Suicide In China Research Articles

Interpersonal Relationship and Suicide Attempt: The Role of Family and Social Relationship.

This study investigates the role of family and social relationships in cases of attempted suicide in China. Studies, mostly analyzing data from developed countries, have indicated that interpersonal relationships are important predictors of suicidal behaviors. This study's data were derived from a case-control study in China. Family relationships included relationships with spouses, parents, and parents-in-law. Poor family and social relationships were significantly associated with increased risk of attempted suicide in women and men. Depression and social support significantly mediated the association between interpersonal relationship and attempted suicide. Poor relationship with spouse was significantly associated with an elevated risk of attempted suicide. Relationship with parents-in-law was also significantly associated with attempted suicide in women, whereas family relationships played a more important role than social relationships in suicidal behaviors, especially in men. The findings imply that suicide prevention in China could be conducted from the perspective of improving family relationships, especially husband/wife and parents/daughters-in-law relationships.

Exploring Speech Acts in Suicide Notes from the Forensic Linguistics Approach: A Comparative Study of Chinese and American Cases

Suicide notes are the information left by people who commit suicide. In these notes, people employ various speech strategies to express their emotion and will. The strategies and content in suicide note vary with culture. Using the Linguistic Inquiry and Word Count (LIWC) and Chinese LIWC (CLIWC) programs, this study looks at the speech actions in suicide notes as well as the linguistic and affective traits of suicide notes from Chinese and American individuals. The results show that while expressive acts and social words are more prevalent in American notes, suggesting stronger social connectivity, forceful acts predominate in all countries. Chinese suicide notes, on the other hand, show more directed actions and a greater frequency of both good and negative feelings in these actions. Despite the study’s limitations due to the small sample size, it provides valuable insights into the cultural differences in the language of suicide and suggests directions for future research, including larger-scale analyses and the development of AI-driven tools for suicide prevention.

Suicide in China: The Trends and Differentials From 2002 to 2021

ABSTRACTObjectiveThe objective of this study was to provide an updated analysis of suicide characteristics in China from 2002 to 2021, with the aim of informing the development of evidence‐based suicide prevention strategies.MethodsThe Ministry of Health‐Vital Registration System (MOH‐VR) provided the data on suicide mortality, which enabled us to examine the average annual percentage change (AAPC) in suicide rates using a Poisson regression model.ResultsNotably, there has been a significant decline in suicide rates observed in both urban and rural areas. In the early years of the study period, higher suicide rates were observed among females compared to males; however, a shift occurred after 2005, with male suicide rates surpassing those of females. Except for 2005, rural areas consistently exhibited higher suicide rates than urban areas. Furthermore, suicide rates exhibited an increasing trend with age, irrespective of gender or region.ConclusionThese findings highlight a decreasing trend in suicide rates in China over the past two decades, although gender and regional disparities persist. Going forward, sustained efforts in suicide prevention, with a specific focus on mental health, are warranted.

Epidemiological characteristics and behaviors of online broadcast suicidality in China: implications for targeted prevention strategies.

Suicide is a global health concern, exacerbated by stigma around mental illnesses. Online platforms like Twitter and Sina Weibo have seen a rise in "online broadcast suicide," where individuals share suicidal thoughts and actions. However, there is limited understanding of the epidemiological characteristics, particularly in China. This study aims to analyze the demographics and behaviors of individuals engaging in online broadcast suicide in China to inform targeted prevention strategies. A total of 525 incidents were identified through systematic retrieval of relevant news reports from online sources. Subsequently, a content analysis was performed on these reports to extract detailed information on the characteristics of each individual incident. Among the incidents analyzed, the male-to-female ratio was 1:1.6, with an average age of 23.1 ± 5.9 years. Approximately 71.9% took place in Southern China. Unemployment was reported in 15.0% of incidents. Relationship breakup (62.3%) was cited as the leading cause of suicide. Wrist cutting (58.2%) emerged as the predominant suicide method, and home (36.2%) was the most common location for these tragic events. Instant messaging apps were the primary platforms (54.7%) for conveying suicidal thoughts and actions. Additionally, among the 525 incidents examined, 12.0% disclosed having a mental disorder, and 7.6% had a history of prior suicide attempts. Significant variations were observed across age, gender, region, and occupation categories. This study emphasizes the importance of developing suicide prevention programs for internet users. Besides, interventions should be customized to meet the specific needs of various populations.

