Health-risk behaviors and suicidal behavior in older adults: Structural equation modeling using a decade of Korean...

Suicide among older adults is a critical public health concern. The current study investigated the structural pathways linking health-risk behaviors to suicidal behaviors in older adults, with particular attention to the mediating roles of sleep, smoking, depression, and anxiety.

Data from 5671 adults aged 65 years and older who participated in the Korea National Health and Nutrition Examination Survey (2013-2023) were analyzed. Structural equation modeling (SEM) was employed to evaluate the direct and indirect relationships among sociodemographic factors, health-risk behaviors, mental health, and suicidal ideation. In addition, gender-stratified analyses were conducted to explore differences in pathways between men and women.

Inadequate sleep, current smoking, and physical inactivity were identified as key health-risk behaviors associated with suicidal ideation. Inadequate sleep showed a significant indirect association structure on suicidal ideation through depression and anxiety, indicating a complete mediation pathway. Gender-specific differences were also evident, with depression serving as the primary mediator leading to suicidal behaviors among older women, whereas anxiety played a greater mediating role in suicidal behaviors among older men.

Depression, anxiety, and health-risk behaviors are major modifiable factors associated with suicidal ideation. These findings underscore the need for integrated suicide prevention strategies for older adults that address both health behaviors-including sleep disturbances and smoking-and mental health support. Furthermore, gender-specific approaches are warranted, with prioritization of depression management for older women and anxiety intervention for older men in tailored prevention strategies.