Negative life events and attempted suicide in rural China

Stress events and stress symptoms in Chinese secondary school students: gender and academic year characteristics of the relationship

Objective

To explore the relationship between stress events and stress symptoms and their gender and academic year characteristics in Chinese secondary school students.

Methods

4,995 secondary school students were investigated by the Adolescent Self-rating Life Events Checklist (ASLEC) and the Calgary Symptoms of Stress Inventory (C-SOSI).

Results

First, there were significant differences in all dimensions and total scores of stress events and stress symptoms between boys and girls in secondary school and between junior high school students and senior high school students. Second, the dimensions and total scores of stress events in secondary school students are positively correlated with the dimensions and total scores of stress symptoms. Third, the influence of punishment on the stress symptoms of secondary school boys is the most obvious, and the influence of punishment, adaption, relationship stress, and learning stress on the stress symptoms of secondary school girls is the most obvious. The influence of punishment on the stress symptoms of junior high school students is the most obvious, and the influence of punishment and relationship on the stress symptoms of senior high school students is the most obvious.

Conclusion

Stress events and stress symptoms of Chinese secondary school students have significant differences in gender and academic year. The same stress event has different influence mechanisms on the stress symptoms of Chinese secondary school students of different genders and different academic years.

History of suicide attempt associated with amygdala and hippocampus changes among individuals with schizophrenia

Abnormalities in subcortical brain structures may reflect higher suicide risk in mood disorders, but less is known about its associations for schizophrenia. This cross-sectional imaging study aimed to explore whether the history of suicide attempts was associated with subcortical changes among individuals with schizophrenia. We recruited 44 individuals with schizophrenia and a history of suicide attempts (SZ-SA) and 44 individuals with schizophrenia but without a history of suicide attempts (SZ-NSA) and 44 healthy controls. Linear regression showed that SZ-SA had smaller volumes of the hippocampus (Cohen's d = -0.72), the amygdala (Cohen's d = -0.69), and some nuclei of the amygdala (Cohen's d, -0.57 to -0.72) than SZ-NSA after adjusting for age, sex, illness phase, and intracranial volume. There was no difference in the volume of the subfields of the hippocampus. It suggests the history of suicide attempts is associated with subcortical volume alterations in schizophrenia.

Predicting the risk of suicide attempt in a depressed population: Development and assessment of an efficient predictive nomogram

The purpose of this study was to develop and validate a user-friendly suicide attempt risk nomogram in depression, supporting timely interventions by clinicians. We collected clinical data of 273 depressed patients from January 2020 to January 2021. Suicide attempt was assessed conducting the Mini International Neuropsychiatric Interview. First, optimized features were filtrated through the least absolute shrinkage and selection operator regression analysis. Subsequently, we selected variables with nonzero coefficients and entered them into multiple logistic regression model and nomogram function to construct a visual predicting suicide attempt model. Additionally, the C-index, calibration plot and decision curve analysis, were applied to assess discrimination, calibration, and clinical practicability. Finally, the bootstrapping validation was applied to assess internal validation. Finally, eleven clinical features are screened out in the prediction nomogram. The model presented tiptop calibration and pleasant discrimination with a C-index of 0.853. A towering C-index value, up to 0.799, could also be attained in the interval validation analysis. In addition, decision curve analysis exhibited that our predictive model is clinically effective when the threshold is no less than 1%. These results demonstrate this predictive model was helpful for clinicians assessing the inpatient's suicide attempt recently and implementing individualized treatment strategies.

Early marriage, stressful life events and risk of suicide and suicide attempt: a case-control study in Iran

BACKGROUND

Early Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs.

METHODS

A case-control study was conducted based on the registry for suicide in Malekan county in Iran during 2016-18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel-Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders.

RESULTS

The proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10-15 years, while no association was found for age groups of 26-40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19-9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA.

CONCLUSIONS

We found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors.

