Religion, Psychological Strain, and Suicidality in China: A Preliminary Study

BACKGROUND

There is a lack of religiosity studies in China especially in relation to mental health and suicidality. In this research, we focus our studies on medical workers of which some studies reported to have higher stress, and to pilot our studies in this adult age-group.

DATA AND METHODOLOGY

Data were obtained by a questionnaire survey in a large public hospital in a big metropolitan city of China. The final sample consisted of 1012 respondents with 237 (23.4%) being male and 775 (76.6%) being female. The respondents were of three groups: (1) Believers (n = 34; 3.5%); (2) Non-Believers or Atheists (n = 547; 55.8%); and (3) Agnostics or Fence-Sitters (n = 400; 40.8%). Suicidality was measured by the NCS-Suicidality Scale, and standard measures were employed for other major variables.

FINDINGS

In line with other recent studies in China, the religion rate among the urban adults remained low (3.5%). However, about 40.8% of the respondents chose "don't know" and could be fence-sitters on the issue of religious belief. Many of them are involved in various folk beliefs which may not be considered as religious. The religious believers were at higher risk of suicidality and depression than the atheists and the fence-sitters. However, the fence-sitters were higher than the believers and atheists on psychological strains, and they were higher on depression compared to the atheists.

CONCLUSION

The religious believers and religious fence-sitters have higher psychopathologic risks and suicidal risk than the atheist group. Religion as of low prevalence in Chinese societies is a social value deviant from the norm and its practitioners are likely to be marginalized or stigmatized. The Strain Theory of Suicide is used for detailed explanations.

Non-Disclosure and Suicidal Ideation in Adolescent Victims of Bullying: An Analysis from the Family and School Context

In recent years, suicide rates among bullying victims have raised much concern among educators and health professionals. Suicide is the fourth leading cause of preventable death among adolescents, data that warn about the need to monitor the signs before victims' suicidal behavior to prevent this fatal outcome. In the present study, the role of victims' silence about their victimization situation was analysed, as well as the particular impact of family and school environments. More specifically, we examined the mediating role of the victim's non-disclosure between the parental styles (observing the father's and mother's roles separately) and the school climate, concerning suicidal ideation in victims. The sample consisted of 2,977 adolescents (48.5% boys), aged 11-17 years (M = 14.1, SD = 1.42), of whom 635 (21.3%) reported having been victims of bullying in the past year. The results showed that parental styles of rejection and indifference were positively related to victims' non-disclosure of bullying and suicidal ideation. Conversely, a positive school climate showed a negative relationship with victims' disclosure of the bullying situation and suicidal ideation. The findings also indicated that non-disclosure mediates the relationship between the mother's parental style and suicidal ideation. These findings expand knowledge about the role of bullying victims' social context and the variable disclosure with regards to suicidal ideation in adolescents victimized by peers at school.

Negative Life Events and Procrastination among Adolescents: The Roles of Negative Emotions and Rumination, as Well as the Potential Gender Differences

Procrastination (the intentional delay of action despite knowing that one will be worse off due to the delay) is a widespread phenomenon with various negative consequences, especially among adolescents. Based on relevant evidence, this study examined the relation between negative life events and adolescents' procrastination, as well as the underlying mechanisms-specifically, the effects of negative emotions and rumination, as well as the potential gender differences. A total of 780 adolescents (M_age = 12.92 years old; 52.2% females) were recruited to complete a set of questionnaires assessing negative life events, procrastination, depression-anxiety-stress symptoms and rumination. Results showed that negative life events were positively associated with procrastination, and negative emotions significantly mediated the relation; rumination played a moderating role in this mediation model, specifically, both the direct and indirect effects in this mediation model were stronger for adolescents with higher rumination. Besides this, gender differences in this moderated mediation model were also found-the indirect effect of negative emotions was stronger for girls, and this mediating effect could be moderated by rumination only for boys. These results expanded our understanding of how negative life events influence procrastination and when (or for whom) negative life events influence procrastination the most. The findings also have significant implications for the prevention and intervention of adolescents' procrastination.

