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

Epidemiological features of suicidal ideation among the elderly in China based meta-analysis

BACKGROUND

Studies on the prevalence of suicidal ideation (SI) and its associated factors among the elderly in China show considerable variability. This meta-analysis aims to clarify the epidemiological features of SI in this population.

METHODS

We systematically searched English and Chinese databases for relevant literature up to September 15, 2022. The extracted data facilitated the calculation of prevalence and odds ratios (ORs) for factors associated with SI among China's elderly.

RESULTS

We analyzed 31 cross-sectional studies, comprising a total of 79,861 participants from over 20 provinces and municipalities. The pooled prevalence of SI was found to be 11.47% [95% confidence interval (CI): 7.82-15.71%]. Significant variations in prevalence were influenced by residence, physical health (including chronic diseases and daily living capabilities), mental health (depressive symptoms and life satisfaction), economic status, and time-specific assessment tools. Notably, the prevalence from 2011-2020 (15.59%, 95% CI: 9.08-23.44%) was almost double that of 2001-2010 (7.85%, 95% CI: 5.08-11.16%). The SI prevalence in the eastern region (8.06%, 95% CI 5.59-10.94%) was significantly lower than in the central and western regions (16.97%, 95% CI 12.04-22.53%). Fourteen factors exhibited a significant pooled OR greater than 1 (p < 0.05), and two factors had ORs less than 1 (p < 0.05), indicating notable association with SI among the elderly.

CONCLUSION

SI among China's elderly showed relatively high prevalence and considerable heterogeneity across different characteristics and associated factors. This underscores the need for targeted intervention strategies and standardized temporal assessments of SI to effectively address suicide risk in this population.

The long-term changing patterns of suicide mortality in China from 1987 to 2020: continuing urban-rural disparity

BACKGROUND

Over the past three decades, China has experienced significant changes in urban-rural, gender, and age-specific suicide mortality patterns. This study aimed to investigate the long-term trends in suicide mortality in China from 1987 to 2020.

METHODS

Suicide mortality data were obtained from China's National Health Commission. Joinpoint regression analysis was used to examine changes in trends and age-period-cohort modeling to estimate age, period, and cohort effects on suicide mortality from 1987 to 2020. Net drift, local drift, longitudinal age curves, and period relative risks were also calculated.

RESULTS

Crude and age-standardized suicide mortality in China showed continuing downward trends from 1987 to 2020, with a more pronounced decrease in rural areas (net drift = -7.07%, p<0.01) compared to urban areas (net drift = -3.41%, p<0.01). The decline curve of urban areas could be divided into three substages. Period and cohort effects were more prominent in rural areas. Suicide risk was highest among individuals aged 20-24 and gradually increased after age 60. Females, particularly those of childbearing age, had higher suicide risk than males, with a reversal observed after age 50. This gender reversal showed distinct patterns in urban and rural areas, with a widening gap in urban areas and a relatively stable gap in rural areas.

CONCLUSIONS

Suicide mortality in China has consistently declined over the past three decades. However, disparities in age, gender, and urban-rural settings persist, with new patterns emerging. Targeted suicide prevention programs are urgently needed for high-risk groups, including females of childbearing age and the elderly, and to address the slower decrease and reversing urban-rural gender trends.

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

BACKGROUND

In 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.

METHODS

Official 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.

RESULTS

In 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.

CONCLUSION

Overall 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.

Female Labor-Force Participation as Suicide Prevention: A Population Study in Taiwan

OBJECTIVE

Female labor-force participation (FLFP) has been theorized as contributing to higher suicide rates, including among women. Evidence on this relationship, however, has been mixed. This study explored the association between FLFP and suicide in an understudied context, Taiwan, and across 40-years.

METHODS

Annual national labor-participation rates for women ages 25-64, and female and male suicide-rates, for 1980-2020, were obtained from Taiwan's Department of Statistics. The associations between FLFP rates and sex/age-stratified suicide-rates, and between FLFP rates and male-to-female suicide-rates ratios were assessed via time-series regression-analyses, accounting for autoregressive effects.

RESULTS

Higher FLFP rates were associated with lower female suicide-rates (ß = -0.06, 95% CI (Credibility Interval) = [-0.19, -0.01]) in the adjusted model. This association held in the age-stratified analyses. Associations for FLFP and lower male suicide-rates were observed in the ≥45 age-groups. FLFP rates were significantly and positively associated with widening male-to-female suicide-rates ratios in the adjusted model (ß = 0.24, 95% CI = [0.03, 0.59]).

CONCLUSION

This study's findings suggest that FLFP protects women from suicide, and point to the potential value of FLFP as a way of preventing suicide. In Taiwan, employed women carry a double-load of paid and family unpaid care-work. Child care-work is still done by mothers, often with grandmothers' support. Therefore, this study's findings contribute to evidence that doing both paid work and unpaid family care-work has more benefits than costs, including in terms of suicide-protection. Men's disengagement from family care-work may contribute to their high suicide rates, despite their substantial labor-force participation.

