Negative life events as triggers on suicide attempt in rural China: a case-crossover study

Suicidality, perceived chronic stress, and stress-induced cortisol changes of individuals with schizophrenia

The associations of suicidality with stress are poorly studied in schizophrenia. The study aimed to determine whether suicidality was correlated with perceived chronic stress and the cortisol fluctuations under stress tasks in schizophrenia. High suicidality was defined as a lifetime history of suicide attempts or suicidal ideation in the past 2 weeks. Individuals with schizophrenia and high suicidality (SZ-HS, n = 59), with low suicidality (SZ-LS, n = 207), and healthy controls (HC, n = 196) finished the Perceived Stress Scale. Then, they participated in an experiment that induced stress using the Paced Auditory Serial Addition Task and the Mirror Tracing Persistence Task. Negative affect was measured at baseline and after finishing each task. The salivary cortisol was collected before-, after 20 min, and after 40 min of the tasks. SZ-HS had elevated perceived stress than SZ-LS and HC. Mixed effect models showed that stress tasks induced cortisol changes in all groups; cortisol of SZ-LS was reduced more than HC, but SZ-HS and SZ-LS did not differ in cortisol fluctuations. SZ-HS and SZ-LS experienced similar negative affect changes during tasks and the difference in withdrawal rates was nonsignificant. SZ-HS had an increased error rate than SZ-LS. In conclusion, suicidality was correlated with high-level perceived stress but did not result in differences in cortisol reactivities under stress tasks. It suggests the inconsistency between appraisal of stress and biological stress system disturbance among SZ-HS compared to SZ-LS.

Association between negative life events through mental health and non-suicidal self-injury with young adults: evidence for sex moderate correlation

BACKGROUND

Non-suicidal self-injury (NSSI) has exhibited an increasing trend in recent years and is now globally recognized as a major public health problem among adolescents and young adults. Negative life events (NLEs) are positively associated with NSSI. We sought to explore (1) whether sex plays a role in the risk of NLEs leading to NSSI and (2) the role played by mental health (MH).

METHODS

We adopted a multi-stage cluster sampling method to select college students across four grades from May to June 2022. Generalized linear models were used to evaluate the relationships between NLEs, sex, MH and NSSI, presented as incidence-rate ratios (RRs) with 95% confidence intervals (CIs). We examined the complex relationship between these variables using the PROCESS method for moderation analysis.

RESULTS

Following the exclusion of data that did not meet the study requirements, data from 3,578 students (mean age: 20.53 [± 1.65] years) were included. Poisson regression results indicate that high-level NLEs (RR = 0.110, 95%CI: 0.047-0.173) are associated with increased NSSI. Furthermore, interaction effects were observed among sex, NLEs and NSSI. MH and sex moderated the relationship between NLEs and NSSI.

CONCLUSION

Identifying risk factors for NSSI is also important when exploring the interaction between NLEs and MH given the potential for NSSI to significantly increase the risk of later psychopathological symptoms and substance abuse problems. In addition, the significance of sex differences in risk factors for NSSI should be determined. This study evaluated how the impact of NLEs on NSSI can be reduced among adolescents from multiple perspectives.

Suicide attempts in the adult Mexican population: an analysis of sociodemographic characteristics and associated factors

OBJECTIVE

Suicide is the culmination of a process or continuum known as suicidal behavior that proceeds from ideation and planning to attempt. The objective was to estimate the prevalence of suicide attempts in the adult Mexican population and to analyze their main associated factors.

METHODS

We conducted an observational, cross-sectional, and descriptive study with information from the National Health and Nutrition Survey (2018). Self-reported lifetime suicide attempt was used in the analysis. We analyzed depression, obesity, tobacco smoking, and alcohol consumption as suicide attempt-associated factors using a multivariate logistic regression model.

RESULTS

The prevalence of adult suicide attempt was 2.0% (95%CI 1.8-2.2) and it was higher among women (2.4%; 95%CI 2.2-2.8) and young people (2.9%; 95%CI 2.4-3.4). Low education (OR=1.6; 95%CI 1.2-2.2), being single (OR=1.3; 95%CI 1.0-1.6), having obesity (OR=1.4; 95%CI 1.1-1.8), consumption of alcohol (OR=2.4; 95%CI 1.7-3.4) or tobacco smoking (OR=1.8; 95%CI 1.4-2.4), and having strong symptoms of depression (OR=10.1; 95%CI 6.2-16.3) were associated with a higher prevalence of suicide attempts.

