Dear Editor,

The paper titled “A systematic review of psychosocial protective factors against suicide and suicidality among older adults” by Ki and colleagues (Ki et al., Reference Ki, Lapierre, Gim, Hwang, Kang, Dargis, Jung, Koh and Mishara2024) is a thought-provoking review that emphasizes the importance of improving protective factors for the development of suicide prevention and intervention in older adults. Strikingly, the authors pointed out that most studies have focused on receiving support among the interpersonal protective factors, while ignoring the more beneficial role of giving support to others. The thought that ensues is what role will social support reciprocity play in specific risk factors and suicidal behavior?

Since the coronavirus disease 2019 pandemic, media coverage of mental health and suicide has gained widespread attention (Hawton et al., Reference Hawton, Marzano, Fraser, Hawley, Harris-Skillman and Lainez2021). Strikingly, the suicide rate among the Chinese rural older population was reportedly much higher than urban older adults (Phillips et al., Reference Phillips, Li and Zhang2002). Preventing suicidal ideation among older adults in rural China is not just a local issue but a reflection of broader global challenges associated with aging, mental health, and socioeconomic development. Intimate partner violence (IPV) has received attention as a recognized individual-level risk factor for suicidal behaviors in low- and middle-income countries (Keynejad et al., Reference Keynejad, Hanlon and Howard2020). However, due to the complex interplay of cultural norms, stigma and insufficient access to services, IPV among older adults in rural China is often underreported and neglected. Focusing on IPV for Chinese rural older adults contributes to the goal that all people, regardless of age or geographic location, have the right to live free from violence and abuse. Addressing the relationship between IPV and suicidal ideation in this group is crucial for public health and social justice.

Compared to one-way forms of social support, social support reciprocity focuses on fairness and active participation between individuals, developing healthier and more balanced relationships. Mizuno et al., showed that reciprocity of social support was associated with a reduced risk of psychological distress and suicidal ideation among Japanese older adults (Mizuno et al., Reference Mizuno, Hikichi, Noguchi, Kawachi and Takao2019). Furthermore, social support reciprocity helps to counteract the effects of stressors and adversity, including traumatic events such as IPV. Thus, social support reciprocity may be a novel perspective to mitigate the possibility of suicidal ideation among older adults experiencing IPV. To further explore these relationships, this study aimed to explore the role that social support reciprocity plays in the relationship between IPV and suicidal ideation among Chinese rural older males and females.

Data were obtained from the latest round of the Shandong Rural Elderly Health Cohort (SREHC) (Wang et al., Reference Wang, Fu, Li, Jing, Wang, Zhao and Zhou2021). Study design, variables and statistical analyses are provided in detail in the supplement. Of all participants (n = 2,204), 14.2% had physical IPV and 20.6% had emotional IPV among Chinese rural older adults. We performed a gender-stratified analysis given the gender-based heterogeneity in IPV and suicidal ideation (Table 1). Among female older adults with physical IPV, the highest risk was still observed for low receipt/low provision (Odds Ratio [OR] = 9.42, p = 0.038), followed by high receipt/low provision (OR = 6.28, p = 0.038). While among male older adults with physical IPV or emotional IPV, suicidal ideation was not associated with any social support reciprocity types (all p > 0.05). The adjusted model showed significant associations between low receipt/low provision and suicidal ideation among female older adults with emotional IPV (OR = 4.31, p = 0.047).

Table 1. Association between intimate partner violence and reciprocity of social support on suicidal ideation among Chinese rural older adults, 2022

IPV = intimate partner violence.

All model controlled for age, education, marital status, living arrangement, economic condition, smoking status, alcohol consumption, activity engagement, chronic disease, physical disability, psychological distress. Bold type denotes statistical significance (p-value < 0.05).

Our study found that social support reciprocity mitigates the effects of physical, but not emotional, IPV on suicidal ideation among rural Chinese female older adults. In rural China, traditional gender roles often place females in a subordinate position and males in a position of authority. In addition, females and males have different types of social networks and ways of seeking and providing support. Females are generally more likely to engage in reciprocal social support networks that provide emotional support and practical help when needed.

Taken together, exploring the impact of mitigating IPV on suicidal ideation among rural Chinese older adults from the perspective of social support reciprocity can help develop more inclusive and effective solutions. Reciprocity in social support creates an environment of mutual empowerment among IPV survivors. While receiving support is crucial for immediate safety and emotional healing, the act of giving support can reinforce survivors’ sense of self-worth and agency. This balanced exchange helps to mitigate the potential for suicidal ideation in rural older adults who have experienced physical IPV. Local governments should promote low-cost social engagement programs to enhance social interaction and ultimately prevent suicidal ideation among rural older adults with IPV. Such strategies may be particularly beneficial in resource-poor settings for suicide prevention.