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Risk factors for suicide in China's youth: a case-control study

Published online by Cambridge University Press:  10 September 2007

X. Y. Li ,
M. R. Phillips ,
Y. P. Zhang ,
D. Xu  and
G. H. Yang
X. Y. Li*
Affiliation:
Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
M. R. Phillips
Affiliation:
Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
Y. P. Zhang
Affiliation:
Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
D. Xu
Affiliation:
Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
G. H. Yang
Affiliation:
Institute of Basic Medical Sciences, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
*
*Address for correspondence: Dr X. Y. Li, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing 100096, People's Republic of China. (Email: [email protected])
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Abstract

Background

Suicide is the most common cause of death among youth in China.

Method

A case-control psychological autopsy study in 23 geographically representative disease surveillance points around China collected information from family members and close associates of 114 persons aged 15–24 years who died by suicide (cases) and 91 who died of other injuries (controls).

Results

Among the 114 suicides 61% were female, 88% lived in rural villages, 70% died by ingesting pesticides (most commonly stored in the home), 24% previously attempted suicide, and 45% met criteria of a mental illness at the time of death. Multivariate logistic regression identified several independent risk factors: severe life events within 2 days before death (OR 31.8, 95% CI 2.6–390.6), presence of any depressive symptoms within 2 weeks of death (OR 21.1, 95% CI 4.6–97.2), low quality of life in the month before death (OR 9.7, 95% CI 2.8–34.1), and acute stress at time of death (moderate: OR 3.1, 95% CI 0.8–11.9; high: OR 9.1, 95% CI 1.2–66.8). A significant interaction between mental illness at time of death and gender indicated that diagnosis was an important predictor of suicide in males (OR 14.0, 95% CI 2.6–76.5) but not in females (OR 0.3, 95% CI 0.0–3.6). Prior suicide attempt was related to suicide in the univariate analysis (OR 57.5) but could not be included in the multivariate model because no controls had made prior attempts.

Conclusions

Suicide prevention efforts for youth in China must focus on restricting access to pesticides, early recognition and management of depressive symptoms and mental illnesses, improving resiliency, and enhancing quality of life.

Keywords

Case-control studyChinarisk factorssuicideyouth
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 3 , March 2008 , pp. 397 - 406
Copyright
Copyright © Cambridge University Press 2007