Restrictive fertility policy and elderly suicides: evidence from China

Abstract This paper presents an empirical investigation of the hypothesis that exposure to the restrictive fertility policies of the Chinese “Later, Longer, Fewer” campaign in the 1970s contributes to the dynamics and patterns of elderly suicides in China in the period 2004–2017. We apply an identification strategy that exploits variation in exposure to this policy across birth cohorts that is based on the different timing of the implementation of the fertility policies across Chinese provinces. The results show that cohorts with a greater exposure to the restrictive fertility policy in the 1970s exhibit higher suicide rates during old ages.

A Comparative Analysis of Mechanisms for Preventing Adolescent Suicide in China and Japan

China and Japan are both Asian countries that are geographically adjacent and share a common cultural heritage. Suicide is a significant public health concern in both countries. While Japan has established a relatively mature framework for suicide prevention, China lacks national suicide prevention mechanisms. This paper analyzes the disparity in adolescent suicide prevention between China and Japan so that China can learn from Japan’s experience in this area and develop effective, systematic mechanisms for the prevention and intervention of adolescent suicide.

Suicidal Behaviors among Chinese Primary and Secondary School Students: A Causal Analysis

Suicide has emerged as a severe global public health issue, ranking as the fourth most common cause of death for young people aged 15 to 19 years, according to the World Health Organization. Suicidal incidents among Chinese elementary and secondary school kids have increased recently, causing irreparable harm to families, schools, and society as a whole. To contribute to continuing efforts to strengthen suicide prevention strategies for Chinese adolescents, this paper focuses on studying the causes of teenage suicide in China from personal, familial, educational, and social viewpoints.

Validity and reliability of a Chinese language suicide screening questionnaire-observer rating (CL-SSQ-OR) assessment for children/adolescents.

A Suicide Screening Questionnaire-Observer Rating (SSQ-OR) has been used to assess risk of suicide among individuals and to help clinicians identify and rescue individuals attempting suicide. To prevent the risk of suicide in China, a Chinese language SSQ-OR (CL-SSQ-OR) needs to be introduced. To test the validity and reliability of a CL-SSQ-OR. A total of 250 individuals were enrolled in this study. Each completed a CL-SSQ-OR assessment, Patient Health Questionnaire-9, and the Beck Scale for Suicide Ideation. Confirmatory factor analysis (CFA) was adopted to determine structural validity. Spearman correlation coefficients were adopted to determine criterion validity. An internal correlation coefficient (ICC) was used to test inter-consistency and Cronbach's α coefficient was used to test split-half reliability. CFA was conducted with use of the maximum variance method to evaluate the item results. All of the items received scores >0.40. In addition, good model fit indices were observed for the two-factor structure RMSEA = 0.046, TLI = 0.965, CFI = 0.977. The items' factor loading of the CL-SSQ-OR in the first factor ranged from 0.443 to 0.878. The items' factor loading of the CL-SSQ-OR in the second factor ranged from 0.400 to 0.810. The ICC of the total CL-SSQ-OR was 0.855. Cronbach's α was 0.873. The CL-SSQ-OR described here demonstrates ideal psychometric properties and is found to be a suitable tool for screening Chinese children/adolescents who are at risk of suicide.

Secular trends of suicide risk for residents in mainland China (2004 to 2019): An updated age–period–cohort analysis

BackgroundThe overall suicide rate in China has dropped substantially since the 1990s, but a slowdown in the decrease and even a reversing trend was observed in specific groups in recent years. This study aims to investigate the latest suicide risk in mainland China by using the age-period-cohort (APC) analysis. MethodThis population-based multiyear cross-sectional study included Chinese ages 10 to 84 years using data from the China Health Statistical Yearbook (2005–2020). Data were analyzed by the APC analysis and intrinsic estimator (IE) technique. ResultsThe data satisfactorily fit the constructed APC models. The cohort effect indicated a high risk of suicide among people birth in 1920–1944 and a sharp decline in the 1945–1979 cohort. The lowest risk occurred in the 1980–1994 cohort before a sharp increase in generation Z (birth years in 1995–2009). The period effect showed a declining trend since 2004. The age effect indicated that the suicide risk increased over time, except for a gradual decline from age 35 to 49. The suicide risk increased greatly in adolescents and reached the highest among the elderly. LimitationsThe aggregated population-level data and the non-identifiability of the APC model could result in bias in the accuracy of results in this study. ConclusionsThis study successfully updated the Chinese suicide risk from the age, period and cohort perspective using the latest available data (2004–2019). The findings enhance the understanding of suicide epidemiology and provide evidence supporting policies and strategies at the macro-level for suicide prevention and management. Immediate action is needed to focus on a national suicide prevention strategy that targets generation Z, adolescents and the elderly which will require a collaborative effort by government officials, public/community health planners and health care agencies.