CONCLUSION

These results help better understand suicidal behavior in Mexico and identify the factors that increase the likelihood of suicide attempts, which is essential to help reduce suicide mortality. This research is crucial for developing early interventions and prevention programs aimed at reducing suicide's public health burden.

The role of effective factors on suicidal tendency of women in Turkey

Background/Aim

This study aims to identify the variables that influence the suicidal tendency of women who are married, have had a relationship or are currently in a relationship in Turkey.

Methods

This study uses cross-sectional data from the 2014 Hacettepe University Institute of Population Studies National Research on Domestic Violence Against Women in Turkey. Data from 6,458 women between the ages of 15 and 49 were analyzed in this dataset. Binary logistic regression was used to determine the factors influencing women's suicidal tendencies.

Results

Based on the analysis's findings, age, education level, health status, number of children, the sector in which the spouse/partner works, the drinking status of the spouse/partner, the situation where the spouse/partner fights with another man in a way that involves physical violence, the cheating status of the spouse/partner, the controlling behaviour of the spouse/partner, exposure to various types of violence by both the spouse/partner and someone other than the partner, and the household income level variables were found to be associated with the suicidal tendency of women.

Conclusion

Prioritizing women who are, in particular, between the ages of 15 and 24, live in the south of Turkey, have a high school education, are in poor health, are childless, have low household incomes, live with an unemployed spouse or partner, and are exposed to various forms of violence from their partner or other sources can be achieved more effective results in reducing and preventing women's suicidal behaviors.

Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks

Although suicide is a leading cause of preventable death worldwide, current prevention efforts have failed to substantively mitigate suicide risk. Suicide research has traditionally relied on subjective reports that may not accurately differentiate those at high versus minimal risk. This narrative review supports the inclusion of objective task-based measures in suicide research to complement existing subjective batteries. The article: 1) outlines risk factors proposed by contemporary theories of suicide and highlights recent empirical findings supporting these theories; 2) discusses ongoing challenges associated with current risk assessment tools and their ability to accurately evaluate risk factors; and 3) analyzes objective laboratory measures that can be implemented alongside traditional measures to enhance the precision of risk assessment. To illustrate the potential of these methods to improve our understanding of suicide risk, the article reviews how acute stress responses in a laboratory setting can be modeled, given that stress is a major precipitant for suicidal behavior. More precise risk assessment strategies can emerge if objective measures are implemented in conjunction with traditional subjective measures.

Stressful Life Events and Near-term Suicidal Risk in a Clinical Population

The present study examined 22 specific stressful life events (SLEs) in relation to recent and prospective suicidal thoughts and behaviors (STBs). The effect of assessment method (self-report vs. chart-based ratings) and inpatient/outpatient status was also investigated. Past 3-month STBs and SLEs were assessed for 1,058 psychiatric patients; 696 completed one-month follow-up assessments. SLEs were common, with 684 participants (64.7%) reporting at least one. Total number of SLEs correlated with recent and prospective STB. A higher incidence of SLE's was found with self-report vs. chart-based measures (on 20 SLEs) and inpatients vs. outpatients (on 7 SLEs). SLEs of interpersonal rejection and loss, homelessness and academic failure offered elevated risk. In sum, SLEs are common and associated with STBs in psychiatric patients. SLEs of interpersonal rejection and loss, homelessness and academic failure may merit increased clinical attention.

Assessment of risk factors for suicidal behavior: results from the Tehran University of Medical Sciences Employees' Cohort study

Introduction

Suicide is a major issue of concern for public health. It is estimated that suicide accounts for 700,000 deaths every year. A personal history of one or more suicide attempts is the most important determinant of suicide among the general population. This study aimed to assess the major risk factors associated with suicidal behaviors among Iranian employees in a medical setting.

Methods

In this study, 3,913 employees of Tehran University of Medical Sciences who participated in the employees' cohort study conducted by the university were recruited. Suicidal behaviors (SBs) and their associated risk factors were evaluated using the World Mental Health Composite International Diagnostic Interview (CIDI) Version 3.0. Univariate and multivariate logistic regressions were performed to identify the determinants of SBs among the participants, and crude and adjusted odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs) were calculated.