Negative coping style mediates the relationship between negative mental and suicide risk among migrant workers in China

Suicide is increasingly recognized as a major public health concern among migrant workers in China. Despite negative mental and negative coping styles being core themes found in suicide notes, there is scarce research addressing the theoretical framework of underlying mechanisms between these variables. The study was designed to examine the relationships of negative mental, negative coping styles, and suicide risk among migrant workers. It hypothesized that negative mental would exert a positive effect on suicide risk via increased negative coping. Using a cross-sectional design, the study was conducted using a sample of 3095 migrant workers from Shenzhen, China. Self-made Suicide Risk Scale (SRS), Short-form of the ULCA Loneliness Scale (USL-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7), Simplified Coping Style Questionnaire (SCSQ) were used to collect data. Structural equation modeling (SEM) was performed to quantitatively explore the path effects between negative mental, negative coping styles and suicide risk. Results showed that negative coping style had a positive association with suicide risk (β = 0.029, P < 0.001). Negative mental had both direct and indirect positive effects on suicide risk through negative coping styles (β = 0.109, β = 0.013, P < 0.001). Therefore, to prevent suicidal behaviors among migrant workers, targeted interventions focusing on improving their mental health and coping strategies are needed.

Risk Assessment on Suicide Death and Attempt among Chinese Rural Youths Aged 15-34 Years

Background: Although many suicide risk assessment tools are available in the world, their validity is not adequately assessed. In this study, we aimed to develop and evaluate a suicide risk assessment model among Chinese rural youths aged 15–34 years. Method: Subjects were 373 suicide deaths and 507 suicide attempters aged 15–34 years in three Chinese provinces (Shandong, Liaoning, and Hunan). Information about the community residents was also collected as the control groups. Social-demographic, social and psychological variables were examined for the suicides, suicide attempters, and community residents. Logistic regressions based on subjects from Shandong and Liaoning provinces were conducted to establish the suicide risk assessment models. Receiver operating characteristic (ROC) curves were drawn, and area under the ROC curves (AUC) were calculated to show how well the models separated the group being tested into those with and without suicide attempt or suicide. Results: The assessment model for suicide death included education years (OR = 0.773, p < 0.001), agricultural worker (OR = 2.091, p < 0.05), physical health (OR = 0.445, p < 0.05), family suicide history (OR = 6.858, p < 0.001), negative life events (OR = 1.340, p < 0.001), hopelessness (OR = 1.171, p < 0.001), impulsivity (OR = 1.151, p < 0.001), and mental disorder (OR = 8.384, p < 0.001). All these factors were also supported in the assessment model for suicide attempt, with an extension of very poor economic status (OR = 1.941, p < 0.01) and social interaction (OR = 0.855, p < 0.001). The AUC was 0.950 and 0.857 for the sample used to establish the assessment models of suicide death and attempt, respectively. The AUC was 0.967 and 0.942 for the sample used to verify the established assessment models of suicide death and attempt, respectively. Conclusions: Compared with some other assessment tools, the models for suicide death and attempt in the current study performed well among Chinese rural youths aged 15–34 years. A reliable suicide risk assessment approach, which includes multiple risk factors, should be evaluated in various cultures and populations.

Testing the Strain Theory of Suicide – The Moderating Role of Social Support

Abstract. Background: According to the strain theory of suicide, strains, resulting from conflicting and competing pressures in an individual's life, are hypothesized to precede suicide. But social support is an important factor that can mitigate strains and lessen their input in suicidal behavior. Aims: This study was designed to assess the moderating role of social support in the relation between strain and suicidality. Methods: A sample of 1,051 employees were recruited in Beijing, the capital of China, through an online survey. Moderation analysis was performed using SPSS PROCESS Macro. Social support was measured with the Multidimensional Scale of Perceived Social Support, and strains were assessed with the Psychological Strains Scale. Results: Psychological strains are a good predictor of suicidality, and social support, a basic need for each human being, moderates and decreases the effects of psychological strains on suicidality. Limitations: The cross-sectional survey limited the extent to which conclusions about causal relationships can be drawn. Furthermore, the results may not be generalized to the whole of China because of its diversity. Conclusion: Social support has a tendency to mitigate the effects of psychological strains on suicidality.

Associations between depression, anxiety, stress, hopelessness, subjective well-being, coping styles and suicide in Chinese university students

Suicide is a major public health concern worldwide. This study aimed to predict the suicidal behavior of Chinese university students by studying psychological measures such as hopelessness, orientation to happiness, meaning in life, depression, anxiety, stress, and coping styles. In November 2016, a stratified-clustered-random sampling approach was utilized to select subjects from two large public medical-related universities in Shandong province, China. This sample consisted of 2,074 undergraduate students (706 males, 1,368 females; mean age = 19.79±1.39 years). The students’ major risk factors for suicide were depression, anxiety, stress, and hopelessness, and the students’ minor risk factors included orientation to happiness and coping styles (including self-distraction, self-blame and substance use). Notably, the presence of meaning in life had a positive effect on preventing suicide and acted as a protective factor, which suggests that it is important to identify risk factors as well as protective factors relevant to the target population group in order to increase the effectiveness of counseling and suicide prevention programs.

