Research report
Parent-reported suicidal behavior and correlates among adolescents in China

https://doi.org/10.1016/j.jad.2007.04.012Get rights and content

Abstract

Background

Suicidal risk begins to increase during adolescence and is associated with multiple biological, psychological, social, and cultural factors. This study examined the prevalence and psychosocial factors of parent-reported suicidal behavior in Chinese adolescents.

Methods

A community sample of 1920 adolescents in China participated in an epidemiological study. Parents completed a structured questionnaire including child suicidal behavior, illness history, mental health problems, family history, parenting, and family environment. Multiple logistic regression was used for data analysis.

Results

Overall, 2.4% of the sample talked about suicide in the previous 6 months, 3.2% had deliberately hurt themselves or attempted suicide, and 5.1% had either suicidal talk or self-harm. The rate of suicidal behavior increased as adolescents aged. Multivariate logistic regression indicated that the following factors were significantly associated with elevated risk for suicidal behavior: depressive/anxious symptoms, poor maternal health, family conflict, and physical punishment of parental discipline style.

Limitations

Suicidal behavior was reported by parents. No causal relationships could be made based on cross-sectional data.

Conclusions

The prevalence rate of parent-reported suicidal behavior is markedly lower than self-reported rate in previous research. Depressive/anxious symptoms and multiple family environmental factors are associated with suicidal behavior in Chinese adolescents.

Introduction

Suicide represents a major worldwide social and public health problem with about one million deaths and 10–20 million attempters in the world each year (National Center for Injury Prevention and Control, 2002). China has by far the world's largest number of reported suicides: about 300,000 each year, comprising 42% of all suicides worldwide and 56% of all suicide in women (Lee and Kleinman, 2000). A recent national estimation reported an annual suicide rate of 23 per 100,000; two times higher than the average global rate (Phillips et al., 2002a). Among young adults aged 15–34 years, suicide accounts for 19% of all deaths and is the leading cause of death. Unlike most other countries, suicide rates in women are much higher than in men, with 25% higher than that for men (Phillips et al., 2002a). Psychological autopsy studies from different parts of the world show that over 90% of suicide victims have current mental disorders (Hawton and van Heeringen, 2000). However, only about half of suicide victims in China are known to be associated with psychiatric disorders (Phillips et al., 2002b, Zhang et al., 2004). Despite high suicide rates and unique epidemiological characteristics of suicide in China and non-fatal suicidal behaviors being a major risk factor for completed suicide in the future, relatively little is known about epidemiological characteristics of non-fatal suicidal behavior and its risk and protective factors in Chinese youths.

Recently, our group has reported suicidal behavior and risk factors in a sample of 1362 adolescents in a rural prefecture of China (Liu, 2004, Liu and Tein, 2005, Liu et al., 2005a, Liu et al., 2005b). Results of the study indicated that 19% of the sample reported having suicidal ideation and 7% reported having suicide attempts during the past 6 months. Suicidal behavior in elder, female adolescents was very prevalent, with 33% and 12% of 18-year-youths reporting some suicidal ideation and attempts during the past 6 months, and about 50% and 17% of females reporting suicidal ideation and attempts, respectively (Liu et al., 2005b). As previous studies of youth suicidal behavior in Western countries (Borowsky et al., 2001, Lewinsohn et al., 1994, Shaffer et al., 1996), we found that suicidal behavior in Chinese adolescents is associated with multiple biological, psychological, and family factors, including age, sleep loss, nightmares, life stress, poor family relationships, depressive symptoms, and aggressive behavior (Liu, 2004, Liu and Tein, 2005, Liu et al., 2005a, Liu et al., 2005b).

There is evidence that reported behavioral problems in children may differ across sources of information (Achenbach et al., 1987, Deng et al., 2004). Research shows that parent-reported behavioral problems in Chinese children are less prevalent than in Western children (Liu et al., 1999), but self-reported problems in Chinese adolescents are comparable to Western samples (Liu et al., 2000b). Thus, the prevalence and risk factors of suicidal behavior as reported by parents may also be different from child self reports. For example, parent-reported suicidal behavior may represent serious suicidal thought and more severe suicide action that had caused attention of parents. However, no studies have examined parent-reported suicidal behavior and psychosocial correlates in Chinese adolescents. The current study reported here is sought to examine the prevalence of parent-reported suicidal behavior of Chinese adolescents and its associations with various child developmental, psychosocial, and family risk factors. Suicidal behavior in the current study was defined as suicidal talk or deliberate self-harm/suicide attempt as measured by the Child Behavior Checklist (Achenbach, 1991).

Section snippets

Subjects and procedure

In 1997, an epidemiological survey on mental health problems among children aged 6–16 years was carried out in one prefecture of Shandong Province, which is located in the eastern part of mainland China (Liu et al., 2000a). Briefly, 12 towns were randomly selected, based on a list of all the towns in the prefecture. We explained the aims of the project to the local education committee and were given permission to conduct the survey in their schools. As representing schools of average

Prevalence of suicidal behavior

Overall, 2.4% of the sample had talked about suicide during the past 6 months, 3.2% had deliberately hurt or attempted to kill themselves, and 5.1% had either suicidal talk or self-harm (i.e., suicidal behavior). Of 62 adolescents who had self-harm, 19.4% talked about suicide, while among 47 of those who talked about suicide, 25.5% had self-harm/suicide attempt (OR = 12.50, 95%CI = 6.13–25.51).

Fig. 1 shows the prevalence rates of suicidal behaviors (suicidal talk, self-harm, and either suicidal

Discussion

This report represents the first investigation on the prevalence and risk factors of parent-reported suicidal behavior among adolescents from mainland China. Principal findings of this study include: 1) During the past six months, 2.4% of the sample had talked about suicide, 3.2% had deliberately hurt or attempted to kill themselves, and 5.1% had either talked of or actually attempted to harm themselves (i.e., suicidal behavior); 2) depression/anxiety was the only significant psychopathological

Acknowledgements

This study was supported in part by the Shandong Medical Research Foundation, People's Republic of China, and the Multi-Investigator Proposal Development Grant Program, Arizona State University.

References (26)

  • T.M. Achenbach et al.

    Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity

    Psychol. Bull.

    (1987)
  • I.W. Borowsky et al.

    Adolescent suicide attempts: risks and protectors

    Pediatrics

    (2001)
  • R.S. Byrd et al.

    Bedwetting in US children: epidemiology and related behavior problems

    Pediatrics

    (1996)
  • Cited by (41)

    • Distinct trajectories of suicidal behaviors throughout the university stage and associated risk and protective factors: A large-scale prospective study

      2022, Journal of Affective Disorders
      Citation Excerpt :

      As for the influence of family conflict, we did not find it can distinguish between different suicide risk trajectories after accounting for other factors. This finding is inconsistent with previous studies which have found that family conflict can increase the risk of suicide, especially among children (DeVille et al., 2020; Soole et al., 2015) and adolescents (An et al., 2010; Liu et al., 2008; Xing et al., 2010). This inconsistency may be explained by the fact that, compared to children and teenagers, college students are relatively independent of their parents in terms of their living environment.

    View all citing articles on Scopus
    View full text