Suicide Rates In China Research Articles

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.

Estimating the role of air quality improvements in the decline of suicide rates in China

Estimating the role of air quality improvements in the decline of suicide rates in China

Declining suicide rates in China (1990–2017): Gender and age specific analyses

BackgroundIn China suicide rates have been declining for about three decades. Patterns of suicide for women and men across the lifespan over time however have not been systematically documented. MethodsOfficial suicide mortality data (from 1990 to 2017) available via China CDC were used to examine suicide patterns by gender and age in each of the 33 provincial-level regions. Suicide data were aggregated by five years, except for the year of 2017. The bar graphs were used to descriptive the change tread of the suicide rate. ResultsIn the past three decades, the decline in female suicide rates was greater than that in the male rates, with the overall male to female (M/F) ratio changing from 0.88 in 1996 to 1.56 in 2017. The overall suicide rate of male was 8.82 and female was 5.65 per 100,000 persons in 2017. However the decline of suicide rates for people aged 70 and older was the greatest declination (33.73/per 100,000 persons) among all the age groups in China. ConclusionOverall suicide rates have declined over the three decades in China, particularly among females and individuals age 70+ years. Suicide rates continue to be higher among individuals aged 50 and older (particularly among men), and this population should continue to the focus for prevention.

Urbanisation and Declining Suicide Rates in China Between 2005 and 2017.

Worldwide suicide rates have declined since 2000s, with China being the primary contributor. This study aimed to investigate whether urbanisation is associated with decreasing suicide rates in China. Suicide rates and economic indicators of 31 provinces, municipalities, and autonomous regions of China between 2005 and 2017 were analysed. Poisson random intercept models were used to determine associations between suicide rates, urbanicity, sexes, and gross regional product (GRP). Between 2005 and 2017, suicide rates in 31 provinces, municipalities, and autonomous regions of China continued to decrease. Urbanicity and GRP were associated with decreased suicide rates among Chinese males and females. An increase in urbanicity by 1% was associated with a 2.2% decrease in suicide rates (p < 0.001). The most urbanised and populous cities (Beijing, Shanghai, Tianjin) had the lowest suicide rates. Urbanicity was associated with a greater decline in suicide rates among females, compared with males. Association between increased urbanicity and reduced suicide rates was independent of GRP. Urbanisation was associated with declining suicide rates in China; this association was stronger among females than males.

Changes and explanations of suicide rates in China by province and gender over the past three decades

ObjectivesThis study is aimed to summarize the declining trends of suicide rates by gender in China and in each of its provinces, and to explain the changes from a public health perspective. Study designThis is a study with existing data. MethodsData of suicide mortality were provided by China CDC (1990 to 2017). Data of suicide in each of the 33 provinces were aggregated every five years, except for the year of 2017. A statistical model was performed with the provincial region as the unit of analysis. ResultsThe overall suicide rate in China decreased from 20.9/100,000 in 1990 to 7.2 in 2017, marking a decrease of suicide rate in China by 65%. The gender ratio has increase from 0.88 in 1990 to 1.56 in 2017. Suicide rates have been going down in each of the 33 provinces. The national suicide rates are negatively correlated with GDP per capita, population density, and life expectancy, but positively related to rural population density. ConclusionsThe reduction of suicide rates in China is explained by the reduction of psychological strains which is a consequence of the fast-growing economy in the country. Given its large population and rapid decrease of the suicide deaths, China contributed to the global reduction of suicide mortalities.

Socio-economic determinants of suicide rates in transforming China: A spatial-temporal analysis from 1990 to 2015

SummaryBackgroundChina has experienced dramatic social changes in the last three decades. This study aimed to investigate socio-economic factors related to suicide rates in China from 1990 to 2015, and examine how the impacts of these factors on suicide rates changed over time.MethodsSuicide rates in 31 provinces in mainland China between 1990 and 2015 were obtained from the Global Burden of Disease (GBD) Study 2019. Temporal-spatial modelling was applied to assess the effects of GDP per capita, urbanization, migration, employment, divorce, proportions of children and older adults on provincial overall, male and female suicide rates.FindingsThe overall suicide rate in China declined from 18·1 /100,000 in 1990 to 8·6 /100,000 in 2015, with considerable spatial variation in the magnitude of decline across provinces. The protective effects of increasing in GDP per capita, and urbanization, on provincial suicide rate were strong in 1990 (log GDP: -3·56 [95% CI: -6·15, -0·96], urbanisation: -0·07 [-0·14, -0·01]), however these effects were negligible by 2015. The association between employment and suicide rates has shifted from positive to negative over the study period, while migration remained a constant risk factor for high suicide rates (0·04 [0.00, 0·09]).InterpretationThis study highlighted the dynamic effects of economic and social factors on suicide rates in the context of transforming China. To maintain further reductions in suicide rates cannot rely simply on improving people's materialistic and economic conditions. A more holistic approach to improve overall population well-being is needed.FundingHumanities and Social Sciences Prestigious Fellowship (37000320) and the General Research Fund (17611619) at the University of Hong Kong.