Understanding the Reasons for Suicide Among Older Adults in Rural China Using In-Depth Interviews

Background: Suicide is a complex public health problem. Suicide rates are higher in rural areas than in urban areas and among older adults than any other age group in China. Aims: This study aimed to acquire a comprehensive understanding of rural older adults' reasons for suicide through qualitative exploration and to provide additional insights for suicide prevention work. Method: In-depth interviews were conducted with people familiar with older adults who had died by suicide ("informants"). The data were analyzed using a thematic approach. Results: Data were available for 242 people who died by suicide. Informants identified two or more reasons for suicide among most people who had died. Physical illness, psychological distress, and interpersonal conflicts were the most common reasons. The rate of mental disorders as diagnosed by psychiatrists was higher than that reported by the informants. Limitations: Information bias is inevitable because of the use of proxy informants. Conclusion: The reasons for suicide are complex and diverse, and research on suicide should focus more on the mechanisms of interaction between reasons. Greater attention should be paid to physical and mental health as well as to improving interpersonal and problem-solving skills for older adults in China.

High cellphone use associated with greater risk of depression among young women aged 15-24 years in Soweto and Durban, South Africa

BACKGROUND

The ubiquity of cellular phone (cellphone) use in young people's daily lives has emerged as a priority area of concern for youth mental health.

OBJECTIVE

This study measured the prevalence of depression and its association with high cellphone use among youth in Soweto and Durban, South Africa.

METHODS

We analysed cross-sectional, baseline survey data among youth aged 16-24 who participated in a dual-site cohort study, 'AYAZAZI', conducted from 2014 to 2017. The primary outcome was depression using the 10-item Center for Epidemiologic Studies Depression Scale, with a score of ≥ 10 indicating probable depression. Cellphone use was measured via self-reported average number of hours of active use, with 'high cellphone use' defined as daily usage of ≥ 8. Multivariable logistic regression models assessed the independent relationship between high cellphone use and probable depression, adjusting for potential confounders.

RESULTS

Of 425 participants with a median age of 19 years (IQR = 18-21), 59.5% were young women. Overall, 43.3% had probable depression, with a higher prevalence among women (49.0% vs. 34.9%, P = .004). Nearly all (94.6%) owned a cellphone. About one-third (29.5%) reported spending ≥ 8 hours per day using their cellphone (39.3% of women vs. 14.9% of men, P < .001). In the overall adjusted model, youth reporting high daily cellphone use had higher odds of probable depression (aOR: 1.83, 95% CI: 1.16-2.90). In gender-stratified models, high daily cellphone use was associated with probable depression among women (aOR: 2.51, 95% CI: 1.47-4.31), but not among men (aOR: 0.87, 95% CI: 0.35-2.16).

CONCLUSIONS

Among a cohort of South African youth, we found a high prevalence of probable depression and high cellphone use (30%). The findings indicate a need for intersectoral initiatives focused on meaningful mental health support for South African youth to support positive growth and development.

The Young Lives Matter study protocol: A case-control study of the determinants of suicide attempts in young people in India

Suicide is the second leading cause of death among young people in India. Over 40% of all suicides occur in people between 15 and 29 years of age. Suicide attempts are estimated to be 15 times more common than suicides and substantially increase the risk of subsequent death. However, there has been little systematic study of the determinants for suicide attempts in young people, which makes it difficult to design contextually appropriate and comprehensive suicide prevention strategies for this population. The proposed case-control study seeks to address this knowledge gap by studying a range of risk and protective factors for suicide attempts in young people in India. Field work will be in Yashwantrao Chavan Memorial Hospital (YCMH) hospital, in Pimpri-Chinchwad, Pune, India. Cases will be 15-29-year-old individuals admitted to the hospital with self-inflicted non-lethal injuries and poisoning. They will be matched for age and gender with those presenting at the General Medicine outpatient department with other health complaints. In each group, 150 persons will be recruited from YCMH from October 2019 to September 2022 and will undergo a comprehensive semi-structured interview. The primary exposure variable is negative life events over the past 12 months. Secondary exposure variables considered include: demographic characteristics, psychological factors, addictive behaviours, personal resources, adverse experiences over their lifetime, social support, suicidal behaviours in the family and social environment, and exposure to suicide-related information. Data will be analysed using conditional logistic regression. Following completion of the study, workshops will be held with young people, mental health professionals and policy makers to develop a theory of change that will be used to promote suicide prevention. Results will be disseminated via peer-reviewed publications, reports to young people and mental health organisations, and news articles. The study was approved by the Institutional Review Board at Sangath.

