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Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Factors associated with suicidal behaviors in mainland China: a meta-analysis

Authors: Ying Li, Yafei Li, Jia Cao

Published in: BMC Public Health | Issue 1/2012

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Abstract

Background

Suicide is a major public health issue in China. Studies of suicide risk factors have reported both inconsistent and inconclusive results. This review aimed to determine suicide risk factors in China.

Methods

Medline/PubMed, EMBASE, CNKI (China National Knowledge Infrastructure) and VIP (Chinese Journal of Science and Technology of VIP) were searched for relevant reports. Two investigators independently assessed the eligibility of identified studies and extracted data. Pooled odds ratios (and 95% confidence intervals) were calculated for each factor with Revman 5.0.

Results

Forty-four studies with 192,362 subjects were included. The pooled results indicated that mood disorders and stressful life events (physical illness, suicide of relatives) increased the risk of suicide ideation among the entire population. Socio-family environment (single or remarried parent, study pressure and academic achievement) and unhealthy behaviors (smoking, alcohol drinking, and drug use) were risk factors for suicide ideation among youth. Unhealthy behaviors (smoking and alcohol drinking), mood disorders, and stressful life events (suicide of relatives) were the main risk factors for attempted suicide. Persons living in rural areas, and those with lower education, mood disorders, and/or a history of negative life events had a higher risk of completed suicide. In China, before 2000, females had a significantly higher rate of completed suicide than males, while after 2000, no significant gender difference was found.

