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

Associated Factors of Suicidal Behavior Among Persons with Physical Disability: A Systematic Review

Background

Suicide is common among persons with physical disabilities as they face several physical, social, psychological, and economic problems. They are at risk for suicidal thoughts, behaviors, and death by suicide. We aimed to systematically review empirically published articles and identify the associated factors of suicidal ideation and suicide attempts in persons with physical disabilities.

Methods

A systematic search was carried out on the literature published from January 1, 2000 to January 19, 2023 in PubMed, Cochrane, Web of Science, Google Scholar, Shodh Ganga, and so on. All the synonyms of keywords or MeSH terms for suicidal ideation, suicide attempt, and physical disability were used. Two hundred thirty-six articles were found, and after following inclusion and exclusion criteria, 12 remained.

Result

The associated factors of suicidal behavior were disability status (11/12 studies), burdensomeness (8/12 studies), felt stigma (4/12 studies), depressive symptoms (6/12 studies), loneliness (2/12 studies), lack of social and emotional connectedness (2/12 studies), long-term physical or mental disability (2/12 studies), congenital disability (1/12 studies), and aggression (1/12 studies).

Conclusion

Timely, evidence-based, low-cost interventions can provide great assistance and address the specific needs of this vulnerable population as they have higher risk for suicidal behavior.

Do neoliberal values provide a fertile soil for suicidal ideation?

BACKGROUND

Values associated with neoliberal ideologies are blamed for damaging the social fabric. They may also have deleterious effects on suicidal ideation.

OBJECTIVE

We investigated whether neoliberal values were associated with the risk for suicidal ideation through a set of mediating factors (suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability).

METHODS

A total of 508 (249 female) adults from the U.S. responded to a self-administered questionnaire that contained measures of suicidal ideation, neoliberal values, suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability. We tested a path model that linked neoliberal values to suicidal ideation through multiple mediators. We tested total versus partial mediation models.

RESULTS

We found empirical evidence for a full mediation of the association of neoliberal values with perceived stress. Neoliberal values were associated with suicide stigma; suicide stigma was associated with negative attitudes towards help-seeking, which, in turn, were associated with high levels of perceived stress. The association of neoliberal values with suicide acceptability was partially mediated. Perceived stress was positively associated with suicide risk directly and indirectly through suicide acceptability.

CONCLUSION

Our findings suggest that values related to neoliberal ideologies prepare a context that fosters the risk for suicide. For a contextualized understanding of suicidal behavior, more research is needed that explores the role of social, cultural, political, and economic ideologies in the suicidal process.

Relationship of religion with suicidal ideation, suicide plan, suicide attempt, and suicide death: a meta-analysis

BACKGROUND

Suicide is a significant public health problem and one of the leading causes of death worldwide. The effect of religion on suicidal behaviors (i.e., ideation, plan, attempt, and death) is an important issue worthy of consideration.

METHODS

Major electronic databases, including MEDLINE, Web of Science, and Scopus, were searched for the articles published until 26 April 2021. Reference lists were also screened. Observational studies addressing the associations between religion and suicidal behaviors were also examined. Between-study heterogeneity was investigated using the χ2, τ2, and I2 statistics. The probability of publication bias was explored using the Begg and Egger tests, as well as trim-and-fill analysis. The effect size was expressed as odds ratio (OR) with 95% confidence intervals (CIs) using a random-effects model.

RESULTS

Out of 11 389 identified studies, 63 articles were eligible, involving 8,053,697 participants. There was an inverse association between religion and suicidal ideation OR  =  0.83 (95% CI: 0.78, 0.88; P < 0.001), suicidal plan OR  =  0.93 (95% CI: 0.83, 1.04; P =  0.200), suicide attempt OR  =  0.84 (95% CI: 0.79, 0.89; P < 0.001), and completed suicide OR  =  0.31 (95% CI: 0.14, 0.72; P =  0.006). There was a no evidence of publication bias.

CONCLUSIONS

The results of this meta-analysis support the notion that religion can play a protective role against suicidal behaviors. Nonetheless, the effect of religion on suicidal behaviors varies across countries with different religions and cultures. Although this association does not necessarily imply causation, an awareness of the relationship between religion and suicide risk can be of great help in suicide prevention policies and programs.

Were suicide deceased more determined to die than attempters? A comparison study based on two psychological autopsy studies

The reason that some victims of suicide behaviors survived while the others died is unknown, and few studies have been conducted for Chinese populations. We aimed to analyze the effect of suicide intent on outcomes of suicide behaviors, and to explore the impact of psychological strain on suicide intent. Data for this study was derived from two psychological autopsy research projects conducted in China. The same interview procedure and instruments were used in the two projects. Suicide intent was measured by Beck's Suicidal Intention Scale. Information on psychological strain was obtained. A total of 274 suicide deaths and 507 suicide attempters were included in the study. After controlling for socio-demographic variables, suicide intent was significantly associated with suicide death among people having suicide behaviors. Aspiration strain and coping strain were significantly associated with suicide intent. Significant intent-death association and psychological strain-suicide intent association were found in this study. Suicide intent might be an intermediate variable in the pathway from psychological strain to suicide death. Therefore, suicides might be more determined or motivated to die than those attempters who did not die of the act. Future research should continue to explore the mechanism of the psychological strain-suicide intent association, and more efforts on suicide prevention should be made from the perspective of psychological strain.