Socio-Economic Determinants of Suicide Rates in Transforming China: A Spatial-Temporal Analysis from 1990 to 2015

Background China has experienced dramatic economic and social changes in the last three decades. The aims of this study were to investigate socio-economic factors related to suicide rates in China from 1990 to 2015, and to examine how the impacts of these factors on suicide rates changed over time.Methods This study made use of suicide rates in 31 provinces in mainland China over 1990–2015 from the Global Burden of Disease (GBD) Study 2019. Spatial autoregression with provincial- and time-fixed effects was adopted to assess the effects of socio-economic factors on provincial suicide rates.Findings Suicide rates in all provinces decreased from 1990 to 2015, and there was considerable spatial variation regarding the magnitude of change. Economic development and urbanisation initially played an important role in lowering suicide rates in the first decade, but their protective role has diminished over time. The association between employment and suicide rates has shifted from positive to negative over the study period. The effects of divorce on increasing female suicide rates started to emerge in recent years, while the mitigating effect of children on female suicide rates has strengthened. Migration was a constant risk factor for higher suicide rates over the study period.Interpretation This study highlighted the dynamic effects of economic and social factors on suicide rates in the context of transforming China. Addressing China’s suicide rate presents ongoing challenges. To achieve further reduction cannot merely rely on improving people’s materialistic and economic conditions. A more holistic approach to improve overall well-being among the population is needed. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: MISSING

Relationship of the high proportion of suicidal acts involving ingestion of pesticides to the low male-to-female ratio of suicide rates in China.

The 2014 World Health Organization report on global suicide identified large differences in the male-to-female ratio of suicide rates between countries: most high-income countries (HICs) report ratios of 3:1 or higher while many low- and middle-income countries (LMICs) - including China and India - report ratios of less than 1.5:1. Most authors suggest that gender-based social-cultural factors lead to higher rates of suicidal behaviour among women in LMICs and, thus, to relatively high female suicide rates. We aim to test an alternative hypothesis: differences in the method and case-fatality of suicidal behaviour - not differences in the rates of suicidal behaviour - are the main determinants of higher female suicide rates in LMICs. A prospective registry of suicide attempts treated in all 14 general hospitals in a rural county in China was established and data from the registry were integrated with population and mortality data from the same county from 2009 to 2014. There were 160 suicides and 1010 medically-treated suicidal attempts in the county; 84% of female suicides and 58% of male suicides ingested pesticides while 73% of female attempted suicides and 72% of male attempted suicides ingested pesticides. The suicide rate (per 100 000 person-years of exposure) was 8.4 in females and 9.1 in males (M:F ratio = 1.08:1) while the incidence of 'serious suicidal acts' (i.e. those that result in death or received treatment in a hospital) was 81.5 in females and 47.7 in males (M:F ratio = 0.59:1). The case-fatality of serious suicidal acts was higher in males than in females (19 v. 10%), increased with age, was highest for violent methods (92%), intermediate for pesticide ingestion (13%) and lowest for other methods (5%). The incidence of medically serious suicidal behaviour among females in rural China was similar to that reported in HICs, but the case-fatality was much higher, primarily because most suicidal acts involved the ingestion of pesticides, which had a higher case-fatality than methods commonly used by women in HICs. These findings do not support sociological explanations for the relatively high female suicide rate in China but, rather, suggest that gender-specific method choice and the case-fatality of different methods are more important determinants of the demographic profile of suicide rates. Further research that involves ongoing monitoring of the changing incidence, demographic profile and case-fatality of different suicidal methods in urban and rural parts of both LMICs and HICs is needed to confirm this hypothesis.

Suicides in China from 2008-2017: A longitudinal epidemological study.

