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Spatiotemporal variation and social determinants of suicide in China, 2006–2012: findings from a nationally representative mortality surveillance system

Published online by Cambridge University Press:  03 July 2015

S. Liu ,
A. Page ,
P. Yin ,
T. Astell-Burt ,
X. Feng ,
Y. Liu ,
J. Liu ,
L. Wang  and
M. Zhou
S. Liu
Affiliation:
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
A. Page
Affiliation:
School of Science and Health, University of Western Sydney, Sydney, Australia
P. Yin
Affiliation:
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
T. Astell-Burt
Affiliation:
School of Science and Health, University of Western Sydney, Sydney, Australia School of Geography and Geosciences, University of St Andrews, St Andrews, UK
X. Feng
Affiliation:
School of Science and Health, University of Western Sydney, Sydney, Australia School of Health and Society, University of Wollongong, Sydney, Australia
Y. Liu
Affiliation:
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
J. Liu
Affiliation:
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
L. Wang
Affiliation:
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
M. Zhou*
Affiliation:
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
*
*Address for correspondence: M. Zhou, Ph.D., National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, 100050 Beijing, People's Republic of China. (Email: [email protected])
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Abstract

Background

Suicide in China has declined since the 1990s. However, there has been limited investigation of the potential spatiotemporal variation and social determinants of suicide during subsequent periods.

Method

Annual suicide counts from 2006 to 2012 stratified by county, 5-year age group (⩾15 years) and gender were obtained from the Chinese Disease Surveillance Points system. Trends and geographic differentials were examined using multilevel negative binomial regression models to explore spatiotemporal variation in suicide, and the role of key sociodemographic factors associated with suicide.

Results

The suicide rate (per 100 000) in China decreased from 14.7 to 9.1, 2006–2012. Rates of suicide were higher in males than females and increased substantially with age. Suicide rates were higher in rural areas compared with urban areas; however, urban–rural disparities reduced over time with a faster decline for rural areas. Within both urban and rural areas, higher rates of suicide were evident in areas with lower socio-economic circumstances (SEC) [rate ratio (RR) 1.85, 95% confidence interval (CI) 1.31–2.62]. Suicide rates varied more than twofold (median RR 2.06) across counties, and were highest in central and southwest regions of China. A high proportion of the divorced population, especially for younger females, was associated with lower suicide rates (RR 0.60, 95% CI 0.46–0.79).

Conclusions

Geographic variations for suicide should be taken into account in policy making, particularly for older males living in rural areas and urban areas with low SEC. Measures to reduce disparities in socio-economic level and alleviate family relation stress are current priorities.

Keywords

Geographical variationmortalitysocial determinantssuicidetrends
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 15 , November 2015 , pp. 3259 - 3268
Copyright
Copyright © Cambridge University Press 2015 

