Journal of Qualitative Research in Health Sciences

Document Type : Original Article

Authors

1 1. Assistant Professor, Department of Counseling, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran

2 Associate Professor, Department of Counseling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

3 Professor, Iranian Research Center on Aging, Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

4 Professor, Iranian Research Center on Aging, School of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

5 Professor, Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: The high rate of complete suicide in older adults on the one hand and the low report of suicidal thoughts by them compared to other groups on the other hand, indicate the importance of suicide in this group. The objective of this study was to explore the structural factors contributing to suicidal ideation in Iranian older adults.
Methods: This was a qualitative study using grounded theory approach. The sample included a total of 13 community-dwelling (visiting day-care centers and psychiatric clinics) and institutionalized older adults aged 60 years or above selected using purposive and theoretical sampling methods. The data were collected using in-depth  semi-structured interviews. The data were analyzed using constant comparative method, constant review of the written text of the interviews, field notes, and memo writing via Strauss and Corbin’s method.
Results: The results indicated 2 main categories including perceived adversities and negative self-concept that were represented in the form of 10 subcategories including having a difficult life, financial strain, retirement, disempowerment, disrupted family, being lonely, being a trouble to others, self-perceived uselessness, lack of control over life, and losing reputation.
Conclusion: Suicidal ideation among Iranian older adults occurs in the context of negative life events that can cause significant pain and suffering. The concepts related to family, health, and performance of older adults are especially important in the development of suicidal thoughts due to their cultural significance. Therefore, professionals and policymakers can reduce suicidal ideation in older adults by enriching social interactions, increasing welfare activities, paying more attention to spiritual capacities, and generally reducing the structural challenges in day-care centers and nursing homes.

Keywords

  1.  