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References

Agerbo, E, Nordentoft, M, Mortensen, PB (2002). Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study. British Medical Journal 325, 74–78.CrossRefGoogle ScholarPubMed
Beautrais, AL (2000). Risk factors for suicide and attempted suicide among young people. Australian and New Zealand Journal of Psychiatry 34, 420–436.Google Scholar
Beautrais, AL (2001). Suicides and serious suicide attempts: two populations or one? Psychological Medicine 31, 837–845.CrossRefGoogle ScholarPubMed
Brent, DA (1989). The psychological autopsy: methodological considerations for the study of adolescent suicide. Suicide and Life-Threatening Behavior 19, 43–57.Google Scholar
Brent, DA, Baugher, M, Bridge, J, Chen, T, Chiappetta, L (1999). Age- and sex-related risk factors for adolescent suicide. Journal of the American Academy of Child and Adolescent Psychiatry 38, 1497–1505.Google Scholar
Chen, TH, Hoppe, FM, Iyengar, S, Brent, D (2003). A hybrid logistic model for case-control studies. Methodology and Computing in Applied Probability 5, 419–426.Google Scholar
Coll, X, Law, F, Tobias, A, Hawton, K, Tomas, J (2001). Abuse and deliberate self-poisoning in women: a matched case-control study. Child Abuse & Neglect 25, 1291–1302.Google Scholar
Conner, KR, Phillips, MR, Meldrum, S (2007). Predictors of low-intent and high-intent suicide attempts in rural China. American Journal of Public Health Published online: 29 March 2007. doi: 10.2105/AJPH.2005.077420.Google Scholar
Conner, KR, Phillips, MR, Meldrum, S, Knox, KL, Zhang, YP, Yang, GH (2005). Low-planned suicides in China. Psychological Medicine 35, 1197–1204.Google Scholar
Dudley, MJ, Kelk, NJ, Florio, TM, Howard, JP, Waters, BG (1998). Suicide among young Australians, 1964–1993: an interstate comparison of metropolitan and rural trends. Medical Journal of Australia 169, 77–80.Google Scholar
Edgardh, K, Ormstad, K (2000). Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen-year-old boys and girls. Acta Paediatrica 88, 310–319.Google Scholar
Evans, E, Hawton, K, Rodham, K (2005). Suicidal phenomena and abuse in adolescents: a review of epidemiological studies. Child Abuse & Neglect 29, 45–58.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P, Version 2.0, 8/98 revision). Biometrics Research Department: New York.Google Scholar
Gould, MS, Fisher, P, Parides, M, Flory, M, Shaffer, D (1996). Psychosocial risk factors of child and adolescent completed suicide. Archives of General Psychiatry 53, 1155–1162.Google Scholar
Gould, MS, Greenberg, T, Velting, DM, Shaffer, D (2003). Youth suicide risk and preventive interventions: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry 42, 386–405.Google Scholar
Groholt, B, Ekeberg, O, Wichstrom, L, Haldorsen, T (1997). Youth suicide in Norway, 1990–1992: a comparison between children and adolescents completing suicide and age- and gender-matched controls. Suicide and Life-Threatening Behavior 27, 250–263.Google Scholar
Groholt, B, Ekeberg, O, Wichstrom, L, Haldorsen, T (1998). Suicide among children and younger and older adolescents in Norway: a comparative study. Journal of the American Academy of Child and Adolescent Psychiatry 37, 473–481.Google Scholar
Haldane, JBS (1956). The estimation and significance of the logarithm of a ratio of frequencies. Annals of Human Genetics 20, 309–311.Google Scholar
Hanley, JA, McNeil, BJ (1982). The meaning and use of the area under the receiver operating characteristic (ROC) curve. Radiology 143, 29–36.Google Scholar
Hawton, K, James, A (2005). Suicide and deliberate self harm in young people. British Medical Journal 330, 891–894.Google Scholar
Hawton, K, Appleby, L, Platt, S, Foster, T, Cooper, J, Malmberg, A, Simkin, S (1998). The psychological autopsy approach to studying suicide: a review of methodological issues. Journal of Affective Disorders 50, 269–276.Google ScholarPubMed
Krug, EG, Dahlberg, LL, Mercy, JA, Zwi, AB, Lozano, R (eds) (2002). World Report on Violence and Health. World Health Organization: Geneva.Google Scholar
