Suicide in China: Community Attitudes and Stigma

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.

Psychache, Hopelessness, and Suicidal Ideation and Behaviors: A Cross-Sectional Study from China

This study explored the relationship between variables emphasized in the theory's first step of the three-step theory (3ST)-psychache, hopelessness, and their interaction-to suicide-related variables (i.e., lifetime suicidal ideation and attempt, past-year suicidal ideation, communication of suicidal thoughts, and self-reported future suicide attempt likelihood). Chinese undergraduate students (N = 11,399; mean age = 20.69 ± 1.35) from seven provinces participated in this cross-sectional survey. They answered the Suicidal Behaviors Questionnaire-Revised, Psychache Scale, and Beck Hopelessness Scale. Bivariate and multivariate analyses were used to examine the association between psychache, hopelessness, and hopelessness × psychache interaction on the outcome variables. Bivariate analyses showed that psychache and hopelessness were correlated with suicidal ideation and behaviors. In multiple regression models, the interaction between psychache and hopelessness was significantly associated with past-year suicidal ideation and self-report chances of a future suicide attempt, p < 0.001, though effect sizes for the interaction term were small. The results are broadly consistent with the 3ST's proposition of how the combination of pain and hopelessness is related to various suicide-related variables. The low prevalence of suicide-related communication should inform future suicide prevention measures by encouraging help-seeking. Psychache as a correlate of the self-reported likelihood of a future attempt could be further investigated.

The short-term effects of individual and mixed ambient air pollutants on suicide mortality: A case-crossover study

It is critical to explore intervenable environmental factors in suicide mortality. Based on 30,688 suicide cases obtained from the Mortality Surveillance System of the Jiangsu Provincial Centre for Disease Control and Prevention, we utilized a case-crossover design, and found that the OR of suicide deaths increased by a maximum of 0.71 % (95 % CI: 0.09 %, 1.32 %), 0.68 % (95 % CI: 0.12 %, 1.25 %), 0.77 % (95 % CI: 0.19 %, 1.37 %), 2.95 % (95 % CI: 1.62 %, 4.29 %), 4.18 % (95 % CI: 1.55 %, 6.88 %), and 0.93 % (95 % CI: 0.10 %, 1.77 %), respectively, for per 10 μg/m3 increase in the particulate matter (PM) with diameters ≤ 2.5 µm (PM2.5), PM with diameters ≤ 10 µm (PM10), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and per 0.1 mg/m3 increase in carbon monoxide (CO) concentrations with the conditional logistic regression analysis. People living in county-level cities were more susceptible. Particularly, a significant positive association was found between air pollutant mixture exposure and suicide deaths (OR=1.04,95 % CI: 1.01, 1.06). The excess fraction of suicide deaths due to air pollution reached a maximum of 8.07 %. In conclusion, we found associations between individual and mixed ambient air pollutants and suicide deaths, informing the development of integrated air pollution management and targeted measures for suicide prevention and intervention. ENVIRONMENTAL IMPLICATION: As a major contributor to the global burden of disease, air pollution was confirmed by accumulating studies to have adverse impact on mental health, and potentially lead to suicide deaths. However, systematic studies on the association between air pollution and suicide mortality are lacking. We explored the associations of multiple air pollutants and pollution mixtures with suicide deaths and assessed excess suicide mortality due to air pollution, emphasizing the importance of air pollution control on suicide prevention. Our study provides evidence to support mechanistic studies on the association between air pollution and suicide, and informs comprehensive air pollution management.

Public Stigma Toward Schizophrenia Within Latino Communities in the United States

Public stigma toward those experiencing symptoms of schizophrenia in the general population is high; yet research into such stigma within the diverse Latino communities remains under-investigated. This study employed a randomized experimental vignette methodology to assess various domains of public stigma toward individuals experiencing psychosis and/or diabetes within Latino communities. A communitybased sample of 243 Latino adults participated. Contrary to our expectations, respondents who were more sympathetic toward those with mental health problems tended to score higher on public stigma. The belief that a person was responsible for their own mental health problems was associated with higher levels of stigma. Results indicate that perceptions of dangerousness toward someone experiencing psychosis were common, and the perception that a person was responsible for their mental health problems was associated with higher levels of stigma Results emphasize the complex nature of stigma within the diverse Latino communities and the need for ongoing research.

The Roles of Endorsement and Stigma in Suicidal Ideation and Behavior among Chinese College Students

Previous studies have suggested that stereotypes towards suicide, including endorsement of suicide and stigma toward suicide, may contribute to suicidal ideation and behaviors. However, this has not been examined directly. In this study, we examined whether endorsement of suicide and stigma toward suicide are involved in the pathway from suicidal ideation to suicide attempts among college students. To this end, we used the Suicidal Ideation Attributes Scale (SIDAS), the Suicidal Behaviors Questionnaire-Revised (SBQ-R), and the Stigma of Suicide Scale (SOSS) to assess suicidal ideation, suicide attempts, endorsement of suicide, and stigma toward suicide, respectively, in a sample of 944 Chinese college students (mean age, 20.97 years). Using mediation analysis, we found that suicidal ideation partially mediated the relationship between endorsement of suicide and suicide attempts and between stigma toward suicide and suicide attempts. These findings provide novel evidence that endorsement of suicide and stigma toward suicide are closely associated with suicide attempts, but partially through the influences of suicidal ideation. Future studies should elaborate on their longitudinal relationships. Implications of these findings for clinical practices are discussed with reference to the ideation-to-action framework of suicide, aiming to reduce suicidal behaviors.

Latinos' Conceptualization of Depression, Diabetes, and Mental Health-Related Stigma

Depression and diabetes are two of the most common health conditions experienced by those from Latino backgrounds. However, community-based stigma toward these health conditions may discourage those experiencing symptoms of depression or diabetes from seeking professional assistance. To assess stigma in the Latino community toward these common health conditions, a community-based sample of 469 Latino participants in a major urban area in the [Southwestern United States — Houston, TX] completed a face-to-face survey using an experimental vignette methodology. Participants were asked to name the problem that the subject of the vignette was experiencing based on the symptoms described in the vignette. This survey also inquired about public stigma toward individuals experiencing symptoms of depression and/or diabetes. Results indicate that although the majority (60%) of the sample were able to correctly identify symptoms of depression, it was more difficult for them to identify symptoms of depression with co-occurring diabetes. Overall levels of public stigma toward those experiencing depression were moderate, and co-occurring symptoms of diabetes did not moderate stigma toward those experiencing depression. These findings indicate a need for intervention approaches within the Latino community to increase health literacy related to depression and type 2 diabetes, as well as an ongoing need to reduce stigma toward those experiencing symptoms of depression. Implications for future research, practice, and health promotion are discussed.