Incidence, prevalence, and mortality of schizophrenia from 2016 to 2020 in Shandong, China

The epidemiology of schizophrenia has been reported in many countries. However, due to the limitations of those studies, the findings cannot be generalized to other parts of the world, especially in China. In this study, the incidence, prevalence, and mortality of schizophrenia in Shandong, China were calculated using data from the National Severe Mental Disorder Registration System collected between 2016 and 2020 and census data from 2010 to 2020. The overall incidence decreased from 9.61 per 100,000 in 2016 to 4.40 per 100,000 in 2020, the aggregate prevalence was approximately 3.20 per 1000, and the overall mortality ranged from 6.17 per 100,000 to 7.71 per 100,000. The evidence from this study indicated that the incidence, prevalence, and mortality of schizophrenia were higher in rural areas than in urban areas. Females had higher incidence, prevalence, and mortality than males. This study provided epidemiological information on schizophrenia and opened avenues for future research.

Social Support, Psychological Strain, and Suicidality: Evidence from Chinese Universities

This study aimed to apply psychological strain theory to explore the relationship between psychological strain and suicidality among Chinese young adults with a moderating effect of perceived social support. A questionnaire was administered with the Multidimensional Scale of Perceived Social Support (MSPSS), Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Psychological Strain Scale (PSS) among 13,250 college students across China. The main determinants of suicidal behavior were examined with multiple linear regression. Two steps of multiple regression were employed to define the moderating effect of social support. A positive relationship between psychological strain and suicidality was reported in the study, and social support was confirmed as a moderating factor between psychological strain and suicidal behavior.

Epidemiological profile, temporal analysis, and future projections of suicide cases in rural cities in the extreme south of Brazil

The present study aimed to verify the time series (2000-2017) of death rates by suicide and its associated factors in 4 municipalities in the extreme south of Brazil. Data were obtained through the analysis of medical reports and police report bulletins at the Instituto Médico Legal, in the city of Rio Grande. The suicide rate in the Rio Grande region varied from 4 to 11 suicides per 100,000 inhabitants and it is estimated that by 2030 this rate could reach 16.5 suicides per 100,000 inhabitants. The rural cities of Santa Vitória do Palmar and Chuí present even higher suicide averages when compared to Rio Grande, the most populous city of the four. The death rate from suicide increased gradually in the period analyzed, with the prevalence rising among the youngest and the elderly population. A more comprehensive understanding of the influences of environmental issues on suicidal decisions constitutes an important action that needs to be taken, both because of regional vulnerabilities and the target population identified. Evidence indicates that knowledge of factors affecting individuals residing in this Brazilian region where increased suicide rates are recorded needs to be recognized as a priority.

Establishment and validation of a nomogram for suicidality in Chinese secondary school students

BACKGROUND

Accurately identifying high-risk of suicide groups and conducting appropriate interventions are important to reduce the risk of suicide. In this study, a nomogram technique was used to develop a predictive model for the suicidality of secondary school students based on four aspects: individual characteristics; health risk behaviors; family factors; and school factors.

METHODS

A total of 9338 secondary school students were surveyed using the stratified cluster sampling method, and subjects were randomly divided into a training set (n = 6366) and a validation set (n = 2728). In the former, the results of the lasso regression and random forest were combined, from which 7 optimal predictors of suicidality were determined. These were used to construct a nomogram. This nomogram's discrimination, calibration, clinical applicability, and generalization were assessed using receiver operating characteristic curves (ROC), calibration curves, decision curve analysis (DCA), and internal validation.

RESULTS

Gender, depression symptoms, self-injury, running away from home, parents' relationship, relationship with father, and academic stress were found to be significant predictors of suicidality. The area under the curve (AUC) of the training set was 0.806, while that of the validation data was 0.792. The calibration curve of the nomogram was close to the diagonal, and the DCA showed the nomogram was clinically beneficial across a range of thresholds of 9-89 %.

LIMITATIONS

Causal inference is limited due to the cross-sectional design.

CONCLUSION

An effective tool was constructed for predicting suicidality among secondary school students, which should help school healthcare personnel assess this information about students and also identify high-risk groups.

The Mediating Effect of Stress between Extracurricular Activities and Suicidal Ideation in Chinese College Students

OBJECTIVE

The objective of this study was to explore the relationship between extracurricular activities, stress, and suicidal ideation and to examine the mediating effect of stress between extracurricular activities and suicidal ideation in Chinese college students.

METHOD

A total of 6446 college students were surveyed with a web-based online data collection system using the self-made demographic questionnaire, Suicidal Behaviors Questionnaire-Revised (SBQ-R), and the 21-Item Depression Anxiety Stress Scales (DASS-21). SPSS 24.0 was used for descriptive statistics and correlation analysis, and the bootstrap method in the process procedure for SPSS Version 3.4.1 was used to construct the mediating effect model.