Stressful life events and hopelessness in adults: the mediating role of mentalization and emotional dysregulation

Objective:

Hopelessness is considered a risk factor for several mental and behavioral disorders. Research has shown that a stressful life event can be a significant predictor of hopelessness. The aim of the current research study was to explore the relationship between stressful life events and hopelessness, as well as to analyses the mediation effect of both mentalization and emotional dysregulation on this relationship.

Methods:

In a cross-sectional design, 607 participants recruited from the Spanish general population completed a series of measures.

Results:

Hopelessness was significantly related to stressful life events (r = 0.24, p < 0.001), emotion dysregulation variables (r = 0.18/0.38), and most measures of mentalization (r = 0.02/0.34). A good-fitting structural equation modeling-based mediation model (χ²/df = 2.04; root mean squared error of approximation = 0.042 [90%CI 0.033-0.050]; comparative fit index = 0.97; non-normed fit index = 0.97) showed that mentalization significantly mediated the relationship between stressful life events and hopelessness, while emotion dysregulation had no significant mediating effect.

Conclusions:

These results could have important clinical implications, such as the development of mentalization-based interventions for people living under a large number of stressors.

The Role and Comparison of Stressful Life Events in Suicide and Suicide Attempt: A Descriptive-Analytical Study

Background: In recent years, suicide in Iran has become a growing concern. Although stressful life events (SLEs) are increasing as a global prevalence, suicide attempters (SAs) and the impact and association between suicide and SLEs are poorly understood. Objectives: This study aimed at examining the role and effect of SLEs in suicides and SAs. Methods: This descriptive-analytical study was performed during 2014 to 2016 based on 186 records (through random quota sampling) of suicidal behaviors (SBs), including 154 SAs and 32 suicide cases in Malekan County, East Azerbaijan, Iran. A valid semi-structured Life Event questionnaire (LEQ) with 43-items of common types of SLEs in the last year before SBs was used by trained interviewers through single sitting and face to face interviews. The point-biserial correlation and multiple logistic regression analysis were utilized to estimate the adjusted odds ratios and confidence intervals for suicide risk. Results: A significant correlation was found between SLEs scores and suicide (R = 0.739). Comparing SLEs types between the two groups of SAs and suicides, it was revealed that the highest odds ratios were related to financial problems (OR = 11.9; 95% CI = 4.00 - 35.85), early marriage (OR = 4.97; 95% CI = 1.68 - 14.65), exposure to new conditions (OR = 8.79; 95% CI = 1.3 - 59.22), and family conflicts (OR = 2.53; 95% CI = 1.23 - 6.53), respectively. Conclusions: SLEs are most strongly associated with committing suicide. Suicide determinants are different from SA. SLEs management by health systems is imperative to improve life skills in suicide prevention.

Test of a clinical model of poor physical health and suicide: The role of depression, psychosocial stress, interpersonal conflict, and panic

BACKGROUND

This study employed a structural equation model to examine the relationships between poor physical health, suicide, depression, psychosocial stress, interpersonal conflict, and panic.

METHODS

The sample consisted of a large, archived set of mental health treatment-seeking adults who completed a behavioral outcome questionnaire prior to beginning treatment.

RESULTS

Results supported the extant literature indicating that poor physical health, depression, psychosocial stress, interpersonal conflict, and panic impose increased risk for suicidal ideation, with depression demonstrating the highest risk for increased suicidal ideation. The results also supported the hypotheses that depression, psychosocial stress, interpersonal conflict, and panic would mediate the association between poor physical health and suicidal ideation. Although no a priori hypotheses were made regarding relationships among the 15 physical illnesses examined, results indicated that HIV/AIDS had the strongest correlation with depression and the weakest correlation with interpersonal conflict.

