Suicidal morbidity among rural Chinese ages 16--34 years in the transforming China.

摘要

Background. Suicide in China now is recognized as a major public health challenge. It is distinctively associated with a preponderance of more deaths in women than men, and heavy burdens among rural youth and young adults. Although there are accumulating data regarding the epidemiology of suicide, there are only meager data on suicidal ideation and attempts. Determining whether risk factors for attempted suicide and suicidal ideation are similar to those for suicide will contribute to formulating future prevention efforts.;Methods. This was a cross-sectional community survey of all available individuals, ages 16-34 years, of 10 randomly selected villages in the Mianyang Region, Sichuan Province. Each participated in face-to-face interviews with structured questionnaires regarding indicators of suicidal morbidity, a range of sociodemographic characteristics, as well as psychopathological and socio-cultural features. We report the lifetime and one-year prevalence of suicidal ideation, planning, and attempts among the youth and young adults of these communities, and their demographic, psychopathological, and social-cultural correlates.;Findings. 1654 subjects, 98% of those approached and 55% of the enumerated potential subjects were interviewed. Among the unapproachable subjects with demographic profile gathered (n=995), 77% (n=811) were unobtainable because they were migrant workers. Lifetime and one-year prevalence data included: Any suicidal ideation -- 18.8%, 5.2%, respectively; serious ideation -- 8.7%, 2.3%; planning -- 5.7%, 1.5%; and attempt -- 2.8%, 0.5%. Comparisons among strata of demographic characteristics showed more prevalent suicidal ideation and attempts associated with female gender, lower education, lower income, farmers, greater rurality of residence, and having never married or "other" married. There was a higher prevalence of suicide ideation, but not for suicide attempt, among students. High risks of suicidality were also found in those with a higher score of depressive symptoms in the past two weeks, with positive screening of major depression or dysthymia, higher score of neuroticism. Poor quality of life and lower life satisfaction increased the risk for suicidality, but the impact was secondary to depression. Many socio-cultural factors that have not been elucidated in previous research were found to be associated with suicidality, including attitude toward suicide, reasons for living, violence exposure, religiosity, and exposure to completed suicide, aside from the number of life events. Surprisingly, alcohol use is not harmful, in fact, is potentially beneficial; and having a religion is a risk factor instead of being protective as observed in most countries.;Discussion and conclusions. Our results uncovered, despite coming from a national population with a relatively elevated risk for death by suicide, a prevalence of suicidal ideation and attempts that is comparable to internationally reported data. The overall pattern of correlates for ideation, planning, and attempts was similar in many respects to those reported for completed suicide within the same population, on the perspective of demographic distribution. We consider the contexts for these findings, including the potential impacts of rapid urbanization and large numbers of migrant workers. Our results underscored the significance of depression as a major risk factor for suicidal morbidity. In addition, a number of socio-cultural factors were also vital. Findings from this study helped to shed light on the factors associated with suicidal morbidity in China. The most important lesson is that both psychopathological and sociocultural factors affect suicide morbidity in China, with more traits in the sociocultural domain surviving the final analysis. It reminds researchers that when looking at Chinese suicide, the endeavor should not be limited to psychopathology and the puzzle of why the rates of depression among Chinese suicide were lower than other countries. Instead, socio-cultural components should be paid equal attention. This is especially helpful for suicide prevention efforts in communities or from the public health perspective, for example, that attitude toward suicide (an important associate of suicidal morbidity in China based on our data) is possible to change under the movement of public education. The treatment for depression can only reach clinical samples, yet most of people who die by suicide come instead from communities. Local knowledge is essential as the profile of risks might differ markedly from other countries such as alcohol use and religiosity.