The acceptability of suicide among rural residents, urban residents, and college students from three locations in China: a cross-sectional survey

Suicide attempts in the absence of depression: Differences between broad cultural groups

Suicide is one of the leading causes of death worldwide (WHO, 2021). Depression is a common precursor to suicide and suicidality; however, individuals' experience of depression and the meaning of suicide differs depending on one's cultural background (Colucci, 2013; Goodmann et al., 2021; Kleinman, 2004). The current study explores the relationship between suicide and depression among six broad cultural groups in a large sample (N = 17,015) of adults representing six broad cultural groups (Latin America, South Asia, former Soviet Bloc, Western English-speakers, Chinese, and Arab World). Participants were recruited to a multilingual depression and suicide screening study via Google Ads (Leykin et al., 2012; Gross et al., 2014). As expected, the presence of depression was associated with suicide attempts. However, cultural group moderated this association, with Chinese participants being most likely to report suicide attempts while screening negative for depression. Although depression remains an important predictor of suicidality, it appears that certain cultural groups may be at higher risk even when depression is not present. Clinicians should consider using culturally adapted assessments for depression and suicidality.

Finished with Life Anyway and Then Stigmatized for Attempting Suicide-An Overview

This article provides an overview of suicide and how society deals with it. Starting from early societal imprints through historical, religious and political influences, the origins of stigmatization are addressed. Even today, suicidal people experience stigmatization not only from society but also from the health system that treats suicidal people. This has far-reaching consequences for the people affected and runs counter to optimal treatment. Different approaches to a possibly improved handling of suicidality will be discussed.

Comparison of Stigmatization of Suicidal People by Medical Professionals with Stigmatization by the General Population

Stigmatization of suicide (SOS) affects help-seeking for suicidality and impedes successful treatment. This study aimed to identify different types of stigmatization and understand the causes and glorification of suicide by comparing three groups; within each of the following groups, the impact of age and gender was explored: (1) practicing medical professional in direct contact with suicidality (psychotherapists, psychiatrists, related medical professions (nurses, etc.)), (2) future medical professionals still in training, (3) and the general population with no professional contact with suicidality. German adults completed an online survey with a total of 742 participants. A MANCOVA was calculated with age and gender being controlled as covariates, due to different distribution. Practicing professionals showed significantly higher levels of SOS than the other groups, while the future professionals showed no differences in SOS from the general population. The understanding of suicide causes was similar across all groups. Men showed higher levels of SOS than women, while women scored higher at understanding of causes and glorification of suicide. Within the individual groups, female professionals in the age group "36-65 years" stigmatized suicide most, while showing the least glorification. The results suggest that tendencies towards SOS are promoted by practical experience with suicidality. Therefore, special training is recommended to reduce SOS.

Social Support and Suicide Risk Among Chinese University Students: A Mental Health Perspective

Background: World Health Organization recognizes suicide as a public health priority. This study aimed to investigate the risk life events which led university students to consider suicide and explore the protective mechanism of social support (including subjective support, objective support, and support utilization) on suicide risk. Methods: Three thousand nine hundred and seventy-two university students were recruited in Harbin, China. Social Support Rating Scale, Self-Rating Anxiety Scale, the Beck Depression Inventory, and the 25-item scale of suicide acceptability were used to collect participants' information. Descriptive statistics, Pearson's correlation, and mediation analysis were employed for statistical analysis. Results: "Drug addict," "infected with HIV," and "incurable illness" were the top three events that led university students to consider suicide. Social support played an important protective role against suicide risk. Subjective support and support utilization had total effects on suicide acceptability, including direct and indirect effects. Anxiety (indirect effect = -0.022, 95% CI = -0.037 ~ -0.009) and depressive symptoms (indirect effect = -0.197, 95% CI = -0.228 ~ -0.163) mediated the relationship between subjective support and suicide acceptability; meanwhile, the association between support utilization and suicide acceptability was mediated by anxiety (indirect effect = -0.054, 95% CI = -0.088 ~ -0.024) and depressive symptoms (indirect effect = -0.486, 95% CI = -0.558 ~ -0.422). However, the protective impact of objective support worked totally through decreasing anxiety (indirect effect = -0.018, 95% CI = -0.035 ~ -0.006) and depressive symptoms (indirect effect = -0.196, 95% CI = -0.246 ~ -0.143). Moreover, the mediation effects of depressive symptoms had stronger power than anxiety in the impact of social support on suicide risk. Conclusions: Among Chinese university students, suicide acceptability was elevated when there was a health scare. Social support effectively reduced suicide risk via decreasing anxiety and depressive symptoms. From the mental health perspective, families, peers, teachers, and communities should work together to establish a better social support system for university students, if necessary, help them to seek professional psychological services.