Conclusions

Socio-family environment, lifestyle, life events and psychiatric/psychological factors are associated with suicidal behaviors in China. Further case–control or cohort studies are needed to better understand suicide behaviors in China. Meanwhile, there is an urgent need for comprehensive studies of suicide interventions among high-risk populations.
Appendix
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Literature
1.
World Health Organization: Suicide rates per 100,000 by country, year and sex (Table). 2010, Geneva 27 Switzerland: World Health Organization
2.
3.
Ji J, Kleinman A, Becker AE: Suicide in contemporary China: a review of China's distinctive suicide demographics in their sociocultural context. Harv Rev Psychiatry. 2001, 1: 1-12.CrossRef
4.
Phillips MR, Li X, Zhang Y: Suicide rates in China, 1995–99. Lancet. 2002, 9309: 835-840.CrossRef
5.
Zhang J, Jing J, Wu XY, Sun WW, Wang CT: A Sociological Analysis of the Decline in the Suicide Rate in China. Social Sci China. 2011, 5: 97-113.
6.
Zhang JX, Tang JS, Weng Z, Chai XS: Epidemiological Investigation of Suicide in Shandong Province. Chin Ment Heal J. 1999, 4: 248-249.
7.
Kong Y, Zhang J: Access to farming pesticides and risk for suicide in Chinese rural young people. Psychiatry Res. 2010, 2: 217-221.CrossRef
8.
Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M: Risk factors for suicide in China: a national case–control psychological autopsy study. Lancet. 2002, 9347: 1728-1736.CrossRef
9.
Li XY, Fei LP, Zhang YP, Ji HY, Xu D, Yang GH: The characteristics and risk factors for suicides with 15–24 years of age: a case–control study. Chinese J Psychiatry. 2005, 4: 231-235.
10.
Zhang ZQ, Guo LT: Suicide Ideas of Middle School Students. Chin Ment Heal J. 2003, 12: 852-855.
11.
Liu RK, Wang WQ, Jia YH, Chen J, Wu TY: Risk Factors for Suicide Idea among Middle School Students in TianJin. Chinese J Pest Control. 2007, 11: 808-810.
12.
Ou GZ, Wu ZD, Xu Y: Analysis on suicide ideation and related factors among medical junior class students in Fujian Province. Chinese J Health Ed. 2008, 3: 167-169.
13.
Ma L, Zhang JX, Wei SQ: Suicidal Ideation and Experiences of Being Bullied and Their Relationship among High School Students. Chinese J School Health. 2003, 5: 446-
14.
15.
Cochran BG: The combination of estimates from different experiments. Biometrics. 1954, 10: 101-129. 10.2307/3001666.CrossRef
16.
Higgins JP, Thompson SG: Quantifying heterogeneity in a meta-analysis. Stat Med. 2002, 21: 1539-1558. 10.1002/sim.1186.CrossRefPubMed
17.
Fan YG, Xiao Q, Li WX, Song YM, Ye QL, Ye DQ: Correlated Study between Soci-Psychological Factors and Suicide Ideation Among Medicos. Chinese J School Health. 2008, 4: 328-330.
18.
Zhang M, Wang LG, Xing YF: Influencing Factors to Suicidal Ideation among Middle School Students. Chinese Journal of School Health. 2007, 5: 429-
19.
Zeng LN, Chen ZY: Suicide Ideation of College Students in Guangzhou. Chinese Journal of School Health. 2006, 10: 863-864.
20.
Li XY, Fei LP, Yang SJ, Wang ZQ, Zhang YP, Li C: Relationship of Suicide Acceptability to Self-reports of Suicidal Ideation and Behavior. Chin Ment Heal J. 2009, 10: 734-738.
21.
Yang BS, He J, Zhong Y, Peng SP, Niang ZS: Analysis on Suicide Behaviors among the Rural Middle School Students in Henan Province. Chinese Journal of School Health. 2008, 10: 912-913.
22.
Pan XQ, Shi ZM, Yuan BJ, Dai Y: Relationship between depressive mood and related risk behaviors among middle school students in Jiangsu Province. Chinese Journal of School Doctor. 2006, 4: 343-345.
23.
Chen ZX, Yang J: Questionnaire investigation and case study on psychological crisis. China Youth Study. 2006, 2: 57-60.
24.
Yang XH, Zhou H, Wang SM: Epidemiological Investigation of Suicidal Ideation in College Students. Chinese Journal of School Health. 2007, 6: 527-528.
25.
Duan WD, Hu CY, Liu F, Hu JZ, Gao H, Wang J, et al: A survey on suicide idea and attempt in the parents of middle school students in Shenzhen. Medical Journal of Chinese People's Health. 2008, 192: 194-199.
26.
Hou JL, Qin XX, Li HX, Chen W, Tang SY, Jia XJ, et al: Survey on Suicidal Ideation among Suicide Attempters of Four General Hospitals. China Modern Doctor. 2010, 18: 38-40.
27.
Sun XL, Li KQ, Cun LJ, Jiang QP, Gao LH, Liu YQ, et al: The prevalence of suicide attempters in people aged 18 and older in Hebei Province. Chin Ment Heal J. 2010, 5: 362-365.
28.