LIMITATIONS

Firstly, the study sample was primarily Caucasian, limiting its generalizability. Secondly, causal inferences should be interpreted with caution, due to the quasi-experimental design. Thirdly, these data were self-reported, which create response biases since suicidal ideation is stigmatized.

CONCLUSIONS

These findings highlight the importance of considering interpersonal factors as potential mediators in the relationship between poor physical health, mental illness, and suicide. Clinically, the impact of an active major depressive episode on an individual who is struggling with a serious physical illness may be strongly predictive of suicidal ideation.

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

This study aims to investigate the potential triggering of negative life events (NLEs) on suicide attempt in rural China. A case-crossover design was used to study 1200 suicide attempters aged 15-70 years. NLEs were assessed by a modification of Paykel's Interview for Recent Life Events. NLEs had significant triggering effects on the day of and month of suicide attempt. Marriage/love, family/home, and friend/relationship were the types of NLEs found to trigger suicide attempt when occurring on the day and month of suicide attempt. Specifically, increased risk of suicide attempt was associated with quarreling with a partner or family member on the day and month of suicide attempt. Being disappointed in a love affair, fighting with a partner, family poverty and loss of face during the month of attempts were linked to increase odds of suicide attempt. Further, when month of suicide attempt was assigned as the case period, the impact of NLEs on suicide attempt was greater among those who were younger and without mental disorders. These findings provide knowledge of the triggering of NLEs on suicide attempt, especially among the young and those without mental disorders. Further, family conflicts should be a greater focus of attention in suicide prevention.

Association of polymorphisms in HTR2A, TPH1, and TPH2 genes with attempted suicide in rural China

OBJECTIVE

We aimed to test the association of polymorphisms in HTR2A, TPH1, and TPH2 genes with attempted suicide in rural China.

PARTICIPANTS AND METHODS

On the basis of a case-control study, we recruited 1200 pairs of participants from Shandong Province, China. The blood samples of 712 suicide attempters and 739 nonsuicide attempters were collected finally. We tested seven single nucleotide polymorphisms: rs6313 and rs6311 in HTR2A, rs4537731, rs1800532, and rs1799913 in TPH1, and rs4448731 and rs4641527 in TPH2.

RESULTS

In univariate analysis, allele C of rs4537731 was associated negatively with attempted suicide among total and male samples; however, the association was not statistically significant in multivariate analysis after adjusting for other potential confounding factors. No association between other six single nucleotide polymorphisms and attempted suicide was found in the total, male, or female samples.

CONCLUSION

This study did not support the effect of these seven serotonergic gene polymorphisms on attempted suicide in rural China.

Suicide contagion, gender, and suicide attempts among adolescents

Exposure to suicidal behavior (ESB) through social networks is often associated with an increased risk of suicidality, but empirical research-largely limited to the Western populations-has produced mixed results. Using survey data, we examined (a) the association between ESB and suicide attempt, and (b) the exacerbating role of ESB on gender differences in suicide attempt risk among Turkish adolescents (N = 2035). ESB was significantly associated with increased risk of suicide attempt, and it contributed to the higher attempt risk among girls. Suicidal behaviors spread through social networks via ESB, and suicide contagion exacerbates the existing gender differences.

Relationship between mortality in people with mental disorders and suicide mortality in China during 2000 to 2014: An observational study

Suicide is one of the top 10 causes of death in many countries. Although there are many studies on mental disorders, few studies have examined mortality in suicide population and mentally ill population. This study examined the association between mortality and mental disorders using data on suicides and mental disorders in China. Data from China's Health and Family Planning Statistical Yearbook for 2000 to 2014 were used to analyze the relationship between mortality associated with suicide and mental disorders. The analyses found that mortality among people with mental disorders dropped from 5.42/10 million in 2000 to 2.68/10 million in 2014, decreased more among females than males, and differed between urban and rural areas; that suicide mortality dropped from 10.79/10 million in 2000 to 6.79/10 million in 2014; the decrease was greater in women than in men, with suicide being highest among male residents of cities; and no significant correlation was found between mortality among persons with mental disorders and suicide mortality. There was no correlation between suicide mortality and mental-disorder mortality during 2000 to 2014; however, overall mortality decreased more among females than males during this period.

