Supplementary file 1_The association between experiential avoidance, depressive symptoms, and suicidal ideation in hospitalized older adults with functional impairments: the moderating role of resilience.docx

BackgroundExperiential avoidance (EA) has been linked to intensified negative emotions among hospitalized older adults experiencing functional impairment due to physical limitations and the loss of autonomy, and this is linked to elevated suicidal ideation (SI) risk. This study examined the association between EA and SI, proposing depressive symptoms as a mediator and resilience as a moderator.
Methods717 hospitalized older adults with functional impairments were recruited from four hospitals. Participants completed validated questionnaires assessing EA, SI, depressive symptoms, and resilience. Mediation and moderation analyses were conducted using Hayes’ PROCESS macro (Model 4, 7 and 14) in SPSS.
ResultsThe study revealed a significant positive association between EA and SI among hospitalized older adults with functional impairments (β=0.164, P<0.01), with depressive symptoms demonstrating a partial mediating effect in this association (β=0.356, P<0.01). Resilience played a dual moderating role in the associations: the strength of the association between EA and SI is weaker with higher resilience (β=-0.003, P<0.05) and concurrently mitigated the association between depressive symptoms and SI (β=-0.012, P<0.05).
ConclusionEA is associated with SI in hospitalized older adults with functional impairments, with depressive symptoms exerting a partial mediating role in this association. Resilience moderated the associations such that it weakened both the direct link between EA and SI, as well as the link between depressive symptoms and SI. Healthcare professionals should implement targeted suicide prevention strategies, including interventions to reduce EA, depressive symptoms, and enhance resilience, thereby mitigating SI in older adults.