Relationship between Internet addiction, susceptible personality traits, and suicidal and self-harm ideation in Chinese adolescent students

BACKGROUND AND AIMS

Internet addiction (IA) is common among young students. This study aimed to examine the influence and mechanisms of IA and susceptible personality traits on the impact of suicidal ideation in adolescent students in China.

METHODS

This cross-sectional study (09/2012-09/2015) used stratified cluster sampling with "school type" for stratification; 136,266 students from 63 schools completed the questionnaire. Logistic regression analysis was performed to estimate the effect of IA (Young's Internet Addiction Test) and susceptible personality (Barratt impulsiveness scale, Buss & Perry Aggression Questionnaire; and Eysenck Personality Questionnaire-R Short Scale) on suicidal ideation (Scale of Suicidal Ideation).

RESULTS

Suicidal ideation was observed in 20,218 (14.77%) of the students, and IA was detected in 28,836 (21.16%) subjects. Compared with those without IA, students with IA had a higher prevalence of suicidal ideation (P < 0.0001). No planning impulsiveness had a predictive effect on suicidal ideation in the impulsive personality trait, while in the aggressive personality trait, hostility and self-aggression had a predictive effect on suicidal ideation (all P < 0.0001). High psychoticism and neuroticism were impact factors for suicidal ideation, but extroversion was a protective factor (all P < 0.0001).

DISCUSSION

These results highlight the importance of assessing personality traits and reducing IA as a possible means of lessening suicidal ideation. Susceptible personality (such as high psychoticism, high neuroticism, and low extroversion) play a prominent role in influencing the probability of having suicidal behavior among those recently exposed to IA.

CONCLUSIONS

IA and susceptible personality traits were significantly correlated with suicidal and self-harm ideation among adolescent students.

Nonfatal Suicidal Behaviors of Chinese Rural-to-Urban Migrant Workers: Attitude Toward Suicide Matters

OBJECTIVE

To examine the attitude toward suicide (ATS) and its influence on nonfatal suicidal behaviors of Chinese rural-to-urban migrant workers (MWs).

METHOD

Altogether, 3031 MWs completed the positive ATS Scale and structured questions regarding lifetime suicide ideation, plan, and attempt. Mental health help-seeking behaviors of MWs were also investigated.

RESULTS

Overall, MWs held a more negative ATS than the Chinese general population. The lifetime prevalence of suicide ideation, plan, and attempt was 5.5%, 1.3%, and 1.1%, respectively. After controlling for lifetime depressive disorders and other covariates, a negative ATS was still significantly associated with lower risk of lifetime suicide ideation (OR = 0.32), plan (OR = 0.22), and attempt (OR = 0.26). MWs with a negative ATS were more likely to talk to others and seek help by online/telephone consultation for their mental health and suicidal problems (p < .05). A more positive ATS was significantly associated with male gender, low education level, ethnic minority of Miao, low monthly income, and originating from western China.

CONCLUSIONS

The majority of MWs hold a negative ATS, which significantly contributes to their relatively low risk of nonfatal suicidal behaviors. The more help-seeking from others and online/telephone consultation in MWs with a negative ATS may lower their risk of nonfatal suicidal behaviors.

The personal experience of severe suicidal behaviour leads to negative attitudes towards self- and other's suicidal thoughts and behaviours: A study of temperaments, coping strategies, and attitudes towards suicide among medical students

The attitudes individuals have towards suicidal behaviour, be it their own or others', and their capacity for developing specific coping strategies are influenced by affective temperaments that play a significant role in emotional regulation. However, few studies have investigated these specific patterns with a view to stratify them according to the severity of suicidal behaviours in medical students. The Pearson χ2 test for the comparison of categorical variables, the t-test for independent samples of continuous variables and logistic regression analysis were used to compare the association among temperaments, coping strategies, and attitudes towards suicide in a sample of medical students who attend the School of Medicine, Genoa. Severe suicidal thoughts and behaviours relative to those who were not at risk for suicide were also revealed. The severe suicidal thought and behaviour group had significantly more anxious and cyclothymic temperaments together with a higher use of dis-adaptive, lower emotional focus coping strategies, and higher self-reproaching, criticizing, and judgemental attitudes towards suicidality compared to the no severe suicidal thought and behaviour group. The identified pattern suggests the need for clinicians to carefully consider the complex interplay of clinical features which characterize severely at risk for suicide young adults in order to develop effective and comprehensive prevention strategies.

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.

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.

The Relationship Between Regulatory Emotional Self-Efficacy and Core Self-Evaluation of College Students: The Mediation Effects of Suicidal Attitude

This study analyzed the mediation effect of a suicidal attitude from regulatory emotional self-efficacy to core self-evaluation. A measurement study was conducted among 438 college students using the Regulatory Emotional Self-Efficacy Scale, the Core Self-Evaluation Scale, and the Suicide Attitude Questionnaire. Results from the plug-in process in SPSS and the bootstrap method showed that the attitude toward suicidal behavior and the attitude toward family members of an individual who has committed suicide played a double-mediation role, from perceived self-efficacy in managing happiness to core self-evaluation. The results also showed that the attitude toward a person who committed suicide or attempted suicide played a mediation effect from perceived self-efficacy in managing curiousness to core self-evaluation. This research has great significance for improving the understanding of college students' sense of happiness and prevention for self-evaluation.