Religious affiliation and suicidality among college students in China: A cross-sectional study across six provinces

BACKGROUND

Several past studies indicated that religious beliefs, orientation, and practice are protective of suicide. Findings from recent studies in China suggest that religiosity may contribute to increased suicidality. However, few studies have examined the associations between religious affiliation across different faiths and suicidality in China.

OBJECTIVE

The current study examines the association between religious affiliation and suicidality among college students in six provinces in China.

METHODS

We conducted a cross-sectional study involving 11,407 college students from six universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, and Shaanxi. We collected the data between October 2017 and March 2018 using self-report questionnaires. They included self-report measures of depression, psychache, hopelessness, self-esteem, social support, and life purpose.

RESULTS

Participants with a Christian affiliation had 1.5 times (95% CI: 1.14, 1.99, p = 0.004) higher odds of indicating an elevated suicide risk, 3.1 times (95% CI: 1.90, 5.04, p<0.001) higher odds of indicating a previous suicide attempt, and increased overall suicidality (B = 0.105, p < 0.001) after accounting for demographic and risk/protective factors. Christians also scored the highest in depression, psychache, hopelessness, and the lowest social support, self-esteem, and purpose in life. Muslims reported decreased suicidality (B = -0.034, p = 0.031). Buddhism/Daoism yielded non-significant results in the multivariate analyses.

CONCLUSIONS

Christian college students reported increased suicidality levels, perhaps due to public policies on religion. The decreased suicidality levels among Muslims may be attributed to higher perceived social support. The associations between religious affiliation and suicidality, depression, and hopelessness contrast sharply with US samples. This finding may be influenced by interactions between the religious denomination, individual, and social/political factors. This conclusion includes the possibility of anti-religious discrimination, which this paper did not investigate as a possible mediator and therefore remains a conjecture worthy of future investigation.

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.

Stronger psychological strains increase the odds of suicide death: A comparison between suicides and suicide attempters

AIM

This study was aimed to compare the psychological strains between suicides and suicide attempters, so as to verify the hypothesis whether the stronger psychological strains increase the odds of suicide death.

METHOD

The suicide data were collected by a psychological autopsy (PA) study, and the suicide attempt data were from the same rural areas in China. Information was obtained with face to face structured questionnaires interviews. A social value conflict scale, measures of aspiration and deprivation, and Moos's Coping Response Inventory (CRI) were used to measure psychological strains. The Spearman correlation and Logistic regression method were applied to analyse and estimate the odds ratio (OR) of fatality of suicide behaviours from psychological strains.

RESULTS

The value strain, aspiration strain, deprivation strain, and coping strain were all significantly stronger among the suicides than suicide attempters (P < 0.001). Each psychological strain had statistical correlation with suicide behaviour (P < 0.001). The univariable and multivariable Logistic regressions all indicated that rural residence, being never married, and the psychological strains were the independent lethality factors of suicidal behaviours.

CONCLUSIONS

Psychological strains were the independent lethality factors of suicide behaviours. Stronger psychological strains increase the odds of suicide death. The intervention based on the Strain Theory of Suicide could decrease the odds risk of suicide death.

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.

BP neural network prediction model for suicide attempt among Chinese rural residents

OBJECTIVE

This study aimed to establish and assess the Back Propagation Neural Network (BPNN) prediction model for suicide attempt, so as to improve the individual prediction accuracy.

METHOD

Data was collected from a wide range case-control suicide attempt survey. 659 serious suicide attempters (case group) were randomly recruited through the hospital emergency and patient registration system from 13 rural counties in China. Each case was matched the control by same community, gender, and similar age (± 2 ages). Face to face interviews were conducted for each subject with structured questionnaire. Logistic regression was applied to preliminarily screen the factors and BPNN was used to establish the prediction model of suicide attempt.

RESULTS

Multivariate logistic regression indicated that family history of suicide (OR = 4.146), mental problem (OR = 3.876) Low education level, poor health, aspiration strain, hopelessness, impulsivity, depression are the risk predictors and social support, coping skills, healthy community are the protect predictors for suicide attempt. Repetitious data simulation process of BPNN indicated that three-layer BPNN with 9 hidden layer neurons is the optimal prediction model. The sensitivity (67.6%), specificity (93.9%), positive predictive value (86.0%), negative predictive value (84.1%), total coincidence rate (84.6%) manifested that it is excellent to distinguish suicide attempt case.

CONCLUSIONS

The BPNN method is applicative, feasible, credible and good discriminative effect for suicide attempt. The BPNN established has significant clinical meaning for the clinical psychiatrist and lay theoretical foundation for artificial intelligence expert assisted diagnosis system for suicide attempt in the future.