The Gender Ratio of Chinese Suicide Rates: An Explanation in Confucianism

Sociodemographic Characteristics and Clinical Profile of Suicide Attempters Attending the Emergency Department at a Tertiary Care Hospital in Oman: A Retrospective Study

OBJECTIVE

This study examined the sociodemographic and clinical characteristics of individuals who attended the emergency department of a tertiary care center in Muscat, Oman following a suicide attempt.

METHODS

A retrospective study (N=154) was conducted between January 2015 and June 2018. Information that was collected included sociodemographic variables (age, nationality, sex, marital status, and occupation), risk (medical comorbidities, psychiatric history, substance misuse, alcohol misuse, and previous history of suicide attempts), and precipitating factors, as well as the chosen methods for the suicide attempts.

RESULTS

In all, 83.1% of the sample were Omanis, and women constituted 69.5%. The mean age of the sample was 27 years; 30% were students, 42% were unemployed, and 40.9% had a history of psychiatric disorders. Family conflict, suffering from chronic illness, and having social problems were the most common precipitating factors for the suicide attempt. The most common method used in the suicide attempt was drug overdose (48.1%), mainly involving paracetamol (acetaminophen) (40%). Significant gender differences emerged in precipitating factors, history of substance misuse, and methods of suicide.

CONCLUSIONS

The data from this study are consistent with international trends that suggest that women and younger age groups are the most vulnerable to suicide attempts. Although in its infancy, the type of research presented here could lay the groundwork for preventive interventions and programs.

Confucianism and Gender Ratios of Suicide in the World: A WHO Data-Based Study

This study explores how Confucianism affects suicide rates by gender. Data for the study come from the World Health Organization document "Suicide Worldwide in 2019", which provides frequency and gender ratios for suicide rates in 183 member countries. One-way ANOVA and multiple linear regression analysis were used to examine potential differences in suicide rates and male to female ratio of suicides. Independent variables include region, income level, culture, and Confucian values that may be related to suicide. Suicide rates for Confucian countries do not show significant differences from European countries. However, these countries have lower suicide gender ratios.

You Hurt Me, so I Hurt Myself and Others: How Does Childhood Emotional Maltreatment Affect Adolescent Violent Behavior and Suicidal Ideation?

Violent behavior and suicidal ideation are two major public health problems, with the former representing outward attack and the latter characterizing inward attack. The effects of emotional maltreatment in childhood will continue into adolescence. This study explores the impact of childhood emotional maltreatment on adolescent violent behavior/suicidal ideation and its mechanism. Participants were 3,600 adolescents (average age is 16.21 ± 0.99) from the middle east of China. They completed questionnaires measuring emotional maltreatment in childhood, deviant peer affiliation, depression, violent behavior, and suicidal ideation in adolescence. After controlling for demographic variables, we found that deviant peer affiliation and depression mediated between childhood emotional maltreatment and adolescent violent behavior/suicidal ideation. Multi-group analysis results showed that males' deviant peer affiliation would contribute to their violent behaviors. Among female groups, deviant peer affiliation and depression were risk factors for violent behavior and suicidal ideation. a) cross-sectional design was used in this study; b) all the measures were self-reported. Preventing emotional maltreatment in childhood can help reduce violent behavior and suicidal ideation by reducing deviant peer affiliation and depression in adolescence. Males who experienced emotional maltreatment in childhood are more likely to show violent behaviors shaped by external factors such as deviant peer affiliation. In contrast, females' interpersonal orientation and internalizing factors both influence their external and internal aggressive behaviors.

A systematic review of longitudinal studies of suicidal thoughts and behaviors in first-episode psychosis: course and associated factors

PURPOSES

To better assess and reduce suicidal risk in first-episode psychosis (FEP), we aimed to investigate the evolution of suicidal thoughts and behaviors (STBs) and associated factors in FEP.

METHOD

This systematic review (PROSPERO-CRD42020168050) meets PRISMA guidelines. PubMed, Medline, PsycINFO, Embase, EBM Reviews and references lists of relevant articles were searched (February 2020) to identify longitudinal studies, published in English or in French, that assessed the prevalence of STBs at entry to services and over follow-up, and examined factors associated with STBs among all persons with affective and non-affective FEP from a defined catchment area. Screening, data extraction and quality assessment using the adapted Newcastle Ottawa Scale were done independently by two reviewers. Results on prevalence and associated factors are presented by type of STB.

RESULTS

Of 3,177 references, 17 studies of 11 non-overlapping samples (n = 14,907) with varying lengths of follow-up (1-41.7 years) were included. The prevalence of STBs decreased over follow-up. Up to 21.6% made at least one suicide attempt, 27% had suicidal ideation, and 1-4.3% died by suicide during follow-up. Of 53 factors assessed across studies, only male sex, depressive symptoms, and STBs occurring early during follow-up were associated with subsequent STBs. Early intervention for psychosis decreased STBs in the first three years. Other factors were assessed in a single study, yielded conflicting results, or were not associated with STBs.