Age and sex-related differences in risk factors for elderly suicide: Differentiating between suicide ideation and attempts

OBJECTIVE

The purpose of this study was to analyze the age and sex-related differences in socio-demographic factors that influence suicide ideation and attempts in the elderly.

METHODS

The total number of subjects was 93 151, of whom 8441 belonged to the high suicide-risk group (2064 male; 6377 female). Following this identification, we investigated their socio-demographic information, health status, and depressive symptoms, which might have influenced their suicide ideation and attempts.

RESULTS

Residence in an urban area was identified as a risk factor for both male and female elderly in their 60s and 70s and female elderly in their 80s. Marital status showed a different influence on suicide ideation depending on age and sex. A negative perception of one's own health status was a significant risk factor that increased the likelihood of suicide ideation in all ages, except the female elderly in their 60s. No factor was identified that significantly influenced suicide attempts in the male elderly. However, in the female elderly, residence in an urban area and a negative perception of one's own health status were identified as significant risk factors.

CONCLUSIONS

This study revealed that factors known to influence suicide ideation in the elderly from previous studies, such as residence area, separation from a spouse, education level, religion, and drinking, show changed influence as the elderly reach their 70s and 80s. However, a negative perception of one's own health status was a risk factor that encompassed most ages and sexes.

Suicidal Plans and Attempts Among Adolescents in Mongolia

BACKGROUND

Although 75% of suicides occur in low- and middle-income countries, few studies have examined suicidal behaviors among young people in these countries.

AIMS

This study aimed to examine what individual characteristics were associated with suicidal plans and attempts among Mongolian youth and whether suicidal risks and behaviors varied by urban and rural locations.

METHOD

Logistic regression analyses were utilized to investigate suicidal plans and attempts among 5,393 adolescents using the Global Student Health Survey - 2013.

RESULTS

Adolescents who lived in urban areas were at higher risk for suicidal plans and behaviors than those who lived in rural areas; however, the patterns of suicidal risks were similar. Specifically, individual characteristics, such as being female, feeling lonely and worried, smoking cigarettes, drinking alcohol, and having fights at school, were associated with suicidal plans and behaviors regardless of the residential places.

LIMITATIONS

A number of important variables have not been included in the questionnaire such as depression, family and parental support, household income, family constructs etc.

CONCLUSION

Given the comparable patterns of risk between urban and rural adolescents and the relatively high rates of suicidal plans and attempts, similar mental health services and interventions are necessitated for both urban and rural areas.

Attitudes towards suicide in urban and rural China: a population based, cross-sectional study

BACKGROUND

Suicide intervention programs have been guided by findings that attitude towards suicide and suicidal behavior may be causally linked. These findings also make it imperative to identify the factors that influence attitudes towards suicide. However, there has been little research on attitudes towards suicide among the general population, especially in low-income and middle-income countries. This population-based, cross-sectional study investigated the associated factors of attitudes towards suicide among a representative sample of urban and rural adult residents in China.

METHODS

A multi-stage, stratified random sampling approach was implemented to select participants. Data were collected by a survey using the Scale of Public Attitudes about Suicide (SPAS). The survey also collected some socio-demographic factors and suicidal history of participants. Statistical tests were conducted to identify associated factors that account for variations in attitudes towards suicide.

RESULTS

The residents in China generally hold a neutral attitude towards suicide. Attitudes towards suicide among Chinese residents were associated with age, duration of formal education, marital status, job and suicidal ideation. Different attitudinal subscales seemed not to share the same risk factors. However, gender, ethnicity, religious belief, housing style and economic status might not influence residents' attitudes towards suicide. Attitudes towards suicide among Chinese urban and rural residents generally had no statistical difference with one notable exception: opinions on whether or not suicides and suicide attempts are different phenomena.

CONCLUSIONS

Age, duration of formal education, marital status, job and suicidal ideation seem to have an impact on attitudes towards suicide among residents. Urban and rural residents have similar attitudes towards suicide with the only statistically significance difference being their opinions on whether or not suicides and suicide attempts are different phenomena.

Associations between impulsivity, aggression, and suicide in Chinese college students

Background

Although there are accumulating data regarding the epidemiology of suicide in China, there are meager data on suicidal ideation and attempts among college students. Interestingly, elevated impulsivity is thought to facilitate the transition from suicidal thoughts to suicidal behavior. Therefore, the objective of this research was to identify the associations between suicide and the personality factors of impulsivity and aggression.