Results

Overall, 49.6% of respondents (n = 1,939) reported that they were tired of life and thinking about death. The lifetime prevalence rate of suicidal ideation (SI) was 8.1% (n = 317), that of suicide planning (SP) was 7.3% (n = 287), and that of suicide attempts (SA) was 3.1% (n = 122). Being female (OR: 1.87, CI: 1.64-2.12), being divorced (OR: 3.13, CI: 1.88-5.22), having a low level of education (OR: 1.57, CI: 1.15-2.14), and working in clinical and medical services (OR: 1.25, CI: 1.09-1.43) were associated with being tired of life and thinking about death. These factors were also associated with SI, SP, and SA.

Discussion

These findings highlight the need to prioritize mental health for suicide prevention, especially for high-risk groups, in workplace mental health promotion programs and policies.

Physical injuries as triggers for self-harm: a within-individual study of nearly 250 000 injured people with a major psychiatric disorder

BACKGROUND

Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown.

OBJECTIVE

To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders.

METHODS

By using population and secondary care registers, we identified all people born in Finland (1955-2000) and Sweden (1948-1993) with schizophrenia-spectrum disorder (n=136 182), bipolar disorder (n=68 437) or depression (n=461 071). Falls, transport-related injury, traumatic brain injury and injury from interpersonal assault were identified within these subsamples. We used conditional logistic regression models adjusted for age and calendar month to compare self-harm risk in the week after each injury to earlier weekly control periods, which allowed us to account for unmeasured confounders, including genetics and early environments.

FINDINGS

A total of 249 210 individuals had been diagnosed with a psychiatric disorder and a physical injury during the follow-up. The absolute risk of self-harm after a physical injury ranged between transport-related injury and injury from interpersonal assault (averaging 17.4-37.0 events per 10 000 person-weeks). Risk of self-harm increased by a factor of two to three (adjusted OR: 2.0-2.9) in the week following a physical injury, as compared with earlier, unexposed periods for the same individuals.

CONCLUSIONS

Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders.

CLINICAL IMPLICATIONS

Mechanisms underlying the associations could provide treatment targets. When treating patients with psychiatric illnesses, emergency and trauma medical services should actively work in liaison with psychiatric services to implement self-harm prevention strategies.

Relationships between negative life events and suicidal ideation among youth in China: The direct and moderating effects of offline and online social support from gender perspective

Background

Suicidal ideation was proved to be a critical precondition leading to the occurrence of subsequent suicidal behavior. Studies have confirmed that negative life events and forms of social support that youth are experiencing in the current socio-cultural context might have unique impacts on their suicidal ideation. However, the specific mechanism is relatively underexplored.

Objective

We sought to investigate the impacts of offline and online social supports on Chinese students’ suicidal ideation under the pressure of various negative life events, as well as potential gender differences in these relationships.

Methods

Participants were 2,018 middle – high school and university students from Northwestern China, who completed a demographics questionnaire and self-report measures of negative life events, social support, and suicidal ideation.

Results

Offline social support had a significant direct effect on suicidal ideation across genders. Among male youth, offline social support only had a moderating effect on the relationship between punitive negative life events and suicidal ideation. Among female youth, offline social support had a significant moderating effect on suicidal ideation under the pressure of all types of negative life events; Online social support only had a significant direct effect on female youth’s suicidal ideation, although it did significantly moderate the relationship between all types of negative life events and suicidal ideation, across genders.

Conclusion

Our findings revealed direct and moderating effects of offline and online social support on suicidal ideation among youth under the pressure of different types of negative life events, as well as gender-specific patterns in these relationships.