Associations between negative life events and anxiety, depressive, and stress symptoms: A cross-sectional study among Chinese male senior college students

The aims of this study were to explore the associations between negative life events and anxiety, depressive, and stress symptoms among male senior college students who experience negative life events in daily life. Data were obtained from 582 male senior college students recruited from universities in Chongqing China. Participants completed the Adolescent Self-rating Life Events Checklist (ASLEC), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Socio-demographic information, lifestyle information, and a blood sample were acquired. 39 (6.7%), 74 (12.7%), and 39 (6.7%) subjects were depressed, anxious, and stressed, respectively. The results confirmed that negative life events were positively related to mental health problems. Different types of negative life events had their specific associations with being depressed, anxious, or stressed. With respect to different types of negative life events, subjects with more "interpersonal relationship" related problems had a higher probability of being anxious and stressed; whereas, subjects with more "change for adaptation" related problems had a higher probability of being depressed and anxious. These results indicate that more concerns over the events with both high occurrence rate and severity might be helpful to mental health prevention and promotion for senior college students.

The Impact of Negative Life Events on Attempted Suicide in Rural China

This study aims to explore the impact of negative life events (NLEs) on attempted suicide in a Chinese cultural setting. The sample comprised 791 suicide attempters and an equal number of controls matched on age, sex, and location from selected rural counties in China. Conditional logistic regression model was used to examine the association between NLEs and suicide risk. The impact of NLEs on attempted suicide was further examined using regression-based method to explore its mediation effect. The types of NLEs that were most likely to precede a suicide attempt in rural sample included the events in marriage/love, family/home, and friend/relationship. Rural women were more likely to experience more interpersonal conflicts than rural men. Approximately 75.6% of suicide attempters had experienced at least one NLE, and NLEs were strongly associated with attempted suicide. Total effect (0.676), direct effect (0.501), and the total indirect effect (0.301) of NLEs on suicide attempts were significantly mediated by hopelessness and depression. NLEs play a crucial role in predicting suicidal attempt in rural China, and they are mediated by depression and hopelessness.

Mental disorders and suicide attempt in rural China

The prevalence of various mental disorders and their age and gender specific characteristics among suicide attempters remains unclear in rural China. This study using 1:1 paired case-control design included 409 suicide attempters and 409 paired controls matched on age, gender and place of residence. Mental disorders were assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. The prevalence of mental disorders was 32.3% for suicide attempters and 4.9% for paired controls. Mental disorder constituted a significant risk factor for suicide attempt with an adjusted odds ratio of 7.16 (95%CI: 3.65-14.04). The prevalence of mental disorders was higher among male than female suicide attempters. Major depressive disorder was most common in female suicide attempters while alcohol use disorder was most common in the males. The prevalence of mental disorders seemed to increase with age. Suicide attempters of higher ages were more prone to have mood disorders, especially a major depression. Suicide attempters with mental disorders differed from those without mental disorders on a number of socio-economic characteristics and suicidal behavior features. These insights should be taken into account in strategies and efforts to improve mental health care and ultimately to reduce suicidal behavior among residents in rural China.

A self-harm series and its relationship with childhood adversity among adolescents in mainland China: a cross-sectional study

BACKGROUND

Self-harm (SH) is an emerging problem among Chinese adolescents. The present study aimed to measure the prevalence of SH behaviours and to explore the relationship between childhood adversity and different SH subtypes among Chinese adolescents.