Factors associated with help-seeking behavior among medically serious attempters aged 15-54 years in rural China

Increasing help-seeking behavior was one of the effective methods for suicide prevention. However, help-seeking behavior was less explored in rural China. In this study, we aimed to analyze the factors which were associated with help-seeking behavior among medically serious suicide attempters in rural China. Subjects were 791 medically serious suicide attempters aged 15-54 years in rural China. A face-to-face interview was conducted to evaluate the age, gender, education years, marital status, occupation, religious belief, living alone, physical disease, pesticide at home, family suicide history, negative life events, social support, impulsivity, mental disorder, prior suicide act, suicide intent and suicide method for the attempters. The results supported that there were 29.2% of attempters seek help before suicide behavior, and factors that male (OR = 1.45), experiencing negative life events (OR = 1.12), impulsivity (OR = 1.05), suicide intent (OR = 0.92) and suicide by pesticide (OR = 0.68) were associated with increased help-seeking behavior. It is helpful for us to understanding the features of suicide attempters who do not seek help before suicide behavior, and we also should pay more attention on people with these factors in Chinese suicide prevention.

The strain theory of suicide

Suicide is a global public health problem, but very few theories have been developed for its etiology and effective prevention. Presented in this article is a comprehensive and parsimonious theory explaining the socio-psychological mechanism prior to suicidal behavior. Strain, resulting from conflicting and competing pressures in an individual’s life, is hypothesized to precede suicide. The strain theory of suicide (STS) proposes four sources of strain leading to suicide: (1) value strain from differential values; (2) aspiration strain from the discrepancy between aspiration and reality; (3) deprivation strain from the relative deprivation, including poverty; and (4) coping strain from deficient coping skills in the face of a crisis. This new model is built on previous notions of anomie (Durkheim, 1897/1951 ), strain theories of deviance (Merton, 1957 ) and crime (Agnew, 1992 ), although suicide is not a major target for explanation in those theories. Future research with rigorous quantitative data needs to be conducted to further test STS on a more comprehensive level.

The Association Between Depression, Suicidal Ideation and Psychological Strains in College Students: A Cross-National Study

OBJECTIVE

This study examined the differences of psychological strains between Chinese and American college students and discussed how strains may influence individuals' suicidal ideation and depression.

PARTICIPANTS/METHODS

A total of 539 college students (298 from China and 241 from the U.S.) were recruited in March 2016 to complete the survey study. Multiple linear regressions were used in data analysis.

RESULTS

Students in America had higher scores on depression and stress than students in China, while students in China rated higher on suicidal ideation than students in America. In contrast of students in America facing more coping strains, students in China were confronting more value strains in their life.

CONCLUSION

The cross-cultural variations in the effect of psychological strains have been substantiated in current study, indicating that understanding the psychological strains in different cultural contexts is necessary for the early intervention and prevention in college aged populations.

Features for medically serious suicide attempters who do not have a strong intent to die: a cross-sectional study in rural China

OBJECTIVE

Previous studies have implied that there were many Chinese suicide attempters who did not want to die by suicide. In the current study, we explored the factors which were associated with low levels of suicide intent. We also examined features for medically serious suicide attempters who do not have a strong intent to die in rural china.

DESIGN

Cross-sectional study.

SETTING

The interviews occurred between May 2012 and July 2013 in 13 rural counties in Shandong and Hunan provinces, China.

PARTICIPANTS

Subjects were 791 medically serious suicide attempters whose injury and wounds were so serious they required hospitalisation or immediate medical care.

RESULTS

The results supported that less years of education (β=-0.11, p=0.037), religious beliefs (β=1.20, p=0.005), living alone (β=1.92, p=0.017), negative life events (β=0.29, p=0.003), low levels of impulsivity (β=-0.10, p=0.013) and mental disorders (β=2.82, p<0.001) were associated with higher levels of suicide intent.

CONCLUSION

Results imply that there are some medically serious suicide attempters with a higher education and/or exhibit impulsivity who do not want to die by suicide. These findings can inform practice to prevent suicide in rural China.

