Hospitalization, outpatient service use, and perceived healthcare need as mediators of climate change anxiety and suicide ideation among middle-aged and older adults: a population-based path analysis

Background – Suicide theories imply that climate anxiety is indirectly associated with lower suicidal ideation through three mediators: perceived healthcare need, outpatient service use, and hospitalization. However, no study has assessed this relationship. An evaluation of this association in middle-aged and older adults may provide implications for climate change adaptation. Aim – To ascertain whether the relationship between climate anxiety and suicidal ideation is mediated by perceived healthcare need, outpatient service use, and hospitalization. Methods – A cross-sectional design was adopted, and the participants were noninstitutionalized middle-aged and older Ghanaians aged 50 years or above. Multistage sampling was used to select a nationally representative sample (N = 4,147). A serial path model (via structural equation modelling) was tested to assess the relationship, and the effect sizes were stratified by age and chronic disease status to maximize robustness. Results – Climate anxiety was positively associated with perceived healthcare need (β =0.18; t = 11.591; p<0.001), hospitalization (β = 0.12; t = 9.906; p<0.001), and suicidal ideation (β = 0.18; t = 12.074; p<0.001). There was a net negative association between climate anxiety and suicidal ideation through the three mediators. Climate anxiety is more negatively associated with suicidal ideation through the three mediators in the younger age group and among those with at least one chronic disease. Climate Change Anxiety, Healthcare Utilization, and Suicidal Ideation 3 Anxiety – Climate anxiety is negatively associated with suicidal ideation through hospitalization, especially in the younger age group and those with chronic diseases. Enhancing access to inpatient care may protect against suicidality and could be an imperative for climate change adaptation.