Methods

This study’s sampling method employed stratified random cluster sampling. A multi-stage stratified sampling procedure was used to select participants (n = 5,245). We conducted structured interviews regarding a range of socio-demographic characteristics and suicidal morbidity. The Patient Health Questionnaire depression module (PHQ-9) was used to acquire the information about thoughts of being better off dead or hurting themselves in some ways during the past two weeks. The impulsivity symptoms in this study were assessed with the BIS-11-CH (i.e., the Chinese version of the BIS-11), and the Aggressive symptoms were assessed with the BAQ. The statistical package for social science (SPSS) v.13.0 program (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Socio-demographic variables such as ethnic and gender were compared between groups, through the use of χ² tests. The nonparametric test (k Independent Sample test, Kruskal-Wallis H) was performed to determine differences between the personality factors of impulsivity and aggression and suicide.

Results

In total, 9.1% (n = 479) of the 5,245 students reported they have ever thought about committing suicide; and 1% (n = 51) reported a history of attempted suicide (attempters). The analyses detected significant differences in scores on cognitive impulsivity (p < 0.01), when comparing individuals who only had suicidal ideation and individuals who had attempted suicide. Moreover, significant differences were found between ideators only and attempters on scores of self-oriented attack (p < .001).

Conclusions

Suicidal ideation is prevalent among Chinese university students. Students with high aggression scores were more susceptible to committing suicide. Scores on self-oriented attack and cognitive impulsivity may be important factors for differentially predicting suicide ideation and suicide attempts.

Suicide ideation and acceptability among females aged 15 to 34 years in rural China

The suicide rate of females is very close to that of males in China, in contrast to Western societies, in which the rates of male suicide outnumber those of females by three to four times. This study investigated the prevalence of suicidal ideation and prosuicide attitude (acceptability) among females of childbearing age. With the Chinese version of the Scale for Suicide Ideation and the General Social Survey questionnaire, we examined the demographic and psychological risk factors of suicide among Chinese rural young females aged 15 to 34 years. Logistic regression analysis was performed to explore the factors related to suicidal ideation and suicide acceptability. The prevalence rates of suicidal ideation and suicide acceptability among the sampled females are 22.5% and 3.8%, respectively. Education, depression, social support, hopelessness, and negative life events were significantly associated with suicidal ideation. Ethnicity, education, abortion, and depression were significantly associated with suicide acceptability. There is statistical difference between suicide ideation and acceptability. The results indicate that mental disorder remains a major risk factor of suicidal ideation. Sociodemographic and psychological characteristics are associated with suicide acceptability.

HIV and stigma in Liuzhou, China

This paper describes emergent stigma-related themes from individual descriptions of living with HIV in Liuzhou, China. Qualitative interviews were conducted with 23 people living with HIV (PLHIV). To provide contextual information, 14 public health personnel and 4 community workers in Liuzhou were also interviewed. PLHIV experienced enacted, anticipated, and internalized HIV-related stigma, which resulted in negative affective, behavioral, and physical health outcomes, including barriers to health care, preemptive self-isolation, suicidal ideation, and poverty. To lessen stigma, future programs should aim to increase HIV knowledge and empathy for PLHIV among family members, community workers, and health professionals. HIV programs should also include suicide risk assessment for PLHIV, especially immediately after diagnosis and at the onset of HIV-related symptoms.

Permissive attitude toward suicide and future intent in individuals with and without depression: results from a nationwide survey in Korea

Many previous studies have revealed that individuals with depression have higher thought of suicide, although not always exhibiting intent. We investigated the associated factors with respect to intent for suicide in the future. A total of 1584 adults were selected through a nationwide multistage probability sampling, randomly one person per household, and through face-to-face interviews (response rate was 63.4%) using the suicidality module of the Mini-International Neuropsychiatric Interview and the Patient Health Questionnaire-9. The group with depression (n = 152) revealed a significantly higher level of future suicide intent (t = 4.65, p <0.0001) and permissive attitude (t = 4.32, p <0.0001) than did the group without depression, which regarded suicide as free from life suffering, a personal right, and a solution to a difficult situation. After adjusting for all variables in the multiple logistic regression models, permissive attitude (adjusted odds ratio, 3.69; 95% confidence interval, 1.97-6.89) was the only factor significantly associated with future suicide intent, whereas age; sex; education years; monthly income; financial, job, and family stress; physical illness; lifetime suicide attempt; and depression showed no statistical significance. The group with depression showed significantly higher levels of future suicide intent than did the group without depression in those who had a higher permissive attitude (t = 4.18, p <0.0001) but not in those who had lower permissive attitudes (t = 1.98, p = 0.067). Permissive attitude toward suicide was associated with intent for suicide in the future in individuals with depression. Permissive attitude could be evaluated and corrected to prevent suicide.