Suicide Acceptability and Suicide Attempt: A Case-Control Study With Medically Serious Suicide Attempters Aged 15 to 54 Years in Rural China

In the past decades, many studies have discussed the topic of suicide acceptability. However, there is no empirical study which identified that suicide acceptability is associated with suicide attempt worldwide. In the present study participants were 791 medically serious suicide attempters and controls aged 15 to 54 years in rural China. Suicide acceptability was evaluated by four questions in the General Social Survey and some social psychological variables were collected in a face-to-face interview. Logistic regression analysis was performed to examine the association between suicide acceptability and suicide attempt. After controlling some social psychological variables, suicide acceptability was still associated with suicide attempt (odds ratio, 2.85; p < 0.001). Tired of living was the most acceptable reason for the medically serious suicide attempters (32.7%). Suicide acceptability should be assessed when we evaluate an individual's suicide risk. The results contribute to our understanding about suicide acceptability, and they may also be translated into practice in suicide prevention.

Cognitive emotion regulation strategies among Chinese adolescents having unprotected sex: a latent profile analysis

The association between cognitive emotion regulation strategy use and adolescents' risk behavior has long been emphasized. To identify coping profiles of Chinese adolescents having unprotected sex and to examine the characteristics and associations among those subgroups, 541 adolescents (age, 14-19 years) were screened from secondary schools in 10 Chinese cities. By latent profile analysis (LPA), the participants were identified into three latent profiles: the low reaction profile (LRP, N = 70), the medium reaction profile (MRP, N = 369), and the high reaction profile (HRP, N = 102) based on nine subscales of the Cognitive Emotion Regulation Questionnaire (CERQ). By one-way analysis of variance, chi-square tests, and multivariate logistic regression analysis, we found that: the HRP has the highest level of using eight strategies and the lowest unprotected sex, meanwhile the LRP has the lowest level of using nine strategies and the highest unprotected sex among three groups (both p < .05). The low response coping was more prevalent among boys and younger students. It indicates that more active cognitive coping, using both adaptive and maladaptive strategies, may associate with less unprotected sex. The programs of enhancing active copying may be targeted in interventions aiming to reduce adolescent unprotected sex.

Positive and negative life events and reasons for living modulate suicidal ideation in a sample of patients with history of suicide attempts

BACKGROUND

The influence of life events on suicidal behavior remains inconclusive, while reasons for living (RFL) may be protective.

OBJECTIVES

To analyze the association between positive and negative life events and suicidal ideation (SI) and the interaction between life events and RFL on SI.

METHOD

Patients with history of suicide attempts (n = 338) underwent a comprehensive clinical evaluation, including SI (Beck's Suicidal Ideation scale), RFL (Reasons for Living Inventory, RFLI) and life events (family, school, student or professional, social, health and religion-related and other life events) during the last twelve months.

RESULTS

The only negative life events associated with SI were health-related events (OR = 2.01 95%CI[1.04;3.92]). Family-related positive life events and RFL were negatively associated with SI (OR = 0.73 95%CI[0.58;0.91] and OR = 0.98 95%CI[0.97;0.98], respectively). No significant interaction between the number of positive life events and RFLI total score with current SI (p = 0.57) was detected. Family-related positive life events and RFL did not have any additive effect on SI. Positive life events did not moderate the association between health-related negative life events and SI.

LIMITATIONS

This was a retrospective study, the presence of axis II disorders was not investigated and results cannot be generalized due to the sample choice (only suicide attempters).

CONCLUSIONS

Patients with history of suicide attempts could be less sensitive to negative life events, except for those related to health. Clinicians should pay more attention to somatic problems in patients at risk of suicide. Family support, positive psychology and therapies that strengthen RFL should be developed to prevent suicide.

Psychological Strains and Suicidal Intent: An Empirical Study to Relate the 2 Psychopathological Variables

Psychological strains are hypothesized to precede a suicidal intent that may lead to suicide, where psychological strains can be considered a function of social structure embedded with negative life events. This study aimed to test the potential relationship between psychological strains and suicidal intent in Chinese rural suicide attempters. Data regarding medically serious suicide attempters (N = 791) were gathered from county-level emergency rooms in randomly selected counties in rural China (15-54 years of age). Face-to-face interview data were obtained with semistructured instruments. Results showed that the strain variables interacted with gender in predicting degree of suicide intent in Chinese rural suicide attempters. Specifically, aspiration strain and coping strain were associated with suicide intent in Chinese male suicide attempters, whereas value strain was associated with suicide intent in Chinese female suicide attempters. This study supported the strain hypothesis in Chinese rural suicide attempters.