Introduction:We aimed to describe the change of suicide rates in China from 2008 to 2017 and provide suggestions for the prevention of suicide.Subjects and Methods:A longitudinal study included the time point tracking were used in our study. The suicide data in China were collected from the authoritative official website and yearbook of China from 2008 to 2017. Data were analyzed by SPSS (version 18.0, IBM Corp., Armonk, NY, USA). Origin (version 9.0) was used for graph.Results:We found that the suicide rate in China showed a downward trend. The suicide rate for males in rural was the highest, followed by rural women. Then urban male, and urban female suicide rate was the lowest. The difference was statistically significant (F = 88.35, P < 0.01).Conclusions:The suicide rate in rural areas was higher than that in cities, and men were higher than women. The government should focus on preventing high suicide rates in rural areas, especially men.

Relationship of the High Proportion of Suicidal Acts Involving Ingestion of Pesticides to the Low Male-to-Female Ratio of Suicide Rates in China

Background: The reasons for the low male-to-female ratio of suicide deaths in China remain unknown. Methods: A prospective registry of suicide attempts treated in all 14 general hospitals in a rural county in China was integrated with population and mortality data from 2009 to 2014. Outcomes: There were 160 suicides and 1010 medically-treated suicidal attempts in the county; 84% of female suicides and 58% of male suicides ingested pesticides while 73% of female attempted suicides and 72% of male attempted suicides ingested pesticides. The suicide rate (per 100,000 person-years of exposure) was 8·4 in females and 9·1 in males (M:F ratio=1·08:1) while the incidence of 'serious suicidal acts' (i.e., those result in death or receive treatment in a hospital) was 81·5 in females and 47·7 in males (M:F ratio=0·59:1). The case fatality of serious suicidal acts was higher in males than in females (19% vs. 10%), increased with age, was highest for violent methods (92%), intermediate for pesticide ingestion (13%), and lowest for other methods (5%). Interpretation: The low male-to-female ratio of suicide rates in rural China is primarily due to the large proportion of suicidal acts in women involving pesticide ingestion -- which have a higher case fatality than the methods used by women elsewhere. As China and other low- and middle-income countries urbanize it is likely changes in suicide methods will result in more rapid decreases in female than male suicide rates and corresponding increases in the male-to-female ratio of suicide rates. Funding Statement: The study was funded by a grant from the American Foundation for Suicide Prevention. Dr. Tong was supported in part by a United States Public Health Services grant (PHS No. 5D43TW009101, E.D. Caine, PI), and the Beijing Municipal High Rank Health Researcher Training Program (No. 2015-3-111). Dr. Phillips was supported in part by the National Natural Science Foundation of China (NSFC, No. 81371502 and 81761128031). The funding institutions had no role in the design, conduct, analysis, or write-up of the report. Declaration of Interest: The authors have no financial of other conflicts of interest related to this manuscript. Ethics Approval Statement: The authors state: that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Changing of suicide rates in China, 2002–2015

BackgroundThe overall suicide rate in China has dropped substantially since the 1990s, with patterns changing significantly. This study aims to further explore the latest changes in suicide rates in China. MethodsData on gender-age-specific suicide rates for rural and urban residents aged 15 years and above were retrieved from official records. Joinpoint regression analyses were applied to analyze time trends of suicide rates. ResultsOverall, suicide rates in China dropped significantly from 2002 to 2015. However, the national suicide rates have decreased at a slower pace since 2006. Joinpoints on time trends of suicide rates were also observed among rural males, rural females and urban males in 2005, 2006 and 2008, respectively. Declines in suicide rates of a majority of groups aged 25–54 slowed around 2007, and even reversed among males aged 25–34 in both areas and rural males aged 45–54. Male suicide rates were increasingly higher than females' after 2006. Rural suicide rates were about twice those of urban groups in recent years. LimitationsData on suicide is based on a large-sampled surveillance system, which may suffer from some quality flaws. Improvements in the quality of suicide rate data may lead to bias. Information on other potential differences in suicide rates over time is not available. ConclusionsAlthough the suicide rate in China dropped significantly from 2002–2015, a slowdown in the decrease and even a reversing trend was observed in some certain groups, which highlights the urgent need for targeted suicide prevention programs.