RESULTS

Gender, school grades, living area, and family income status were influencing factors for suicidal ideation, stress, and extracurricular activities. Extracurricular activities were negatively correlated with stress (r = -0.083, p < 0.001) and suicidal ideation (r = -0.039, p < 0.01). Extracurricular activities had no direct predictive effect on college students' suicidal ideation (c = -0.198, CI: -0.418, 0.023), while stress had a mediating effect between extracurricular activities and suicidal ideation; the indirect mediating effect was 0.159.

CONCLUSIONS

Extracurricular activities indirectly predict college students' suicidal ideation through stress. A variety of extracurricular activities can decrease the stress and suicidal ideation of college students and benefit their mental health.

Trends of suicide rates by gender and residence in China from 2002 to 2019

Objective

China has undergone tremendous social changes in the last few decades. This study aimed to research the trends of the suicide rates from 2002 to 2019, and to differentiate effects attributable to age, period, and cohort by gender and residence in China.

Methods

Suicide mortality data were obtained from China's Ministry of Health Vital Registration System. Joinpoint regression model was used to estimate the average annual percentage change (AAPC) of the suicide rates and ratios by gender and residence. The age-period-cohort framework was performed to analyze the underlying mechanisms for suicide mortality trends.

Results

Over the observation period, the significant decrease in suicide mortality rates in China for the economic development and urbanization was observed but to different degrees across gender and regional subgroups. The male-to-female ratio of suicide rates increased year by year (AAPC: 1.9%, 95% CI: 0.2% to 3.7%) while the urban-rural ratio changed little (AAPC: 0.9%, 95% CI: -1.8% to 3.7%). The age-period-cohort analysis revealed a marked increased effect of age and overall decreased effect of both period and cohort on suicide mortality rates. However, the recent cohort has presented an inversely increasing effect.

Conclusion

The suicide rate has fallen sharply in China which has undergone tremendous socioeconomic changes. The varied changes in the suicide rate of different residence-, gender-, and age-groups as well as the age, period, and cohort effect on suicide risk further indicate the relationship of development and the suicide rates may be neither static nor identical on different subgroups in a rapidly changing society.

Mortality rates for mental disorders by gender in urban and rural areas in China from 2006 to 2020: An age-period-cohort analysis

This study was to explore the trends of mortality rates for mental disorders by gender in urban and rural areas in China (2006-2020) and estimate the independent effects of age, period, and cohort on the mortality of mental disorders. This study employs data from the China Health Statistical Yearbook. The data were analysed using joinpoint regression analysis as well as age-period-cohort analysis. Results revealed the age-standardized mortality rates of mental disorders in China showed a downward trend, and women had a faster rate of decline than men over the years 2006-2020. Age, period, and birth cohort effects were statistically significant in the trend analysis of mental disorder mortality, and compared with period and cohort effects, age effects were the leading correlate of mental disorder mortality. The risk of death increased with advancing age. Our findings suggest that the mortality of mental disorders showed a downward trend, but some effective measures, especially regarding mental disorders, need to be taken to protect people with these disorders and prevent their occurrence in the setting of an ageing population.

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.

Suicide among young-old and old-old adults in rural China: A case-control psychological autopsy study

OBJECTIVE

Late-life suicide is a vital public health concern. Though gerontological research suggested the young-old and old-old phases were heterogeneous, age differences in the elderly suicide have not been well studied due to the lack of comparable control groups and small samples. The study aimed to examine the age-specific suicidal characteristics and risk factors among the young-old (60-79) and old-old (over 80) elderly.

METHODS

Two hundred and forty two suicide decedents and 242 living comparisons were enrolled in a 1:1 matched case-control psychological autopsy study in rural China: 173 young-old and 69 old-old in each group. Suicidal characteristics, demographic characteristics, living arrangements, physical health, mental disorder, and psychosocial factors were collected. We used logistic regression models to assess risk factors of suicide and test for interactions between age and each risk factor.

RESULTS

Pesticide suicide was more prevalent among young-old suicides than old-old suicides (56.07% vs. 40.58%, p = 0.029). Non-currently married, unemployment, mental disorder, higher disability in physical activities of daily living, higher hopelessness and higher depressive symptom were significantly associated with suicide among older adults. The effect of poor function in physical activities of daily living on suicide was significantly greater during younger ages (p for interaction = 0.038).

CONCLUSIONS

Findings indicated that most suicidal characteristics and risk factors for completed suicide were generally similar among young-old and old-old adults. But poor function in physical activities of daily living predicted increase suicide risk only at younger ages. In addition to common risk factors, age-specific factors should also be noted in suicide prevention.

CLINICAL TRIAL REGISTRATION

According to the ICMJE, purely observational studies (those in which the assignment of the medical intervention is not at the discretion of the investigator) will not require registration. Our study was not registered because this is a case-control study. But all procedures of the study were carried out in accordance with the latest version of the Declaration of Helsinki. The study were approved by the Institutional Review Boards of the Central South University, Shandong University, and Guangxi Medical University.