    1. World Health Organization. Preventing suicide: A global imperative [Internet]. Geneva: World Health Organization; 2014 [cited 2016 Jul 15]. p. 92. https://www.who.int/ageing/events/world-report-2015-launch/en/.
    2. Soleimanvandi Azar N, Mohaqeqi Kamal S H, Sajadi H, Ghaedamini Harouni G R, Karimi S, Foroozan A S. Barriers and Facilitators of the Outpatient Health Service Use by the Elderly. Salmand: Iranian Journal of Ageing. 2020; 15(3):258-77. doi: 10.32598/sija.15.3.551.3.
    3. Sarlak N, Mousavi ST, Raji P. Understanding the elderly’s view of central human functional capabilities. J Qual Res Health Sci. 2020; 9(2):111-22. doi: 10.22062/jqr.2020.91457.
    4. Azkhosh M, Sahaf R, Rostami M, Ahmadi A. Reliability and validity of the 10-item personality inventory among older Iranians. Psychology in Russia: State of the Art. 2019; 12(3):28. doi: 10.11621/pir.2019.0303.
    5. Mohamadi E, Allahyari T, Darveshpoor Kakkei A, Akabakshyi H, Saraei H. Context and causal conditions in active aging phenomenon: A qualitative study. J Qual Res Health Sci. 2016; 5(2):158-74.
    6. Satorres E, Ros L, Meléndez JC, Serrano JP, Latorre JM, Sales A. Measuring elderly people's quality of life through the Beck Hopelessness scale: A study with a Spanish sample. Aging Ment Health. 2018; 22(2):239-44. doi: 10.1080/13607863.2016.1247427.
    7. Van Orden KA, Conwell Y. Issues in research on aging and suicide. Aging Ment Health. 2016; 20(2):240-51. doi: 10.1080/13607863.2015.1065791.
    8. Heisel MJ, Neufeld E, Flett GL. 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 Ment Health. 2016; 20(2):195-207. doi: 10.1080/13607863.2015.1078279.
    9. Rurup ML, Pasman HR, Goedhart J, Deeg DJ, Kerkhof AJ, Onwuteaka-Philipsen BD. Understanding why older people develop a wish to die. A qualitative interview study. Crisis. 2011; 32(4):204-16. doi: 10.1027/0227-5910/a000078.
    10. Ekramzadeh S, Javadpour A, Draper B, Mani A, Withall A, Sahraian A. Prevalence and correlates of suicidal thought and self-destructive behavior among an elderly hospital population in Iran. Int Psychogeriatr. 2012; 24(9):1402-8. doi: 10.1017/S1041610212000245.
    11. Khodabandeh F, Noorbala A, Kahani S, Bagheri A. A study on the factors that associated with attempting suicide in middle and old age. Health Psychology. 2012; 1(1):81-92. [In Persian]
    12. Mokhtari AM, Sahraian S, Hassanipour S, Baseri A, Mirahmadizadeh A. The epidemiology of suicide in the elderly population in Southern Iran, 2011–2016. Asian J Psychiatr. 2019; 44:90-4. doi: 10.1016/j.ajp.2019.07.027.
    13. Yarian S, Ameri NF. The prediction of suicidal ideation based on coping strategies and meaning in life in the elderly. Joge. 2020; 5(1):1-10. [In Persian]
    14. Sarokhani D, Parvareh M, Hasanpour Dehkordi A, Sayehmiri K, Moghimbeigi A. Prevalence of depression among Iranian elderly: Systematic review and meta-analysis. Iran J Psychiatry. 2018; 13(1):55-64. PMID: 29892318.
    15. Conwell Y. Suicide later in life: Challenges and priorities for prevention. Am J Prev Med. 2014; 47(3 Suppl 2):244-50. doi: 10.1016/j.amepre.2014.05.040.
    16. Wiktorsson S, Runeson B, Skoog I, Ostling S, Waern M. Attempted suicide in the elderly: Characteristics of suicide attempters 70 years and older and a general population comparison group. Am J Geriatr Psychiatry. 2010; 18(1):57-67. doi: 10.1097/JGP.0b013e3181bd1c13.
    17. Zhang W, Ding H, Su P, Duan G, Chen R, Long J, et al. Does disability predict attempted suicide inthe elderly? A community-based study of elderly residents in Shanghai, China. Aging Ment Health. 2016; 20(1):81-7. doi: 10.1080/13607863.2015.1031641.
    18. Da Silva RM, Mangas RM, Figueiredo AE, Vieira LJ, de Sousa GS, Cavalcanti AM, et al. The influence of family problems and conflicts on suicidal ideation and suicide attempts in elderly people. Cien Saude Colet. 2015; 20(6):1703-10. doi: 10.1590/1413-81232015206.01952015.
    19. Wiktorsson S, Berg AI, Billstedt E, Duberstein PR, Marlow T, Skoog I, et al. Neuroticism and extroversion in suicide attempters aged 75 and above and a general population comparison group. Aging Ment Health. 2013; 17(4):479-88. doi: 10.1080/13607863.2012.749835.
    20. Bonnewyn A, Shah A, Bruffaerts R, Schoevaerts K, Rober P, Van Parys H, et al. Reflections of older adults on the process preceding their suicide attempt: A qualitative approach. Death Stud. 2014; 38(6-10):612-8. doi: 10.1080/07481187.2013.835753.
    21. Van Orden KA, Wiktorsson S, Duberstein P, Berg AI, Fässberg MM, Waern M. Reasons for attempted suicide in later life. Am J Geriatr Psychiatry. 2015; 23(5):536-44. doi: 10.1016/j.jagp.2014.07.003.