Suicide rates in China, 2004\u20132014: comparing data from two sample-based mortality surveillance systems

BackgroundThe decreasing suicide rate in China has been regarded as a major contributor to the decline of global suicide rate in the past decade. However, previous estimations on China’s suicide rates might not be accurate, since often they were based on the data from the Ministry of Health’s Vital Registration (“MOH-VR”) System, which is biased towards the better-off population. This study aims to compare suicide data extracted from the MOH-VR System with a more representative mortality surveillance system, namely the Center for Disease Control and Prevention’s Disease Surveillance Points (“CDC-DSP”) System, and update China’s national and subnational suicide rates in the period of 2004–2014.MethodsThe CDC-DSP data are obtained from the National Cause-of-Death Surveillance Dataset (2004–2014) and the MOH-VR data are from the Chinese Health Statistics Yearbooks (2005–2012) and the China Health and Family Planning Statistics Yearbooks (2013–2015). First, a negative binomial regression model was used to test the associations between the source of data (CDC-DSP/MOH-VR) and suicide rates in 2004–2014. Joinpoint regression analyses and Kitagawa’s decomposition method are then applied to analyze the trends of the crude suicide rates.ResultsBoth systems indicated China’s suicide rates decreased over the study period. However, before the two systems merged in 2013, the CDC-DSP System reported significantly higher national suicide rates (IRR = 1.18, 95% Confidence Interval [CI]: 1.13–1.24) and rural suicide rates (IRR = 1.29, 95% CI: 1.21–1.38) than the MOH-VR System. The CDC-DSP System also showed significant reversing points in 2011 (95% CI: 2006–2012) and 2006 (95% CI: 2006–2008) on the rural and urban suicide trends. Moreover, the suicide rates in the east and central urban regions were reversed in 2011 and 2008.ConclusionsThe biased MOH-VR System underestimated China’s national and rural suicide rates. Although not widely appreciated in the field of suicide research, the CDC-DSP System provides more accurate estimations on China’s suicide rates and is recommended for future studies to monitor the reversing trends of suicide rates in China’s more developed areas.

Addressing social injustice: a key public mental health strategy.

Addressing social injustice: a key public mental health strategy.

The Change in Suicide Rates between 2002 and 2011 in China

Chinese suicide rates have been reported in various studies in the past two decades, but few of them were based on national data. The most recent mortality data (2002-2011) provided by the China Ministry of Health and the detailed census data provided by the National Population Census were used in this study. We calculated the age-, gender-, and region-specific suicide rates and their trends in the past 10years between 2002 and 2011. The overall suicide rates in China decreased during the study period. The rural/urban ratio of the suicide rates has been significantly reduced from the ratio in the 1990s, and male suicide rates have exceeded those of females. Age was positively associated with suicide rates without the two peaks found in the suicide rates over 20years ago. The Chinese suicide rates have significantly declined in the past decade, with withering of the unique suicide rate patterns previously found in Chinese suicides about 20years ago.

Suicide rates in China from 2002 to 2011: an update

The aims of this study were: (1) to present the time trend of suicide rate among people aged 15 or above in China over the period 2002-2011 and (2) to examine the current profile of completed suicides during 2009-2011. Data on suicide rate in 2002-2011 were provided by the Chinese Ministry of Health (MOH). The trends of region-, gender-, and age-specific suicide rates were examined using Poisson regression models. The mean number of completed suicides for each cohort during 2009-2011 was calculated and a mean national suicide rate was estimated. The overall suicide rate decreased significantly over the past decade, but rates in young males and rural older adults did not reduce and in fact increased among older adults in both urban and rural areas towards the end of the study period. For 2009-2011, 44% of all suicides occurred among those aged 65 or above and 79% among rural residents. The estimated mean national suicide rate was 9.8 per 100,000 and was slightly higher for males than females. The benefits of economic growth, such as higher employment and more educational opportunities for the rural population in particular, may have contributed to the reduced suicide rate in China. However, the recent rapid changes in socioeconomic conditions could have increased stress levels and resulted in more suicides, especially among the elderly. Despite the significant reduction reported here, the latest figures suggest the declining trend is reversing. It will be important to continue monitoring the situation and to examine how urbanization and economic changes affect the well-being of 1.3 billion Chinese.