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References

Burr, JA, McCall, PL, Powell-Griner, E (1997). Female labor force participation and suicide. Social Science and Medicine 44, 1847–1859.CrossRefGoogle ScholarPubMed
Cai, Y, Hu, N, Liu, YN, Wang, L (2012). Analysis on suicide mortality in China population 2010. Chinese Preventive Medicine 6, 480–482.Google Scholar
Cantor, CH (2000). Suicide in the Western world. In International Handbook of Suicide and Attempted Suicide (ed. Hawton, K. and van Heeringen, K.), pp. 9–28. John Wiley: New York.CrossRefGoogle Scholar
Chan, KY, Wang, W, Wu, JJ, Liu, L, Theodoratou, E, Car, J, Middleton, L, Russ, TC, Deary, IJ, Campbell, H, Wang, W, Rudan, I, Global Health Epidemiology Reference Group (GHERG) (2013). Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990–2010. Lancet 381, 2016–2023.Google Scholar
Fukuchi, N, Kakizaki, M, Sugawara, Y, Tanji, F, Watanabe, I, Fukao, A, Tsuji, I (2013). Association of marital status with the incidence of suicide: a population-based cohort study in Japan (Miyagi Cohort Study). Journal of Affective Disorders 150, 879–885.CrossRefGoogle ScholarPubMed
Hong, J, Knapp, M (2013). Geographical inequalities in suicide rates and area deprivation in South Korea. Journal of Mental Health Policy and Economics 16, 109–119.Google ScholarPubMed
Hu, G, Baker, SP, Baker, TD (2010). Urban–rural disparities in injury mortality in China, 2006. Journal of Rural Health 26, 73–77.Google Scholar
Ikeda, A, Iso, H, Toyoshima, H, Fujino, Y, Mizoue, T, Yoshimura, T, Inaba, Y, Tamakoshi, A, JACC Study Group (2007). Marital status and mortality among Japanese men and women: the Japan Collaborative Cohort Study. BMC Public Health 7, 73.CrossRefGoogle ScholarPubMed
Ji, J, Kleinman, A, Becker, AE (2001). Suicide in contemporary China: a review of China's distinctive suicide demographics in their sociocultural context. Harvard Review of Psychiatry 9, 1–12.CrossRefGoogle Scholar
Kõlves, K, Milner, A, Värnik, P (2013). Suicide rates and socioeconomic factors in Eastern European countries after the collapse of the Soviet Union. Sociology of Health and Illness 35, 956–970.CrossRefGoogle ScholarPubMed
Leyland, AH, Goldstein, H (2001). Multilevel Modelling of Health Statistics. Wiley: Chichester.Google Scholar
Li, Z, Page, A, Martin, G, Taylor, R (2011). Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: a systematic review. Social Science and Medicine 72, 608–616.CrossRefGoogle ScholarPubMed
Lockhart, AM, Piegorsch, WW, Bishop, JB (1992). Assessing overdispersion and dose–response in the male dominant lethal assay. Mutation Research 272, 35–38.Google Scholar
Lopez, AD, Mathers, CD, Ezzati, M, Murray, CJL, Jamison, DT (2006). Global Burden of Disease and Risk Factors. Oxford University Press: New York.CrossRefGoogle ScholarPubMed
Merlo, J, Chaix, B, Ohlsson, H, Beckman, A, Johnell, K, Hjerpe, P, Råstam, L, Larsen, K (2006). A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. Journal of Epidemiology and Community Health 60, 290–297.Google Scholar
Merlo, J, Yang, M, Chaix, B, Lynch, J, Rastam, L (2005). A brief conceptual tutorial on multilevel analysis in social epidemiology: investigating contextual phenomena in different groups of people. Journal of Epidemiology and Community Health 59, 729–736.CrossRefGoogle ScholarPubMed
National Health and Family Planning Commission (2012). Work Specification on Management and Treatment of Severe Mental Illness. National Health and Family Planning Commission of the People's Republic of China: Beijing.Google Scholar
National Health and Family Planning Commission (2013). Regulation on Severe Mental Illness Reporting Procedures. National Health and Family Planning Commission of the People's Republic of China: Beijing.Google Scholar
Page, A, Morrell, S, Hobbs, C, Carter, G, Dudley, M, Duflou, J, Taylor, R (2014). Suicide in young adults: psychiatric and socio-economic factors from a case–control study. BMC Psychiatry 14, 68.CrossRefGoogle ScholarPubMed
Phillips, MR, Li, X, Zhang, Y (2002 a). Suicide rates in China, 1995–99. Lancet 359, 835–840.CrossRefGoogle Scholar
Phillips, MR, Liu, H, Zhang, Y (1999). Suicide and social change in China. Culture, Medicine and Psychiatry 23, 25–50.Google Scholar