METHODS

A total of 5726 middle school students were randomly selected in three cities of Anhui province, China, using a stratified cluster sampling method. SH was categorized into five subtypes (highly lethal self-harm, less lethal self-harm with visible tissue damage, self-harm without visible tissue damage, self-harmful behaviours with latency damage and psychological self-harm). Multivariate logistic regression was used to explore the relationships between childhood adversity and different subtypes of adolescent SH.

RESULTS

The prevalence rates of highly lethal self-harm, less lethal self-harm with visible tissue damage, self-harm without visible tissue damage, self-harmful behaviours with latency damage and psychological self-harm were 6.1, 20.4, 32.0, 20.0 and 23.0%, respectively. Childhood sexual abuse and physical peer victimization were associated with each SH subtype with adjusted odds ratios (AORs) ranging from 1.23 to 1.76. Highly lethal self-harm was associated with childhood physical peer victimization, sexual abuse, emotional abuse, and emotional neglect. The less lethal SH subtypes (i.e., less lethal self-harm with visible tissue damage, self-harm without visible tissue damage, self-harmful behaviours with latency damage and psychological self-harm) were associated with childhood peer victimization, family life stress event scores and childhood sexual abuse.

CONCLUSIONS

A high prevalence of SH exists among Chinese adolescents. The association of childhood adversity with SH merits serious attention in both future research and preventive interventions.

Social connectedness, stressful life events, and self-injurious thoughts and behaviors among young adults

OBJECTIVES

Preventing self-injurious thoughts and behaviors (SITBs) is particularly challenging on commuter campuses, given lower social cohesion and higher levels of stress than among traditional college populations. The present study examined the relationship between stressful life events (SLEs) and risk for different forms of SITBs, along with the potential buffering role of social connectedness, in a diverse sample of young adults from a commuter college.

METHODS

Participants were 1712 (81% female; 61% racial/ethnic minority; 20% sexual minority) undergraduate and graduate students from a public commuter college in New York City. Participants completed an anonymous survey that inquired about lifetime and recent (past 12months) history of suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI), along with social connectedness and lifetime history of SLEs.

RESULTS

Lower levels of social connectedness and exposure to a higher number of SLEs were associated with engaging in SITBs in the past year, particularly both suicide attempts and non-suicidal self-injury. However, social connectedness did not buffer against the impact of SLEs on SITBs.

LIMITATIONS

Data are cross-sectional, limiting conclusions about directionality, and females were overrepresented.

CONCLUSIONS

Identifying ways to increase social connectedness on diverse commuter campuses may help decrease risk of SITBs. However, it may not buffer against the impact of SLEs on risk of SITBs. Future studies should examine contextual variables (e.g., type and timing of social support) that may play a role in protecting against SITBs, particularly for those with a history of adversity.

Functional and dysfunctional impulsivity and attempted suicide in rural China: A paired case-control study

This study aimed to clarify the relationship between functional and dysfunctional impulsivity and attempted suicide in rural China. Data of this study came from the investigation of 407 suicide attempters and their paired non-suicide attempters matched with the same gender, age (±3 years) and residence area in six counties in rural Shandong, China. Suicide attempters accounted for a lower proportion on high functional impulsivity, but a higher proportion on high dysfunctional impulsivity than non-suicide attempters. Dysfunctional impulsivity in the male denoted a significant risk factor for attempted suicide, even after adjustment for psychiatric disorder and demographic factors. Suicide attempters with high dysfunctional impulsivity had a higher percent of family suicide history than those with low dysfunctional impulsivity. High functional impulsivity was a significant protective factor for attempted suicide in the group aged 35-59 years, but a significant risk factor in the group aged 15-34 years. Suicide attempters with low functional impulsivity had poorer economic status and older age than those with high functional impulsivity. Our findings support the key roles of functional and dysfunctional impulsivity in attempted suicide among rural residents of China.