Various Types of Negative Life Events Among Youth Predict Suicidal Ideation: A Cross-Sectional Study Based on Gender Perspective

We sought to investigate potential gender differences in various types of negative life events and suicidal ideation among Chinese high school and university students, as well as to analyze the interrelations between different types of negative life events and suicidal ideation among these young students. Participants were 2,018 high school and university students from northwestern China, who completed a demographics questionnaire and self-report measures of negative life events and suicidal ideation. Significant gender differences emerged in the types of negative life events reported and in students’ degree of suicidal ideation. Within each gender group, different types of negative life events were predictive of the intensity of suicidal ideation. The present study provides evidence of the role of negative life events in predicting adolescents’ and young adults’ suicidal ideation regardless of their gender. However, gender differences did emerge in the specific type of negative life events that were predictive of suicidal ideation. For males, greater reports of punishment and adaptation had a significant positive impact on the intensity of their suicidal ideation. For females, greater reports of academic stress, personal loss, interpersonal relationships, and adaptation were all significantly and positively predictive of their suicidal ideation. Parents’ marital status emerged as a significant indicator of suicidal ideation across genders, while age was significant negative predictor of suicidal ideation among females only.

The Narrative-Crisis Model of suicide and its prediction of near-term suicide risk

Despite decades of research, much remains unknown about the transition from chronic to imminent suicidal risk. In the context of COVID-19, this question is even more urgent. The present study tests a novel, stepwise model of this transition, termed the Narrative-Crisis Model. This model proposes that, in people with chronic risk factors, stressful life events can trigger a specific progression of cognitive-affective responses (the suicidal narrative and the suicide crisis syndrome), resulting in increased near-term risk of suicidal thoughts and behavior (STB). Identification of each step in this progression provides opportunities for more precise interventions. Concurrent validity was tested with 732 psychiatric patients and predictive validity with 524 participants, assessed one to two months later. Chronic risk factors were measured with the Childhood Trauma Questionnaire, Relationship Styles Questionnaire, and UPPS-P Impulsive Behavior Scale; acute risk factors with the Stressful Life Events Questionnaire, Suicide Narrative Inventory, and Suicide Crisis Inventory. The Columbia Suicide Severity Rating Scale was administered at the initial research assessment and follow-up. Indirect effects were significant for the full model and most pathways, in both concurrent and prospective analyses. In sum, this study provides empirical support for a novel, stepwise model of the progression from chronic to near-term suicidal risk.

Effects of vitamin D-related gene polymorphisms on attempted suicide

OBJECTIVE

Emerging evidence suggests that vitamin D might protect from attempted suicide. The study aimed to investigate the associations between single-nucleotide polymorphisms (SNPs) related to vitamin D levels identified in a large genome-wide association study and attempted suicide in rural China.

METHODS

This 1:1 matched case-control study included altogether 510 suicide attempters and 510 community controls. Genotypes of four target SNPs (DHCR7-rs12785878, CYP2R1-rs10741657, GC-rs2282679, and CYP24A1-rs6013897) were determined, and a genetic risk score (GRS) was constructed to evaluate the combined effect of them. Demographic and psychological information was acquired through face-to-face interviews.

RESULTS

The A allele of CYP24A1-rs6013897 was significantly associated with attempted suicide (OR = 1.27, 95% CI, 1.03-1.58, P = 0.029), even after adjusting for demographic and psychological confounders (adjusted OR = 1.53, 95% CI, 1.01-2.30, P = 0.043). The GRS analyses revealed a significantly higher risk of attempted suicide with a greater number of low vitamin D alleles (adjusted OR = 1.33, 95% CI, 1.13-1.58, P < 0.001). Subgroup analyses stratified by sex indicated that the genetic associations were only significant among males with adjusted ORs of 3.77 (95% CI, 1.56-9.10) for the A allele of rs6013897 and 2.04 (95% CI, 1.32-3.17) for GRS.

CONCLUSIONS

Our findings identity CYP24A1-rs6013897 as a potential biomarker for attempted suicide and indicate that a genetic predisposition to lower vitamin D levels may contribute to attempted suicide. It suggests the possibility that vitamin D may have the preventive potential for attempted suicide.