The changing global face of suicide

On the basis of WHO estimates for 2004, India and China account for 49% of global suicides, and all low-income and middle-income countries (LAMICs) combined account for 84% of all suicides. 1 WHOThe global burden of disease: 2004 update. World Health Organization, Geneva2008www.who.int/evidence/bod Google Scholar However, high-quality research on suicide in LAMICs is very restricted, so the Article in The Lancet by Vikram Patel and colleagues, 2 Patel V Ramasundarahettige C Vijayakumar L et al. for the Million Death Study CollaboratorsSuicide mortality in India: a nationally representative survey. Lancet. 2012; 379: 2343-2351 Summary Full Text Full Text PDF PubMed Scopus (332) Google Scholar the first nationally representative study to estimate suicide rates in India, is an important contribution to available knowledge. The high estimated overall suicide rates in India of 18·6 per 100 000 boys and men (upper bound 15·7, lower bound 19·8) and 12·7 per 100 000 girls and women (10·7, 13·0), and the fact that suicide is the second most important cause of death in young adults aged 15–29 years, parallel findings from China 3 Phillips MR Li XY Zhang YP Suicide rates in China, 1995–99. Lancet. 2002; 359: 835-840 Summary Full Text Full Text PDF PubMed Scopus (694) Google Scholar and confirm what has been suspected for decades—suicide is a major public health problem in LAMICs that has not received the attention it deserves. Their data suggest that India's National Crime Records Bureau underestimates suicides in men by at least 25% and suicides in women by at least 36%, showing that treating suicide as a criminal offence, as is done in India and many Islamic countries, can result in the frequent misclassification of suicide deaths and, thus, undermine prevention efforts. Suicide prevention: steps to be takenSuicide is a devastating event for individuals, families, and communities. People who experience such a loss, the wider public, and health professionals, often struggle to understand this complex behaviour, which remains taboo in many cultures. In today's Lancet, we publish a three-part Series to illuminate some of the issues around the causes of suicide, the treatments for suicidal ideation and self-harm, and importantly, the prevention of suicide. Full-Text PDF Suicide mortality in India: a nationally representative surveySuicide death rates in India are among the highest in the world. A large proportion of adult suicide deaths occur between the ages of 15 years and 29 years, especially in women. Public health interventions such as restrictions in access to pesticides might prevent many suicide deaths in India. Full-Text PDF

Study on correlation between changes in employment environment and labor force suicide rates in China: 1991-2009

Study on correlation between changes in employment environment and labor force suicide rates in China: 1991-2009

The Acceptability of Suicide Among Rural Residents, Urban Residents, and College Students from Three Locations in China

The Acceptability of Suicide Among Rural Residents, Urban Residents, and College Students from Three Locations in China

Characteristics of young rural Chinese suicides: a psychological autopsy study

Patterns of suicide rates in China differ in many ways from those in the West. This study aimed to identify the risk factors characteristic for young rural Chinese suicides. This was a case-control psychological autopsy (PA) study. The samples were suicides and living controls (both aged 15-34 years) from 16 rural counties of China. We interviewed two informants for each suicide and each control with pretested and validated instruments to estimate psychosocial, psychiatric and other risk factors for suicides. The prevalence of mental disorders was higher among the young Chinese who died by suicide than among the living controls, but was lower than among suicides in the West. Marriage was not a protecting factor for suicide among young rural Chinese women, and never-married women who were involved in relationships were about three times more likely to commit suicide than single women who were unattached. Religion/religiosity was not a protecting factor in Chinese suicide, as it tended to be stronger for suicides than for controls. Impulsivity was significantly higher for suicides than for controls. Psychological strain, resulting from conflicting social values between communist gender equalitarianism and Confucian gender discrimination, was associated significantly with suicide in young rural Chinese women, even after accounting for the role of psychiatric illness. Risk factors for suicide in rural China are different from those in the West. Psychological strain plays a role in suicide. Suicide prevention programs in China should incorporate culture-specific considerations.

Suicide rates in China during a decade of rapid social changes

China accounts for more than 30% of the world's suicides and displays a unique pattern of suicide rates. Prior research had established the link between macrosocial changes and suicide. Comprehensive surveillance system of suicide in this rapidly developing country is much needed. This paper examined the trends of national-, region-, gender-, and age-specific suicide rates, and male to female ratios in suicide in China for the period of 1991-2000, which was a time that rapid economic and social changes took place. A regression model was used to detect any variations in national-, region-, gender-, and age-specific suicide rates and gender ratios reported by the most recent mortality statistics from China's Ministry of Health. National, urban, and rural suicide rates for both men and women decreased significantly for the period of 1991-2000; age-specific suicide rates, however, showed that there were different patterns of changes in suicide rates in rural and urban areas. Although elderly suicide rates showed the most significant decrease in urban areas, younger women showed the largest decrease in rural areas; male to female gender ratio in suicide increased significantly in the urban areas, but no significant change was found in rural areas. Possible explanations that may account for the downward trends in suicide rates and increase in male to female gender ratio in urban area were provided. Longer historical studies are needed to reveal the relationship between macrosocial changes and the pattern of suicide.