A comparative analysis of suicide attempts in left-behind children and non-left-behind children in rural China

To estimate the prevalence of suicide attempts and explore the shared and unique factors influencing suicide risk in left-behind children (LBC) and non-left-behind children (NLBC) in rural China, this study collected data using a multi-stage cluster random sampling method from 13,952 children including 6,034 LBC and 7,918 NLBC. Sociodemographic characteristics, suicide attempts, neglect and physical abuse, negative life events, and loneliness were measured by self-reported questionnaires. Data were analyzed using logistic regression models. Gender and mother's education level were unique influential factors for NLBC while family structure type was a unique influential factor for LBC. The study provides two novel findings regarding NLBC specifically: 1. Children with optimal family socioeconomic status are more likely to report suicide attempts (odds ratio OR = 1)than are those in the general children population, OR 0.52 (95% CI: 0.39-0.70), and 2. Children with higher mother's education level are subject to higher suicide rates in high school, OR 1.67 (95% CI: 1.13-2.46), and post-secondary education, OR 2.14 (95% CI: 1.37-3.37). The unique characteristics of LBC and NLBC in China suggest that investigating risk factors and determining the factors that might be targeted in intervention programs are urgently needed currently.

Suicide attempters with high and low suicide intent: Different populations in rural China

This paired case-control study aimed to compare characteristics between suicide attempters with high and low suicide intent in rural China. We evaluated 409 suicide attempters and their paired controls who were matched with the same gender, age (a difference of no more than 3 years), and similar residence. Compared to paired control, suicide attempt with high and low suicide intent shared the 3 common risk factors of negative life event, high depression score, and low social support score. In addition, mental disorder was an independent risk factor of suicide attempt with high intent. Having a low education level and occupation as a farmer were risk factors of suicide attempt with low intent. Mental disorder and depression were associated with a significantly increased risk of suicide attempt with high intent compared to low intent. Depression was found to be related to suicide attempt with high intent compared to low intent in the subgroups of male or female aged 35-54 or 55-70 years. Distinct characteristics were found in the suicide attempters with different intent. These findings are important and the aim is to transform them into concrete ideas for the prevention of suicide attempt in rural China.

Positive and negative life events and reasons for living modulate suicidal ideation in a sample of patients with history of suicide attempts

BACKGROUND

The influence of life events on suicidal behavior remains inconclusive, while reasons for living (RFL) may be protective.

OBJECTIVES

To analyze the association between positive and negative life events and suicidal ideation (SI) and the interaction between life events and RFL on SI.

METHOD

Patients with history of suicide attempts (n = 338) underwent a comprehensive clinical evaluation, including SI (Beck's Suicidal Ideation scale), RFL (Reasons for Living Inventory, RFLI) and life events (family, school, student or professional, social, health and religion-related and other life events) during the last twelve months.

RESULTS

The only negative life events associated with SI were health-related events (OR = 2.01 95%CI[1.04;3.92]). Family-related positive life events and RFL were negatively associated with SI (OR = 0.73 95%CI[0.58;0.91] and OR = 0.98 95%CI[0.97;0.98], respectively). No significant interaction between the number of positive life events and RFLI total score with current SI (p = 0.57) was detected. Family-related positive life events and RFL did not have any additive effect on SI. Positive life events did not moderate the association between health-related negative life events and SI.

LIMITATIONS

This was a retrospective study, the presence of axis II disorders was not investigated and results cannot be generalized due to the sample choice (only suicide attempters).

CONCLUSIONS

Patients with history of suicide attempts could be less sensitive to negative life events, except for those related to health. Clinicians should pay more attention to somatic problems in patients at risk of suicide. Family support, positive psychology and therapies that strengthen RFL should be developed to prevent suicide.

Characteristics of suicide completers and attempters in rural Chinese population

OBJECTIVE

This study aimed to compare the similarities and differences between suicide completers and attempters in rural China.

METHODS

Two paired case-control studies of completed suicide and suicide attempts were conducted in rural Shandong, China. This analysis included 409 suicide attempters (SA) with a mean age of 43.90 (SD=13.31), 117 suicide completers (SC) with a mean age of 50.38 (SD=13.02) and their controls matched by gender, age (within 3years), and residence. Logistic regression models were used to examine risk factors of suicide attempts and completed suicide and the differences between SA and SC.