Detecting depression of Chinese microblog users via text analysis: Combining Linguistic Inquiry Word Count (LIWC) with culture and suicide related lexicons.

In recent years, research has used psycholinguistic features in public discourse, networking behaviors on social media and profile information to train models for depression detection. However, the most widely adopted approach for the extraction of psycholinguistic features is to use the Linguistic Inquiry Word Count (LIWC) dictionary and various affective lexicons. Other features related to cultural factors and suicide risk have not been explored. Moreover, the use of social networking behavioral features and profile features would limit the generalizability of the model. Therefore, our study aimed at building a prediction model of depression for text-only social media data through a wider range of possible linguistic features related to depression, and illuminate the relationship between linguistic expression and depression. We collected 789 users' depression scores as well as their past posts on Weibo, and extracted a total of 117 lexical features via Simplified Chinese Linguistic Inquiry Word Count, Chinese Suicide Dictionary, Chinese Version of Moral Foundations Dictionary, Chinese Version of Moral Motivation Dictionary, and Chinese Individualism/Collectivism Dictionary. Results showed that all the dictionaries contributed to the prediction. The best performing model occurred with linear regression, with the Pearson correlation coefficient between predicted values and self-reported values was 0.33, the R-squared was 0.10, and the split-half reliability was 0.75. This study did not only develop a predictive model applicable to text-only social media data, but also demonstrated the importance taking cultural psychological factors and suicide related expressions into consideration in the calculation of word frequency. Our research provided a more comprehensive understanding of how lexicons related to cultural psychology and suicide risk were associated with depression, and could contribute to the recognition of depression.

Economic Development and Gender Ratio Change in Chinese Suicide Rates (1990-2017).

Objective: The overall gender ratio in Chinese suicide rates has substantially changed during the past three decades. In this study, we investigated the social economic factors and the mechanisms that may be contributing to this fluctuation. Study Design: This is a secondary analysis using suicide mortality data from the China Centers for Disease Control and Prevention. Methods: A statistical model was performed with province as the unit of analysis. The per capita GDP and income of each provincial-level region were collected from the Economic and Statistical Yearbook. Rate and ratio were used to describe the trend of variations, and correlation analyses were conducted to examine the association between economic development and gender ratio change. Results: The China overall male to female gender ratio of suicide rates increased as the GDP per capita grew (r = 0.439; p = 0.015). The gender ratio changed from 0.88 in 1990 to 1.56 in 2017, with the reversion point between 1995 and 2000. The most radical reverse changes in the gender ratios were found in large municipalities. Conclusions: Cultural and social economic variables may explain the gender ratio changes. Increased economic development has significantly reduced psychological strains on rural young women, which in turn decreased the suicide rate among this sub-population.

The blue whale challenge from urban legend to real harm: Case study analyses of Chinese suicide attempters

The blue whale challenge from urban legend to real harm: Case study analyses of Chinese suicide attempters

Suicide in China: The power of social and economic change

Suicide has ever been a challenging public health problem in China, and has accounted for approximately 17% of all suicide deaths across the world.1 With the rising economic levels and great social changes, a dramatic decline in suicide rates has been observed in China since the economic reform policy enacted dated back to 1970s.2–4 The underlying mechanisms of the rapid declines are complicated and cannot be fully explained by the suicide theories that are mainly originated from western cultures.

After the Foxconn Suicides in China: A Roundtable on Labor, the State and Civil Society in Global Electronics

We seek to tackle myriad problems of a global production system in which China is the world’s largest producer and exporter of consumer electronics products. Dying for an iPhone simultaneously addresses the challenges facing Chinese workers while locating them within the global economy through an assessment of the relationship between Foxconn (the largest electronics manufacturer) and Apple (one of the richest corporations). Eight researchers from Asia, Europe and North America discuss two main questions: How do tech behemoths and the Chinese state shape labor relations in transnational manufacturing? What roles can workers, public sector buyers, non-governmental organizations and consumers play in holding multinational corporations and states accountable for human rights violations and assuring the protection of worker interests? We also reflect on the possibility that national governments, the electronics industry and civil society groups can collaborate to contribute to improved labor rights in China and the world.