CONCLUSIONS

The high prevalence of STBs following onset of psychosis highlights the need for early detection and intervention and ongoing assessment of suicidal risk throughout follow-up, with attention to identified risk factors. The heterogeneity of the studies precluded a meta-analysis and several factors were each assessed by a single study. Additional well-designed longitudinal studies of STBs and associated factors are warranted.

A study on household headship, living arrangement, and recipient of pension among the older adults in association with suicidal risks

BACKGROUND

This study aims to examine whether variation in socioeconomic factors indicative of lower status within families in later life, such as the elderly losing their household headship, living with descendants, and having no pension are associated with suicidal risks among the older adults aged 60 years and above in the world.

METHODS

Using the data from the Global Burden of Disease Study in 2015, the suicide age ratios (i.e., suicide rate ratios between older adults aged >=60 years versus the younger groups aged <60 years) for the 173 regions were computed and compared. The suicide age ratio rather than the actual rate is used to adjust the difference in base rates among different countries. Forest plots were performed to assess whether late-life status within families moderated the worldwide patterns of suicide age ratios. Regression analyses were used to estimate the extent to which the factors reflecting family status affect suicide age ratios. Gender-specific analyses were also performed.

RESULTS

The results showed that higher suicide age ratios were significantly found in regions with lower percentages of the elderly being heads of households (ratios=1.69 vs 2.73, P<0.01), higher percentages of co-residence of the elderly with their descendants (ratios=2.72 vs 1.39, P<0.01), and lower percentages of the elderly receiving a pension (ratios=1.42 vs 2.76, P<0.01). In the adjusted regression, having no pension remained to be a significant determinant for both overall population (P = 0.01) and men (P<0.01) but not for women (P = 0.29), and loss of household headship was only significant for men (P = 0.05) but not for either overall population (P = 0.22) or women (P = 0.55), whereas the elderly living with their descendants was no longer significant for either overall population (P = 0.60) or both genders (men: P = 0.72; women P = 0.11).

LIMITATIONS

The cross-sectional data do not allow to explore causal effect analyses.

CONCLUSIONS

This is the first global study to reveal associations between lower socioeconomic status within families and higher rates of suicide among older adults aged 60 years and above compared with the younger population. Thus, the present ecological findings suggest that strategies to enhance the socioeconomic status of older adults may be important to prevent suicides in later life both within and across countries.

Association of aggression and suicide behaviors: A school-based sample of rural Chinese adolescents

BACKGROUND

To determine the prevalence of suicide behaviors and the associations between aggression and suicide behaviors among a nationwide school-based sample of adolescents in rural China.

METHODS

A total of 16,271 students from 24 junior and 23 senior high schools in five provinces of China participated in a self-administered anonymous survey to report suicide ideation, plans, attempts, aggression and other related information. Multivariable logistic regression models were used to investigate the associations between aggression and the risks of suicide behaviors while controlling for potential confounders.

RESULTS

The prevalence of suicide ideation, plans, and attempts during the past one year was 15.1%, 7.2%, and 3.5% respectively. In the fully adjusted model, participants with high level of total aggression had 4.31 times (95% CI, 3.69-5.05), 4.10 times (95% CI, 3.26-5.11), and 3.29 times (95% CI, 2.62-4.93), higher risk of suicide ideation, plans, and attempts, respectively, compared with subjects who had low level of total aggression. Moreover, high levels of all the five dimensions of total aggression also had positive associations with suicide behaviors.

LIMITATIONS

This study was cross-sectional. Hence, the causal link between aggression and suicide behaviors should be verified in the future studies.

CONCLUSIONS

This study suggests that aggression may be a risk factor for suicide behaviors among rural Chinese adolescents. Our findings highlight the importance of aggression treatment in suicide prevention programs. Further longitudinal studies are needed to confirm these associations.

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.

A systematic analysis of online broadcasts of suicidality in China

INTRODUCTION

This study attempts to analyze the epidemiological characteristics of online broadcasts of suicidality in China.

METHODS

A total of 193 incidents were identified by systematically searching for relevant news reports on the internet. A content analysis on these news reports was conducted to obtain information on the characteristics of each individual incident.

RESULTS

Of these incidents, the ratio of males to females was 1:1.7 (age: 24.6 ± 6.1 years old). Approximately 45.4% and 70.8% of incidents were located in the region of Eastern China and Southern China, respectively, and 15.7% of incidents were unemployed. The most common suicide method was wrist cutting (57.5%), and the most common suicide location was at home (35.2%). Instant messaging apps (52.8%) were most frequently used for broadcasting suicidal thoughts and actions. Relationship breakup (61.1%) was reported as the leading cause of suicide. Furthermore, of the 193 incidents, 19 indicated that they suffered from a mental disorder, and 12 revealed that they had a history of suicide attempts. There were significant gender, age, regional, and occupational differences across the categories.

DISCUSSION

This study indicates that in China, suicide prevention programmes need to target internet users.