Ghose Bishwajit, Wang Ruoxi, Tang Shangfeng, Yaya Sanni
School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.
School of Medicine and Health Management, Tongji Medical College, Wuhan, Hubei, China.
PeerJ. 2019 Jun 12;7:e7108. doi: 10.7717/peerj.7108. eCollection 2019.
Suicide causes rising economic costs and public health risks for communities in the worldwide. Physical activity (PA) is considered a potentially feasible approach to reduce risk of suicide with low cost and high accessibility, and therefore attracting increasing attention. However, current literature on the association between PA and suicidal behavior amongst elderly people in low- and middle-income countries (LMICs) are scarce. Therefore, in this study we aimed to examine the relationship between suicidal thoughts (ST) and suicidal attempts (SA) with PA among elderly people in five LMICs.
Cross-sectional data were collected from WHO's Study of Global Ageing and Adult Health (SAGE) with 2,861 participants aged 50 years or above. Variables included: self-reported occurrence of ST and SA during past 12 months and four types of PA (vigorous physical activity (VPA), moderate physical activity (MPA), walking/bike riding, moderate leisure time physical activity (MLPA)).
The overall prevalence of taking >75 min of VPA/week, >150 min/week, MLPA and walking/bike riding were, respectively, 85.4% (95% CI [81.3-88.7]), 61.6% (95% CI [52.9-69.6]), 9.6% (95% CI [7.2-12.6]) and 75.1% (95% CI [68.7-80.6]). Respectively, 31.0% (95% CI [24.3-38.7]) and 5.5% (95% CI [3.9-7.5]) of the respondents reported having morbid thoughts and SA during last 12 months. In adjusted multivariable regression analysis, not engaging in PA revealed positive association with higher odds of having morbid thoughts and SA, however, with varying degrees for different types of PA among men and women and across countries. The adjusted odds ratio among elderly who encountered ST increased significantly with PA levels (1.265 in male and 1.509 in female with VPA, 1.292 in male and 1.449 in female with MPA, 1.669 in female with LMPA and 3.039 in women with walk/bike); similarly, with SA (1.526, 1.532, 1.474 and 1.392 in women with VPA, MPA, LMPA and Walk/bike, respectively). The degree of adjusted odds ratio varied between genders and among countries.
Although the data were cross-sectional, and no linear dose-response relationship was observed between PA and morbid thought and suicide ideation, the findings provide important indications of potential harmful effects of no/inadequate PA on psychological morbidities among older individuals. Promoting adequate PA among older individuals through community-based suicide prevention programs can potentially contribute to reduction in the burden of PA in LMICs.
自杀给全球各地社区带来不断上升的经济成本和公共卫生风险。身体活动被认为是一种潜在可行的方法，能够以低成本和高可及性降低自杀风险，因此受到越来越多的关注。然而，目前关于低收入和中等收入国家（LMICs）老年人身体活动与自杀行为之间关联的文献稀缺。因此，在本研究中，我们旨在探讨五个低收入和中等收入国家老年人自杀念头（ST）和自杀未遂（SA）与身体活动之间的关系。
从世界卫生组织的全球老龄化与成人健康研究（SAGE）收集横断面数据，共有2861名年龄在50岁及以上的参与者。变量包括：过去12个月内自我报告的自杀念头和自杀未遂情况，以及四种身体活动类型（剧烈身体活动（VPA）、中等强度身体活动（MPA）、步行/骑自行车、中等强度休闲时间身体活动（MLPA））。
每周进行超过75分钟的剧烈身体活动、超过150分钟的中等强度休闲时间身体活动、步行/骑自行车的总体患病率分别为85.4%（95%置信区间[81.3 - 88.7]）、61.6%（95%置信区间[52.9 - 69.6]）、9.6%（95%置信区间[7.2 - 12.6]）和75.1%（95%置信区间[68.7 - 80.6]）。分别有31.0%（95%置信区间[24.3 - 38.7]）和5.5%（95%置信区间[3.9 - 7.5]）的受访者报告在过去12个月内有自杀念头和自杀未遂情况。在调整后的多变量回归分析中，不进行身体活动与出现自杀念头和自杀未遂的较高几率呈正相关，不过，在不同国家的男性和女性中，不同类型身体活动的相关程度有所不同。遇到自杀念头的老年人中，调整后的优势比随身体活动水平显著增加（男性进行剧烈身体活动时为1.265，女性为1.509；男性进行中等强度身体活动时为1.292，女性为1.449；女性进行中等强度休闲时间身体活动时为1.669，女性步行/骑自行车时为3.039）；类似地，与自杀未遂情况相关（女性进行剧烈身体活动、中等强度身体活动、中等强度休闲时间身体活动和步行/骑自行车时分别为1.526、1.532、1.474和1.392）。调整后的优势比程度在性别和国家之间有所不同。
尽管数据是横断面的，且未观察到身体活动与自杀念头和自杀观念之间存在线性剂量反应关系，但研究结果为不进行/身体活动不足对老年人心理疾病的潜在有害影响提供了重要指示。通过基于社区的自杀预防计划促进老年人进行适当的身体活动，可能有助于减轻低收入和中等收入国家的自杀负担。