Epidemiologic Characteristics of Suicide in Panama, 2007–2016

Background and objectives: We aim to describe the demographic characteristics associated with suicide in Panama, to estimate the suicide mortality rate and years of potential life lost (YPLL) to suicide, and to explore the correlation of suicide rates with the Multidimensional Poverty Index (MPI). We present a descriptive retrospective epidemiological report of suicide-related mortality (Panama, 2007–2016). Materials and Methods: Data were matched-merged to calculate unadjusted suicide mortality rates (overall, and by sex, age groups, and administrative region), YPLL, and coefficients (r) for the correlation of MPI and suicide rates. Results: There were 1475 deaths by suicide (86% among men, 47% between 20 and 39 years). The average mortality rate was estimated at 3.91 per 100,000 population with an average YPLL rate of 3.79 per 1000 population. There was a statistically significant trend to reduce YPLL over time (r = −0.93; p< 0.001). Exploratory analyses did not show a significant correlation between the MPI and suicide rates. Our study showed a 6:1 male-to-female ratio of suicide, mostly affecting the age groups of 20–29 and over 80 years. Conclusions: Exploratory analyses on the correlation of the MPI and the suicide rates did not achieve statistical significance, and alternative explanations, such as access to pesticides and alcohol, were further explored to inform potential interventions.

Assessment of Risk Factors for Suicide Among US Health Care Professionals

Importance

Burnout among health care professionals has been increasingly associated with suicide risk. An examination of possible risk factors may help in the prevention of suicide among health care professionals.

Objective

To assess suicide risk factors for 3 categories of health care professionals (surgeons, nonsurgeon physicians, and dentists) compared with non-health care professionals.

Design, Setting, and Participants

Data from the National Violent Death Reporting System were reviewed to identify all individuals who died by suicide in the United States between January 1, 2003, and December 31, 2016. Individuals were divided into health care professionals and non-health care professionals (general population), with the health care professionals further categorized into surgeons, nonsurgeon physicians, and dentists. The covariates of suicide decedents included demographic characteristics (age, sex, race, and marital status), medical history (mental illness, substance use, and physical health), and documented factors associated with the suicide death (job, intimate partner, financial, legal, and other problems). Data were analyzed from October 2 to December 17, 2019.

Main Outcomes and Measures

In this analysis, the outcome variable was occupation, with health care professionals overall and by category compared with the general population. Multiple logistic regression analyses with backward stepwise selection were performed.

Results

A total of 170 030 individuals who died by suicide between 2003 and 2016 were identified. Of those, 767 individuals (0.5%) were health care professionals (mean [SD] age, 59.6 [15.6] years; 675 men [88.0%]; 688 white [89.7%]), with the remainder of the sample (95.5%) comprising the general population (mean [SD] age, 46.8 [31.5] years; 77.7% men; 87.8% white). A total of 485 health care professionals (63.2%) were nonsurgeon physicians, 179 professionals (23.3%) were dentists, and 103 professionals (13.4%) were surgeons. Compared with the general population, risk factors for suicide among health care professionals included having Asian or Pacific Islander ancestry (odds ratio [OR], 2.80; 95% CI, 1.96-3.99; P < .001), job problems (OR, 1.79; 95% CI, 1.49-2.17; P < .001), civil legal problems (OR, 1.61; 95% CI, 1.15-2.26; P = .006), and physical health problems (OR, 1.40; 95% CI, 1.19-1.64; P < .001) and currently receiving treatment for mental illness (OR, 1.45; 95% CI, 1.24-1.69; P < .001). Compared with the general population, health care professionals had a lower risk of suicide if they had black ancestry (OR, 0.55; 95% CI, 0.36-0.84; P < .001) or were female (OR, 0.44; 95% CI, 0.35-0.55; P < .001) or unmarried (OR, 0.36; 95% CI, 0.31-0.42; P < .001). Health care professionals who died by suicide were also less likely to have problems with intimate partners (OR, 0.71; 95% CI, 0.60-0.86; P < .001) or alcohol use (OR, 0.58; 95% CI, 0.45-0.73; P < .001) compared with the general population. Surgeons had a higher risk of suicide compared with the general population if they were older, male, married, had Asian or Pacific Islander ancestry, were currently receiving treatment for mental illness, or had problems with their job or alcohol use. Compared with their nonsurgeon physician colleagues, surgeons had a higher risk of suicide if they were male, older, married, or currently receiving treatment for mental illness.

Conclusions and Relevance

This study highlights risk factors for suicide among health care professionals, with additional analyses of surgeon-specific risk factors. The results may be useful in improving the detection of burnout and the development of suicide prevention interventions among health care professionals.

Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case-crossover study

OBJECTIVE

Clinician narrative style in electronic health records (EHR) has rarely been investigated. Clinicians sometimes record brief quotations from patients, possibly more frequently when higher risk is perceived. We investigated whether the frequency of quoted phrases in an EHR was higher in time periods closer to a suicide attempt.