Phillips, MR, Yang, G, Li, S, Li, Y (2004). Suicide and the unique prevalence pattern of schizophrenia in mainland China: a retrospective observation study. Lancet 364, 1062–1068.Google Scholar
Phillips, MR, Yang, G, Zhang, Y, Wang, L, Ji, H, Zhou, M (2002 b). Risk factors for suicide in China: a national case–control psychological autopsy study. Lancet 360, 1728–1736.CrossRefGoogle Scholar
Qi, X, Tong, S, Hu, W (2010). Spatial distribution of suicide in Queensland, Australia. BMC Psychiatry 10, 106.Google Scholar
Qin, P, Agerbo, E, Mortensen, PB (2003). Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. American Journal of Psychiatry 160, 765–772.Google Scholar
Qin, P, Agerbo, E, Westergard-Nielsen, N, Eriksson, T, Mortensen, PB (2000). Gender differences in risk factors for suicide in Denmark. British Journal of Psychiatry 177, 546–550.CrossRefGoogle ScholarPubMed
Qin, P, Mortensen, PB (2001). Specific characteristics of suicide in China. Acta Psychiatrica Scandinavica 103, 117–121.Google Scholar
Rebholz, CM, Gu, D, Yang, W, Chen, J, Wu, X, Huang, JF, Chen, JC, Chen, CS, Kelly, TN, Duan, X, Bazzano, LA, He, J (2011). Mortality from suicide and other external cause injuries in China: a prospective cohort study. BMC Public Health 11, 56.CrossRefGoogle Scholar
Rehkopf, DH, Buka, SL (2006). The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychological Medicine 36, 145–157.CrossRefGoogle ScholarPubMed
Standing Committee of the National People's Congress (2012). Mental Health Law in the People's Republic of China. Standing Committee of the National People's Congress: Beijing.Google Scholar
Sun, W, Schooling, CM, Chan, WM, Ho, KS, Lam, TH (2011). The association between depressive symptoms and mortality among Chinese elderly: a Hong Kong cohort study. Journals of Gerontology Series A – Biological Sciences and Medical Sciences 66, 459–466.CrossRefGoogle ScholarPubMed
Vaneckova, P, Beggs, PJ, de Dear, RJ, McCracken, KW (2008). Effect of temperature on mortality during the six warmer months in Sydney, Australia, between 1993 and 2004. Environmental Research 108, 361–369.CrossRefGoogle ScholarPubMed
Wang, L, Wang, LJ, Cai, Y, Ma, LM, Zhou, MG (2011). Analysis of under-reporting of mortality surveillance from 2006 to 2008 in China. Chinese Journal of Preventive Medicine 45, 1061–1064.Google ScholarPubMed
Wang, LJ, Phillips, MR, Huang, ZJ, Zhang, YP, Zhao, YX, Yang, GH (2003). Evaluation on the accuracy of reported suicides in the Chinese population. Chinese Journal of Epidemiology 24, 889–892.Google Scholar
World Health Organization (2014). Preventing Suicide: A Global Imperative. World Health Organization: Geneva.Google Scholar
Yang, G, Hu, J, Rao, KQ, Ma, J, Rao, C, Lopez, AD (2005). Mortality registration and surveillance in China: history, current situation and challenges. Population Health Metrics 3, 3.Google Scholar
Yang, G, Wang, Y, Zeng, Y, Gao, GF, Liang, X, Zhou, M, Wan, X, Yu, S, Jiang, Y, Naghavi, M, Vos, T, Wang, H, Lopez, AD, Murray, CJ (2013). Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 381, 1987–2015.Google Scholar
Yang, GH, Zhou, LN, Huang, ZJ, Chen, AP (2004). The trend and geographic distribution of suicide in Chinese population. Chinese Journal of Epidemiology 25, 280–284.Google Scholar
Yang, M, Li, XS (2007). Multilevel Statistical Model in Medical and Health Research. Peking University Medical Press: Beijing.Google Scholar
Yip, P, Liu, K, Hu, J, Song, X (2005). Suicide rates in China during a decade of rapid social changes. Social Psychiatry and Psychiatric Epidemiology 40, 792–798.Google Scholar
Yip, PS, Liu, KY, Law, CK (2008). Years of life lost from suicide in China, 1990–2000. Crisis 29, 131–136.CrossRefGoogle Scholar
Yip, PS, Yousuf, S, Chan, CH, Yung, T, Wu, KC (2015). The roles of culture and gender in the relationship between divorce and suicide risk: a meta-analysis. Social Science and Medicine 128, 87–94.Google Scholar
Zhang, L, Li, Z, Li, X, Zhang, J, Zheng, L, Jiang, C, Li, J (2014). Study on the trend and disease burden of injury deaths in Chinese population, 2004–2010. PLOS ONE 9, e85319.Google Scholar
Zhou, M, Jiang, Y, Huang, Z, Wu, F (2010). Adjustment and representativeness evaluation of National Disease Surveillance Points system. Disease Surveillance 25, 239–244.Google Scholar
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