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

PURPOSE: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.