    22. Lakeman R, FitzGerald M. How people live with or get over being suicidal: A review of qualitative studies. J Adv Nurs. 2008; 64(2):114-26. doi: 10.1111/j.1365-2648.2008.04773.x.
    23. O’Dwyer S, De Leo D. Older adults and suicide. In Wasserman D, (editor). Suicide: An unnecessary death. New York: Oxford University Press. 2016: PP. 215-31.
    24. Luo Y, Waite LJ. Loneliness and mortality among older adults in China. J Gerontol B Psychol Sci Soc Sci. 2014; 69(4):633-45. doi: 10.1093/geronb/gbu007.
    25. Purcell B, Heisel MJ, Speice J, Franus N, Conwell Y, Duberstein PR. Family connectedness moderates the association between living alone and suicide ideation in a clinical sample of adults 50 years and older. Am J Geriatr Psychiatry. 2012; 20(8):717-23. doi: 10.1097/JGP.0b013e31822ccd79.
    26. Rossom RC, Simon GE, Coleman KJ, Beck A, Oliver M, Stewart C, et al. Are wishes for death or suicidal ideation symptoms of depression in older adults? Aging Ment Health. 2019; 23(7):912-8. doi: 10.1080/13607863.2017.1423032.
    27. Juurlink DN, Herrmann N, Szalai JP, Kopp A, Redelmeier DA. Medical illness and the risk of suicide in the elderly. Arch Intern Med. 2004; 164(11):1179-84. doi: 10.1001/archinte.164.11.1179.
    28. Quan H, Arboleda Flórez J, Fick GH, Stuart HL, Love EJ. Association between physical illness and suicide among the elderly. Soc Psychiatry Psychiatr Epidemiol. 2002; 37(4):190-7. doi: 10.1007/s001270200014.
    29. Kjølseth I, Ekeberg O, Steihaug S. Why suicide? Elderly people who committed suicide and their experience of life in the period before their death. Int Psychogeriatr. 2010; 22(2):209-18. doi: 10.1017/S1041610209990949.
    30. Corbin J, Strauss A. Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, California: Sage publications; 2008. doi: 10.4135/9781452230153.
    31. Foroughan M, Wahlund LO, Jafari Z, Rahgozar M, Farahani IG, Rashedi V. Validity and reliability of Abbreviated Mental Test Score (AMTS) among older Iranian. Psychogeriatrics. 2017; 17(6):460-5. doi: 10.1111/psyg.12276.
    32. Corbin J, Strauss A. Grounded theory research: Procedures, canons, and evaluative criteria. Qual Sociol. 1990; 13, 3-21. doi: 10.1007/BF00988593
    33. Van Wijngaarden E, Leget C, Goossensen A. Ready to give up on life: The lived experience of elderly
      people who feel life is completed and no longer worth living. Soc Sci Med. 2015; 138:257-64. doi: 10.1016/j.socscimed.2015.05.015.
    34. Cavalcante FG, Minayo MC. Qualitative study on suicide attempts and ideations with 60 elderly in Brazil. Cien Saude Colet. 2015; 20(6):1655-66. doi: 10.1590/1413-81232015206.06462015.
    35. Im MY, Kim YJ. A phenomenological study of suicide attempts in elders. J Korean Acad Nurs. 2011; 41(1):61-71. Korean. doi: 10.4040/jkan.2011.41.1.61.
    36. Van Der Heide I, Van Rijn RM, Robroek SJ, Burdorf A, Proper KI. Is retirement good for your health? A systematic review of longitudinal studies. BMC Public Health. 2013; 13:1180. doi: 10.1186/1471-2458-13-1180.
    37. Kashanimovahhed B, Hosseinian Sarajehloo F, Bahrami A, Shokri Khoubestani M, Abdoljabari M. Spiritual health in the Iranian elderly: A systematic review. Journal of Pizhūhish dar dīn va salāmat. 2020; 6(2):129-47. doi: 10.32598/sija.13.10.380.
    38. Iman MT, Shirdel E. The experience of emotional well-being of the elderly people residing in nursing homes: A phenomenological study. J Qual Res Health Sci. 2017; 6(3):277-95.
    39. Foroughan M, Rostami M, Younesi SJ. Determinants of suicidal ideation among older adults: A cross-sectional survey in Iran. GeroPsych (Bern). 2021; 34(2):91-99. doi: 10.1024/1662-9647/a000250.
    40. Lee SH, Tsai YF, Chen CY, Huang LB. Triggers of suicide ideation and protective factors of actually executing suicide among first onset cases in older psychiatric outpatients: A qualitative study. BMC psychiatry. 2014; 14:269. doi: 10.1186/s12888-014-0269-9.
    41. Kim OS, Sok SR. Life experiences of elderly people with suicide ideation at the long‐term care hospitals in South Korea. Int J Nurs Pract. 2017; 23(6). doi: 10.1111/ijn.12597.
    42. Gutierrez DM, Sousa AB, Grubits S. Suicidal ideation and attempted suicide in elderly people–subjective experiences. Cien Saude Colet. 2015; 20(6):1731-40. doi: 10.1590/1413-81232015206.02242015.
    43. Fiske A, O'Riley AA. Toward an understanding
      of late life suicidal behavior: The role of lifespan developmental theory. Aging Ment Health. 2016; 20(2):123-30. doi: 10.1080/13607863.2015.1078282.