Gender and Age Differences in Sleep Quality and Suicidal Ideation among Chinese Older Adults

Overview: Based on a representative sample including 3,081 community-dwelling older adults from a cross-sectional study in an eastern province of China, poor sleep quality was identified to be associated with suicidal ideation, and the association tends to differ depending on participants’ gender and age.Proposal text: Background/Rationale
Prior research has found that experiencing sleep problems is associated with suicidal ideation (Harris et al., 2020). However, little research has examined age and gender differences in that association, especially among older adults. To address this knowledge gap, this study aims to examine the association between sleep quality and suicidal ideation by gender and age.

Method
A cross-sectional study was conducted with 3,081 participants aged 60 years and above in an eastern province of China in 2014. Age was classified into young-old (60-74 years) and old-old (≥75years) groups. Sleep quality was assessed using the Chinese version of Athens Insomnia Scale (AIS) (Chen et al., 2015). This scale includes 8 items: difficulty with sleep induction, awakening during the night, early morning awakening, insufficient total sleep time, insufficient overall quality of sleep, decreased well-being during the day, decreased functioning during the day, and sleepiness during the day. The total score of AIS was classified into three sub-groups: no insomnia (0–3), suspected insomnia (4–6), and insomnia (>6). Suicidal ideation was measured with the question, “Have you ever seriously considered suicide in the last 12 months? (Yes/No)”. Guided by the Biopsychosocial model, the biological (e.g., chronic disease), psychological (e.g., self-rated life satisfaction), and social (e.g., social support) factors were also included (Engel, 1977). Multiple logistic regression was used to analyze the relationships between sleep quality and suicidal ideation.

Results
Of the participants, the average age was 69.5 years (SD=7.4) and over half were female (54.9%). Prevalence of suicidal ideation was 5.5% in young-old group and 4.7% in old-old group; 4.6% in males and 5.8% in females. Prevalence of suspected insomnia was 7.8% in males and 9.4% in females; 8.9% in young-old group and 7.9% in old-old group. Prevalence of insomnia was 18.7% in males and 28.1% in females; 23.6% in young-old group and 24.6% in old-old group. Females reported poorer sleep quality compared to males (p < .001). Multiple logistic regression showed that insomnia was significantly predictive of suicidal ideation (OR=1.75, 95%CI: 1.15-2.67) for the total sample. A significant association between sleep quality and suicidal ideation was not identified in males and old-old participants. In females, suspected insomnia (OR=2.10, 95% CI: 1.02-4.31) and insomnia (OR=1.96, 95%CI:1.14-3.34) were associated with suicidal ideation. In young-old participants, insomnia was associated with suicidal ideation (OR=1.89, 95%CI: 1.16-3.06). Of the eight items of AIS, awakening during the night and sleepiness during the day were common risk factors of suicidal ideation for males and females. Sleepiness during the day was a common risk factor of having suicidal ideation for young-old and old-old participants.

Implications
Poor sleep quality is an amendable risk factor for suicide. Social workers can consider the role of improving sleep quality when developing suicide intervention programs for older adults, especially for females and young-old adults. Advancing research in sleep and older women’s health is recommend to promote gender equity in health.

Conclusion
Our results suggest that poor sleep quality is associated with suicidal ideation; however, the association seems to differ depending on participants’ gender and age.