Characteristics and Risk Factors for Suicide in People with Schizophrenia in Comparison to Those without Schizophrenia

BackgroundLittle research has been conducted that compares suicide cases with and without schizophrenia. The aim of the present study was to identify demographic, personal, social, relational, and psychological characteristics among suicides identified posthumously with schizophrenia compared to those without. MethodsThe DSM-IV was used to independently assess the presence of schizophrenia among suicide cases by two psychiatrists. Data on risk factors was collected through a psychological autopsy method, which included structured interviews of two informants for each suicide case (a family member and a close friend). Interview questions included demographic characteristics, suicide risk factors, the Beck Hopelessness Scale, Dickman's Impulsivity Inventory, the Spielberger State-Trait Anxiety Inventory, the Hamilton Depression Scale and the Duke Social Support Inventory. ResultsThe prevalence of schizophrenia was 9.69% among suicide cases in this sample. The schizophrenia suicide group was more likely to be female, older, in poorer physical health, suffer from chronic disease, suffer other psychological disorders, and have a family history of psychological disorders compared to those not diagnosed schizophrenia. Other important risk factors included more frequent past suicide attempts, increased levels of depression and anxiety, lower levels of impulsivity, lower help seeking from friends, and lower social interaction social support. ConclusionsThere is a notable link between schizophrenia and suicide in China. Identification of social, personal, relational, and psychological risk factors could beneficially guide attempts to improve future preventive measures against suicide among those with schizophrenia in China.

Risk factors for suicide in psychiatric emergency patients in Beijing, China: A large cross-sectional study

Psychiatric emergency patients constitute a population at high risk of suicidal thoughts and behaviors (STB). However, the risk factors for STB in this population have not been clearly defined. This study aimed to explore the risk factors for STB in psychiatric emergency patients in China. A cross-sectional analysis was conducted at the emergency department of psychiatry, Anding Hospital, Capital Medical University from 2015 to 2017. The Chinese suicide risk factors scale was used to test the STB of the patients. Multivariable logistic regression analysis was used to determine the risk factors of STB. A total of 12,345 patients were included. Their average age was 36 years. According to the suicide risk scale, 3436 cases (27.83%) were at risk of STB, mainly young adults. The multivariable analysis showed that urban residence, years of education, living in Beijing, ethnic Han, living alone, unemployment, poor relationship with parents, one or more siblings, visit time in the night, family history, disease course, total duration, the total number of psychiatric hospitalizations, a clear diagnosis, Brief Psychiatric Rating Scale total score ≥28.5, Hamilton Depression Rating Scale total score ≥20, and Young Mania Rating Scale total score ≥12 were independent risk factors for STB.

Factors associated with suicide risk among Chinese adults: A prospective cohort study of 0.5 million individuals.

BackgroundSuicide is a leading cause of death in China and accounts for about one-sixth of all suicides worldwide. The objective of this study was to examine the recent distribution of suicide and risk factors for death by suicide. Identifying underlying risk factors could benefit development of evidence-based prevention and intervention programs.Methods and findingsWe conducted a prospective study, the China Kadoorie Biobank, of 512,715 individuals (41% men, mean age 52 years) from 10 (5 urban, 5 rural) areas which are diverse across China in geographic locations, social economic developmental stages, and prevalence of disease patterns. After the baseline measurements of risk factors during 2004 to 2008, participants were followed up for suicide outcomes including suicide and possible suicide deaths. Risk factors, such as sociodemographic factors and physical and mental health status, were assessed by semistructured interviews and self-report questionnaires. Suicide and possible suicide deaths were identified through linkage to the local death registries using ICD-10 codes. We conducted Cox regression to calculate hazard ratios (HRs) for suicide and for possible suicide in sensitivity analyses.During an average follow-up period of 9.9 years, 520 (101 per 100,000) people died from suicide (51.3% male), and 79.8% of them lived in rural areas. Sociodemographic factors associated with increased suicide risk were male gender (adjusted hazard ratios [aHR] = 1.6 [95% CI 1.4 to 2.0], p < 0.001), older age (1.3 [1.2 to 1.5] by each 10-yr increase, p < 0.001), rural residence (2.6 [2.1 to 3.3], p < 0.001), and single status (1.7 [1.4 to 2.2], p < 0.001). Increased hazards were found for family-related stressful life events (aHR = 1.8 [1.2 to 1.9], p < 0.001) and for major physical illnesses (1.5 [1.3 to 1.9], p < 0.001). There were strong associations of suicide with a history of lifetime mental disorders (aHR = 9.6 [5.9 to 15.6], p < 0.001) and lifetime schizophrenia-spectrum disorders (11.0 [7.1 to 17.0], p < 0.001). Links between suicide risk and depressive disorders (aHR = 2.6 [1.4 to 4.8], p = 0.002) and generalized anxiety disorders (2.6 [1.0 to 7.1], p = 0.056) in the last 12 months, and sleep disorders (1.4 [1.2 to 1.7], p < 0.001) in the past month were also found. All HRs were adjusted for sociodemographic factors including gender, age, residence, single status, education, and income. The associations with possible suicide deaths were mostly similar to those with suicide deaths, although there was no clear link between possible suicide deaths and psychiatric factors such as depression and generalized anxiety disorders. A limitation of the study is that there is likely underreporting of mental disorders due to the use of self-report information for some diagnostic categories.ConclusionsIn this study, we observed that a range of sociodemographic, lifestyle, stressful life events, physical, and mental health factors were associated with suicide in China. High-risk groups identified were elderly men in rural settings and individuals with mental disorders. These findings could form the basis of targeted approaches to reduce suicide mortality in China.