RESULTS

Compared to their matched controls, suicide attempters and completers shared the following common risk factors: low levels of education (middle school or under) (OR, 95% CI: 2.79, 1.40-5.55 for SA and 16.98, 1.59-181.60 for SC), negative life events (OR, 95% CI: 7.37, 4.73-11.50 for SA and 21.08, 4.74-93.71 for SC), and mental disorders (OR, 95% CI: 7.52, 3.85-14.69 for SA and 22.39, 2.65-189.60 for SC). Compared to suicide attempts, completed suicide was associated with the following risk factors: male gender (OR, 95% CI: 1.75, 1.06-2.90), advancing age (OR, 95% CI: 1.02, 1.00-1.04), poor family economic status (OR, 95% CI: 6.74, 3.22-14.13), prior suicide attempts (OR, 95% CI: 2.43, 1.18-4.97), family suicide history (OR, 95% CI: 2.59, 1.33-5.06), high suicide intent (OR, 95% CI: 1.15, 1.05-1.27), and highly lethal methods (OR, 95% CI: 13.65, 6.51-28.59).

CONCLUSIONS

Although suicide completers and attempters share some common risk factors, suicide completers are more likely to have prior suicide attempts, family suicide history, and higher suicidal intent, and to use highly lethal methods in rural Chinese.

In my end is my beginning: developmental trajectories of adverse childhood experiences to late-life suicide

OBJECTIVES

Converging evidence suggests that the sequelae of adverse childhood experiences (ACEs) including childhood abuse (e.g., sexual, physical, emotional/verbal abuse, neglect) and other ACE (e.g., family dysfunction, parental loss, parental psychopathology, substance abuse, incarceration, and domestic violence) have pronounced effects on suicidal behaviors (suicidal ideation, attempts, and death by suicide) in older age. There are fundamental changes in the developmental trajectory of biological, psychological and behavioral processes that result from ACE and that exert influence throughout the life span. Different moderators and mediators may affect the extent and nature of the relationship. However, the literature on the specific mechanisms whereby ACE affects suicidality in later life has not been well identified.

METHOD

We review and draw from extant multidisciplinary evidence to develop a heuristic framework through which to understand how ACE may lead to suicide in later life.

RESULTS

Proposed mechanisms span biological factors (neurological, gene-environment), psychiatric and health functioning, and psychosocial development (cognitive biases, coping resources, interpersonal deficits). Evidence suggests that ACEs affect each of these constructs, and it is likely in the interaction of these constructs with late-life stressors that suicidality in older adulthood emerges.

CONCLUSION

ACEs have persistent and multifaceted effects on suicidality in late life. This association is due to multi-varied pathways. It is believed that the explanatory framework developed herein--in which biological, psychological and behavioral factors are organized, and the role of late-life stressors is highlighted--will spark further scientific inquiry into this important area.

Increase in Suicide Rates by Hanging in the Population of Tabasco, Mexico between 2003 and 2012

BACKGROUND

Worldwide, the suicide rate is decreasing. To examine changes in the rates of completed suicide in the Mexican population from 2003 to 2012, we analyzed these changes according to: (i) the method of suicide; (ii) age group and (iii) gender.

METHODS

The data analyzed were obtained from governmental organizations from the State of Tabasco, Mexico. The data provided 1836 cases of subjects born and residing in Tabasco, who completed suicide in this state.

RESULTS

Suicide by hanging was a common choice of suicide method for Mexicans. The rate of suicide by hanging increased from 5.80 to 6.49 per 100,000 persons between 2003 and 2012, a rate percentage increase of 11.89%.

CONCLUSIONS

Hanging was found to be the most common choice of suicide in the Mexican population, probably because the materials required are easily available and the method does not require complicated techniques, especially in the 55-64 age group. Strategies for prevention and intervention should be developed for the Mexican population considering suicide rates by age group and gender.