; 73: e143–e153.

[18] Mann JJ, Bortinger J, Oquendo MA, Currier D, Li S, Brent DA. Family history of suicidal behavior and mood disorders in probands with mood disorders. American Journal of Psychiatry. 2005; 162: 1672–1679.

[19] Hunt IM, Kapur N, Robinson J, Shaw J, Flynn S, Bailey H, et al. Suicide within 12 months of mental health service contact in different age and diagnostic groups: national clinical survey. The British Journal of Psychiatry. 2006; 188: 135–142.

[20] Rihmer Z. Suicide risk in mood disorders. Current Opinion in Psychiatry. 2007; 20: 17–22.

[21] Oh YJ, Kim HD. A study on predictive factors of elderly suicidal ideation. Journal of Convergence for Information Technology. 2018; 8: 1–9.

[22] Han S, Kang S, Yoo W, Phee YG. A study of the determinants of suicidal ideation among the elderly in Korea. Health and Social Welfare Review. 2009; 29: 192–212.

[23] Bruce ML, Kim K, Leaf PJ, Jacobs S. Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample. The American Journal of Psychiatry. 1990; 147: 608–611.

[24] Keyes KM, Pratt C, Galea S, McLaughlin KA, Koenen KC, Shear MK. The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry. 2014; 171: 864–871.

[25] Korea Ministry of Health and Welfare & Korea Foundation for Suicide Prevention. White paper on suicide prevention. Korea Foundation for Suicide Prevention: Seoul. 2020.

[26] OECD. Suicide rates (indicator). 2023. Available at: https://doi.org/10.1787/a82f3459-en (Accessed: 28 August 2023).

[27] WHO. WHO Mortality Database. 2021. Available at: https://www.who.int/data/data-collection-tools/who-mortality-database (Accessed: 27 August 2023).

[28] Korea Ministry of Health and Welfare & Korea Foundation for Suicide Prevention. White paper on suicide prevention. Korea Foundation for Suicide Prevention: Seoul. 2022.

[29] Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J. Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health. 1993; 5: 179–193.

[30] Radloff LS. The CES-D scale. Applied Psychological Measurement. 1977; 1: 385–401.

[31] Jahn DR, Cukrowicz KC, Linton K, Prabhu F. The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults. Aging & Mental Health. 2011; 15: 214–220.

[32] Kim BJ, Kihl T. Suicidal ideation associated with depression and social support: a survey-based analysis of older adults in South Korea. BMC Psychiatry. 2021; 21: 409.

[33] Choi JW, Kim TH, Shin J, Han E. Poverty and suicide risk in older adults: a retrospective longitudinal cohort study. International Journal of Geriatric Psychiatry. 2019; 34: 1565–1571.

[34] Li M, Katikireddi SV. Urban-rural inequalities in suicide among elderly people in China: a systematic review and meta-analysis. International Journal for Equity in Health. 2019; 18: 2.

[35] Park S. Health status and suicidal ideation in Korean elderly: the role of living arrangement. Journal of Mental Health. 2014; 23: 94–98.

[36] Fässberg MM, Cheung G, Canetto SS, Erlangsen A, Lapierre S, Lindner R, et al. A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging & Mental Health. 2016; 20: 166–194.

[37] Muthén B. Latent variable analysis. In D, Kaplan (ed.). The sage handbook of quantitative methodology for the social sciences (pp. 345–368). Sage Publications: Thousand Oaks, CA. 2004.

[38] Duncan TE, Duncan SC, Strycker LA. An introduction to latent variable growth curve modeling: concepts, issues, and application. 2nd edn. Routledge: Abingdon. 2006.

[39] Crestani C, Masotti V, Corradi N, Schirripa ML, Cecchi R. Suicide in the elderly: a 37-years retrospective study. Acta Bio Medica: Atenei Parmensis. 2019; 90: 68–76.

[40] Obuobi-Donkor G, Nkire N, Agyapong VIO. Prevalence of major depressive disorder and correlates of thoughts of death, suicidal behaviour, and death by suicide in the geriatric population—a general review of literature. Behavioral Sciences. 2021; 11: 142.

[41] Eisma MC, Rosner R, Comtesse H. ICD-11 prolonged grief disorder criteria: turning challenges into opportunities with multiverse analyses. Frontiers in Psychiatry. 2020; 11: 752.

[42] Won, Hyejin, Song, Shinae. Effect of spousal bereavement on depression of the elderly: analysis of the impact of traditional gender norms through gender comparison. Health and Social Welfare Review. 2019; 39: 145–172.

[43] Shin J. The effects of associational solidarity and functional solidarity of adult children on depression of Korean older people. Korean Journal of Gerontological Social Welfare. 2022; 77: 157–182.

[44] Nakagomi A, Shiba K, Kondo K, Kawachi I. Can social capital moderate the impact of widowhood on depressive symptoms? A fixed-effects longitudinal analysis. Aging & Mental Health. 2021; 25: 1811–1820.