ArticlesRisk factors for suicide in China: a national case-control psychological autopsy study
Introduction
Analysis of recent mortality data from the Chinese Ministry of Health1 shows that suicide is the fifth most important cause of death in the country, accounting for about 287 000 deaths per year. The WHO 1999 World Health Report2 suggests that suicide is China's fourth most important public-health problem in terms of disability-adjusted life years (DALYs) lost. In China, the rural suicide rate is three-fold the urban rate and there are more suicide deaths among women than men. These patterns are different from those reported in other parts of the world.1, 3 The reasons for this difference and for the relatively high rate of suicide in China are unknown.
To better understand the risk factors for suicide in China, and to develop a suicide-prevention plan specific to this country, we did an unmatched case-control study to identify the characteristics and causes of suicide in the country. We used the psychological autopsy method4, 5 to compare characteristics of people who died by suicide with those of people who died by other types of injury.
Section snippets
Study population
In most case-control studies of suicide, the control group comprises living individuals,6, 7, 8 but we decided to have a control group of people who had died of other causes, because of important methodological advantages4, 5, 9 that are especially relevant in our setting. With a control group of deceased individuals, the sources of information used to assess risk factors are informants who have recently experienced the death of a family member or close associate—and are therefore more
Results
Of the 1220 deaths selected for detailed investigation, appropriate respondents could not be located in 67 cases, participation was refused in 65, data were lost in the mail in 22, and the psychiatric interview was incomplete in one (figure). The median time from death to interview was 11 months (IQR 8–14). The median combined interview time for each case was 3·4 h (2·8–4·2).
In 80 (7·5%) of the 1065 deaths available for analysis, we decided on a cause of death that differed from that recorded
Discussion
Cost-effective ways to address the health scourges faced by developing countries, such as HIV/AIDS, tuberculosis, smoking, depression, and suicide are needed. However, strategies must be developed with a detailed understanding of how biological, social, economic, and cultural variables interact to produce the local constellation of risk factors, protective factors, and treatment networks for these conditions. During the 6 years it took to complete this project, we became aware of the myriad of
References (34)
- et al.
Suicide rates in China 1995–99
Lancet
(2002) - et al.
Psychiatric illness and risk factors for suicide in Denmark
Lancet
(2000) Identification of suicide risk factors using epidemiologic studies
Psychiatr Clin North Am
(1997)The World Health Report 1999
(1999)- et al.
Specific characteristics of suicide in China
Acta Psychiatr Scand
(2001) - et al.
Assessment in absentia: the value of the psychological autopsy method for studying antecedents of suicide and predicting future suicides
- et al.
The psychological autopsy approach to studying suicide: a review of methodological issues
J Affect Dis
(1998) Suicides and serious suicide attempts: two populations or one?
Psychol Med
(2001)- et al.
Are risk factors for suicide universal? A case control study in India
Acta Psychiatr Scand
(1999) The psychological autopsy: methodological considerations for the study of adolescent suicide
Suicide Life—Threat Behav
(1989)
Exploring adult mortality in China: levels, patterns and causes
Structured clinical interview for DSM-IV Axis I disorders
Chinese classification of mental disorders diagnostic criteria
Diagnostic and statistical manual of mental disorders
Statistical methods for rates and proportions
The meaning and use of the area under the receiver operating characteristic (ROC) curve
Radiology
A note on general definition of the coefficient of determination
Biometrika
Cited by (691)
Sex difference in association between suicide attempts and lipid profile in first-episode and drug naive patients with major depressive disorder
2024, Journal of Psychiatric ResearchSuicide risk of chronic diseases and comorbidities: A Korean case-control study
2024, Journal of Affective DisordersSuicide prevention in India
2024, Mental Health and PreventionCharacteristics and symptomatology of major depressive disorder with atypical features from symptom to syndromal level
2023, Journal of Affective Disorders