Li, XY, Phillips, MR (2001). The importance of suicide among reproductive age groups in China in 1998 [in Chinese]. Chinese Public Health Journal 17, 658–670.Google Scholar
Li, XY, Phillips, MR, Ji, HY, Xu, YC, Bian, QT, He, FS (2005). The characteristics of serious suicide attempters living in villages [in Chinese]. Chinese Journal of Nervous and Mental Disorders 31, 272–277.Google Scholar
Li, XY, Phillips, MR, Wang, YP, Zhang, C, Ji, HY, Bian, QT, Ma, ZW, He, FS (2003) Comparison of impulsive and non-impulsive attempted suicide [in Chinese]. Chinese Journal of Nervous and Mental Disorder 29, 27–31.Google Scholar
Li, XY, Yang, RS, Zhang, C, Bian, QT, Ji, HY, Wang, YP, Zheng, YX, He, FS, Phillips, MR (2001). A case-control study of the risk factors in attempted suicide [in Chinese]. Chinese Journal of Epidemiology 22, 281–283.Google Scholar
Lynskey, M, Degenhardt, L, Hall, W (2000). Cohort trends in youth suicide in Australia 1964–1997. Australian and New Zealand Journal of Psychiatry 34, 408–412.Google ScholarPubMed
Maris, RW, Berman, AL, Silverman, MM, Nisbet, PA (2000). Age and the lifespan. In Comprehensive Textbook of Suicidology (ed. Maris, R. W., Berman, A. L. and Silverman, M. M.), pp. 127–145. The Guilford Press: New York.Google Scholar
Martin, G, Bergen, HA, Richardson, AS, Roeger, L, Allison, S (2004). Sexual abuse and suicidality: gender differences in a large community sample of adolescents. Child Abuse & Neglect 28, 491–503.Google Scholar
McAuliffe, C, Corcoran, P, Keeley, H, Arensman, E, Bille-Brahe, U, De Leo, D, Fekete, S, Hawton, K, Hjelmeland, H, Kelleher, M, Kerkhof, AJFM, Lonnqvist, J, Michel, K, Salander-Renberg, EL, Schmidtke, A, van Heeringen, K, Wasserman, D (2005). Problem-solving ability and repetition of deliberate self-harm: a multicentre study. Psychological Medicine 35, 1–11.Google Scholar
Molnar, BE, Berkman, LF, Buka, SL (2001). Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behaviour in the US. Psychological Medicine 31, 965–977.Google Scholar
Mortensen, PB, Agerbo, EE, Qin, T, Westergaard-Nielsen, N (2000). Psychiatric illness and risk factors for suicide in Denmark. Lancet 355, 9–12.Google Scholar
Nagelkerke, NJD (1991). A note on general definition of the coefficient or determination. Biometrika 78, 691–692.Google Scholar
Phillips, MR, Li, XY, Zhang, YP (2002 a). Suicide rates in China, 1995–99. Lancet 359, 835–840.Google Scholar
Phillips, MR, Shen, QJ, Liu, XH, Pritzker, S, Streiner, D, Conner, K, Yang, GH (2007). Assessing depressive symptoms in persons who die of suicide in mainland China. Journal of Affective Disorders 98, 73–82.Google Scholar
Phillips, MR, Yang, GH (2004). Suicide and attempted suicide in China, 1990–2002. Morbidity and Mortality Weekly Report 53, 481–484.Google Scholar
Phillips, MR, Yang, GH, Zhang, YP, Wang, LJ, Ji, HY, Zhou, MG (2002 b). Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet 360, 1728–1736.Google Scholar
Shaffer, D, Gould, MS, Fisher, P, Trautman, P, Moreau, D, Kleinman, M, Flory, M (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry 53, 339–348.Google Scholar
Shi, QC, Zhang, JM, Xu, FZ, Phillips, MR, Xu, Y, Fu, YL, Gu, W, Zhou, XJ, Wang, SM, Zhang, Y, Yu, M (2005). Epidemiological survey of mental illnesses in the people aged 15 and older in Zhejiang Province [in Chinese]. Chinese Journal of Preventive Medicine 39, 229–236.Google Scholar
Speckens, AEM, Hawton, K (2005). Social problem solving in adolescents with suicidal behavior: a systematic review. Suicide and Life-Threatening Behavior 35, 365–387.CrossRefGoogle ScholarPubMed
Vijaykumar, L, Rajkumar, S (1999). Are risk factors for suicide universal? A case control study in India. Acta Psychiatrica Scandinavica 99, 407–411.Google Scholar
Yang, GH, Phillips, MR, Zhou, MG, Wang, LJ, Zhang, YP, Xu, D (2005). Understanding the unique characteristics of suicide in China: national psychological autopsy study. Biomedical and Environmental Sciences 18, 379–389.Google Scholar
Zhang, YP, Li, XY, Wang, LJ, Zhao, YX, Meng, M, Zhang, FG, Peng, J, Shen, MH, Liu, YC, Jiao, ZK, Yang, GH, Phillips, MR (2004). National case-control study of suicide and accidental death [in Chinese]. Chinese Mental Health Journal 18, 861–864.Google Scholar