DESIGN

A case-crossover study was conducted in a large mental health records database. A natural language processing tool was developed using regular expression matching to identify text occurring within quotation marks in the EHR.

SETTING

Electronic records from a large mental healthcare provider serving a geographic catchment of 1.3 million residents in South London were linked with hospitalisation data.

PARTICIPANTS

1503 individuals were identified as having a hospitalised suicide attempt from 1 April 2006 to 31 March 2017 with at least one document in both the case period (1-30 days prior to admission) and the control period (61-90 days prior to admission).

OUTCOME MEASURES

The number of quoted phrases in the control as compared with the case period.

RESULTS

Both attended (OR 1.05, 95% CI 1.02 to 1.08) and non-attended (OR 1.15, 95% CI 1.04 to 1.26) clinical appointments were independently higher in the case compared with control period, while there was no difference in mental healthcare hospitalisation (OR 0.99, 95% CI 0.98 to 1.01). In addition, there was no difference in the levels of quoted text between the comparison time periods (OR 1.09, 95% CI 0.91 to 1.30).

CONCLUSIONS

This study successfully developed an algorithm to identify quoted speech in text fields from routine mental healthcare records. Contrary to the hypothesis, no association between this exposure and proximity to a suicide attempt was found; however, further evaluation is warranted on the way in which clinician-perceived risk might be feasibly characterised from clinical text.

Examining the mechanisms by which adverse life events affect having a history of self-harm, and the protective effect of social support

BACKGROUND

Psychological models of suicide emphasize perceptions of negative stressors, hopelessness and self-harm as key antecedents to suicidal thoughts/acts. Such models also emphasize the potential protective role of social support in these pathways. However, such pathways have not been tested using population level data. Hence, this study aimed to redress this gap.

METHODS

Questionnaire data regarding 24,444 patient suicide deaths were analysed. All individuals died between 1996 and 2015 and were seen by secondary mental health services in England within 12 months before their death. Mediation analyses, using fitted logistic regression models, investigated direct and indirect pathways between negative stressors, hopelessness and a proxy measure of suicide, namely, self-harm history. In addition, the buffering effects of social support were examined in these pathways.

RESULTS

There was a direct effect of negative life events on suicidal behaviors. Supporting contemporary psychological models of suicide, a mediated effect via hopelessness and a protective effect of social support were identified. Social support buffered the pathway between stressful life events and hopelessness, with hopelessness decreasing as social support increased.

LIMITATIONS

Causal inferences are inappropriate as the design was cross-sectional. A proxy measure of suicidality was utilized (history of self-harm) as all individuals had died by suicide.

CONCLUSIONS

This is the first time that population data has been used to test psychological pathways to suicidal acts involving negative stressors, hopelessness and social support. Psychological interventions should focus on increasing social support following negative life events together with ameliorating perceptions of hopelessness.

Factor Structures of General Health Questionnaire-12 Within the Number of Kins Among the Rural Residents in China

The 12-item general health questionnaire (GHQ-12) has been extensively used with Chinese population. Yet, it has not been used from a national representative survey in rural China. The aim of this study was to examine how number of kins associated with the factor structures of the CHQ-12 among the rural residents in China. Data were obtained from the 2009 rural-to-urban migrants survey (RUMiC). Exploratory factor analysis (EFA) (principal component analysis with varimax rotation) was performed to identify factor structures of GHQ-12 regarding number of siblings, age ranking, and number of children. To investigate the reliability of the questionnaire, Cronbach’s alpha was used. Internal consistency was assessed by confirmatory factor analysis (CFA). In all, 32171 rural residents in China from 2009 RUMiC participated in the study. The mean age of the respondents was 37.03 (SD = 19.21) years. The psychometric properties and factor structures of the GHQ-12 used were described. All of the fit indices in CFA models were satisfactory. The two-factor and three-factor structures gathered the satisfactory fit indexes in the part of 2009 subsamples. The rural version of the GHQ-12 was reliable measures of psychological distress among the rural residents in China with respect to number of kins. The two-and three-factor structures derived from the present sample, with good model fit in the CFA analysis, which suggested that two-and three-factor solution could be used to assess mental health of rural residents in rural China.