Influential Path of Social Risk Factors toward Suicidal Behavior-Evidence from Chinese Sina Weibo Users 2013-2018.

(1) Purpose: The purpose of this study was to determine suicidal risk factors, the relationship and the underlying mechanism between social variables and suicidal behavior. We hope to provide empirical support for the future suicide prevention of social media users at the social level. (2) Methods: The path analysis model with psychache as the mediate variable was constructed to analyze the relationship between suicidal behavior and selected social macro variables. The data for our research was taken from the Chinese Suicide Dictionary, Moral Foundation Dictionary, Cultural Value Dictionary and National Bureau of Statistics. (3) Results: The path analysis model was an adequate representation of the data. With the mediator psychache, higher authority vice, individualism, and disposable income of residents significantly predicted less suicidal behavior. Purity vice, collectivism, and proportion of the primary industry had positive significant effect on suicidal behavior via the mediator psychache. The coefficients of harm vice, fairness vice, ingroup vice, public transport and car for every 10,000 people, urban population density, gross domestic product (GDP), urban registered unemployment rate, and crude divorce rate were not significant. Furthermore, we applied the model to three major economic development belts in China. The model’s result meant different economic zones had no influence on the model designed in our study. (4) Conclusions: Our evidence informs population-based suicide prevention policymakers that incorporating some social factors like authority vice, individualism, etc. can help prevent suicidal ideation in China.

Suicide in China: Community Attitudes and Stigma.

China accounts for an estimated third of the world's suicides, yet individuals experiencing suicidality typically do not seek out or receive treatment. This study examines community perceptions and public stigma toward suicide. In Shanghai, China 186 adults were recruited to participate in a survey with an experimental vignette describing a suicidal individual, manipulated on gender and age, followed by questions eliciting attitudes toward suicide. Most participants agreed that the suicidal subject had a serious problem, with seriousness of the problem decreasing with participant's age. Participants reported moderate levels of public stigma. More stigma was found toward adolescent subjects rather than adult. Male subjects were perceived as being more likely to change than females. The public's accurate view of suicide without biases could help prevent suicide from getting worse. Public perceptions regarding a suicidal individual's likelihood to change could lead to stigma reduction, which can subsequently help with effective crisis intervention.

Suicidal Ideation Risk and Socio-Cultural Factors in China: A Longitudinal Study on Social Media from 2010 to 2018.

Many studies cited the importance of social factors as protective and risk factors for suicide. However, there is a lack of evidence on the influences of cultural and moral values. This study aims to examine the association between cultural values and suicidal ideation risks detected on an online social media platform. We collected a total of 5.1 billion pieces of Weibo posts from 2010 to 2018 to calculate their suicidal ideation risks as measured by psychache in the Chinese Suicide Dictionary. We calculated the word frequencies of cultural and moral values based on Cultural Value Dictionary and Moral Foundation Dictionary. We collected economic and population data from the China National Bureau of Statistics. Two-way fixed-effect models were performed to analyze the association between culture, economy, and population factors and suicidal ideation risks. The results confirm the relations between high suicidal ideation risk and public concerns of vice under the Chinese context such as harm (β = 0.193, p < 0.01), betrayal (β = 0.096, p < 0.01), and dirty (β = 0.624, p < 0.001). In addition, extremely individualistic or collectivistic values of the public were associated with high suicidal ideation risks. The finding indicated the significant impact of social culture on suicide risk apart from the influence of the social economy and population characteristics. Our evidence informs population-based suicide prevention policymakers that incorporating cultural and moral values can help prevent suicidal ideation in China.