Abstract
ObjectivesThe objective of this study was to examine, first, the relationship of having a rural vs. urban background with suicidal ideation in Chinese college students, and second, whether a potential relationship was mediated by depression.MethodsA survey was conducted among 1,145 undergraduate students at a university in China. Suicidal ideation and depressive symptoms were measured by the revised Hopkins’ Symptom checklist (SCL-90-R). Associations between rural vs. urban background, depression and suicidal ideation were estimated by multivariable linear regression-based β coefficients, logistic regression-based odds ratios (ORs), and corresponding 95% confidence intervals (CIs). The magnitude of indirect effect and bias-corrected 95% CIs were obtained through bootstrap techniques.ResultsRural background was positively associated with depression, which was in turn associated with suicidal ideation. The OR for rural status and suicidal ideation equaled 2.15 (95% CI = 1.36–3.41). This OR was slightly, though significantly (p<0.05) attenuated by additional adjustment for depressive symptoms (OR = 1.99, 95% CI = 1.15–3.44).ConclusionHaving a rural background is a determinant of suicidal ideation in Chinese college students. Depression may only marginally mediate this association.
Highlights
Suicide is one of the three leading causes of death among adolescents around the world [1,2,3]
We obtained written informed consent from students aged over 18 years, and from the guardians on the behalf of the participants aged less than 18 years. 1170 of the 1300 students participating in the course returned the questionnaire voluntarily, which equals a response rate of 90.0%
We ran the following statistical regression models to explore the hypothesized associations depicted in Figure 1: first, we examined the potential association of rural-urban status with depression using linear regression; second, we assessed whether depression was positively linked to suicidal ideation using logistic regression; third, we investigated whether rural-urban status is related to suicidal ideation using logistic regression; and, fourth, whether this association is attenuated towards the null value of 1.0 after adjustment for depression using logistic regression. b coefficient and odd ratios (ORs) with 95% confidence intervals (CIs) served as the measures of association, adjusted for the potentially confounding effects of age, gender, grade, cigarette smoking, alcohol drinking, and four negative life events
Summary
Suicide is one of the three leading causes of death among adolescents around the world [1,2,3]. Suicidal ideation is an important predictor of suicide attempts and completed suicide and represents a significant marker for other mental health problems among youth. For these reasons, an understanding of its risk factors and protective factors is essential to inform strategies aiming at suicide prevention [4]. For young adults attending college, the risk of suicidal ideation is greater than for the same-age counterparts not attending college [8,9]. The prevalence of suicidal ideation in the past year among college samples in China varied from 13.8% to 20.3% [10,11,12,13,14]
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