A meta-analytic review on social relationships and suicidal ideation among older adults.

Social relationships play an important role in mental health as well as suicidal ideation in later life. In contrast with the other well-established risk factors, despite an increasing number of related studies, no meta-analyses focusing on social relationships and late-life suicidal ideation have been published. Synthesis of data across the studies using different measurements of social relationships would allow for comparison of the effects on late-life suicidal ideation that have not been studied before. Therefore, we conducted a meta-analysis on the studies published between January 1, 2000 and November 31, 2016 extracted from 7 medical and social science databases. 31 studies with 83 estimates of Odds Ratios ("ORs") on the associations between social relationships and late-life suicidal ideation were identified to compute effect sizes using a random-effect model. Sensitivity analyses were also performed to evaluate their heterogeneity and bias. Moderator analyses were further conducted to determine moderating factors of the associations. Eventually, across the 31 studies (203,152 participants), the overall random effect size was OR = 1.57(95% CI [1.40, 1.76]), indicating a 57% likelihood increase of suicidal ideation for elderly participants with discordant social relationships. The functional measures (OR = 1.77; 95%CI [1.48, 2.10]) of social relationships, however, were more predictive than structural measures (OR = 1.37; 95%CI [1.25, 1.51]). Among all the measures of social relationships, elderly mistreatment (OR = 2.31; 95%CI [1.81, 2.94]) had the strongest effect size, followed by perceived loneliness (OR = 2.24; 95%CI [1.73, 2.90]) and poorly perceived social support (OR = 1.59; 95% CI [1.37, 1.83]). The associations between social relationships and late-life suicidal ideation were moderated by country income levels, social-cultural context, study types, and various measurements of social relationships. More importantly, our study is the first meta-analysis to provide significant evidence for improving social relationships, especially in perceived bonds, is a promising strategy in reducing late-life suicide risks.