Bao DX, Fan YG, Ye DQ: Association between suicide ideation and life event and social support in College students. Chinese Journal of School Health. 2009, 10: 939-941.
29.
Juan W, Xiao-Juan D, Jia-Ji W, Xin-Wang W, Liang X: The associations between health risk behaviors and suicidal ideation and attempts in an urban Chinese sample of adolescents. J Affect Disord. 2010, 126: 180-7. 10.1016/j.jad.2010.02.121.CrossRefPubMed
30.
Niu YJ, Wang ZQ, Yang SJ, Fei LP, Wang XQ: Survey of Suicidal Ideation and Suicide Attempts in Inpatients at 40 General Hospitals in Beijing. Chin Ment Heal J. 2006, 7: 457-461.
31.
Tian F, Gao J, Li YM, Cui XH, Han XL: Suicide ideation in the scientific workers in Shanxi province. Chinese Remedies & Clinics. 2010, 6: 662-663.
32.
Sun YH, Zhou JB, Wang B, Yu C, Yang LS: Survey of Suicidal Ideation and Suicide Attempts in the Migrant Workers in Railway Construction Sites. China Preventive Medicine. 2008, 9: 334-338.
33.
Li GY, Tao FB, Xu L: Prevalence and Its Demographic Characteristics of Suicide Behaviors among Technical Secondary School Students. Chinese Journal of School Health. 2004, 3: 316-318.
34.
Yu XM, Lin L, Wang J, Zhang JC, Zhao GZ: Study on self-directed violence and determinants among 1916 middle school students of the outskirts in Beijing. Chinese Journal of Reproductive Health. 2004, 1: 37-40.
35.
Xing Y, Ji CY, Bai Y, Ji H, Wang Y: The prevalence of injuries related behaviors among middle school students in Beijing. Chinese Journal of School Health. 2005, 2: 114-115.
36.
Gao M, Xu F, Shen QF, Zhang JX, Shao FQ, Wang BG, et al: Epidemiology of injury and mood disorder in Middle school in Hefei. Chinese Journal of School Health. 2001, 3: 243-244.
37.
Zhuang X, Zhu XZ, Zhou YP, Lian SY, Xun PC, Jiang SY: An Epidemiological Study on Suicidal Behavior of High School Students. Chinese Journal of School Health. 2007, 5: 412-414.
38.
Huang FY, Tao FB: Interaction Study on Drinking Alcohol and Harmful Behaviors to Health of Secondary School Students. Anhui journal of preventive medicine. 2000, 1: 11-13.
39.
Zeng ZP, Yang Y: Risk Factors for Suicide Attempt among Medical College Students. Chinese Journal of Social Medicine. 2009, 3: 158-160.
40.
Yan HH, Liu ZM, Wang SY, Yang G, Chen LF, Pen H, et al: Study on the relationship between life event and suicide ideation among undergraduates in Guangzhou. Modern Preventive Medicine. 2009, 3: 476-479.
41.
Shang YX, Dong GQ, Liu T: Analysis on prevalence of suicidal ideation and depression and its influence factors among undergraduate students in Yinchuan. Chinese Journal of Public Health. 2008, 8: 934-936.
42.
Lin Q, Xu Y: An Epidemiological Characteristic of Health Risk Behaviors Survey of Undergraduates. Acta Academiae Medicinae Suzhou. 2005, 3: 432-435.
43.
Zhu JP, Peng NN, Zhou YF, Gao GD, Zhu W, Luo CX: Prevalence of behaviors that contribute to unintentional and intentional injuries among college students in Shanghai. Chinese Journal of School Doctor. 2006, 3: 228-231.
44.
Xu HL, Xiao SY, Feng SS, Chen XX: Risk factors for suicide attempt among college students at Central South University. Chinese Journal of Epidemiology. 2004, 4: 288-291.
45.
Zhou L, Xiao SY, Tang Y, Nie XQ: Suicidal ideation and its psychosocial risk factors in junior high school students in rural areas of Liuyang city. Chinese Journal of Behavioral Medical Science. 2005, 12: 1108-1109.
46.
Jiang TT, Lu R, Zhang JX: Risk health related behavior and influencing factors in adolescents. Chinese Community Doctors. 2006, 14: 164-165.
47.
Zhang J, Stewart R, Phillips M, Shi Q, Prince M: Pesticide exposure and suicidal ideation in rural communities in Zhejiang province, China. Bull World Health Organ. 2009, 10: 745-53.
48.
Feng XY, Huang HF, Fu YM, Li Y: Investigation on risk health related behaviors among adolescent in QingPu district of Shanghai. Chinese Journal of School Health. 2006, 3: 240-241.
49.
Sun ML, Ye DQ, Fan YG, Pan FM: A correlation study on quality of life and suicidal ideation among rural females. Chinese Journal of Disease Control & Prevention. 2007, 2: 186-
50.
Huan M, Hamazaki K, Sun Y: Miho Itomura, Hongyan Liu, Wei Kang, et al: Suicide attempt and n-3 fatty acid levels in red blood cells: a case control study in China. Biol Psychiatry. 2004, 7: 490-6.CrossRef
51.
Yang CL, Liu CX, Wang RL, Yang FF, Du SQ, Zhang FG, et al: Case–control study on suicide. Practical Preventive Medicine. 2008, 2: 401-402.
52.
Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S, et al: Suicide and Suicidal Behavior. Epidemiol Rev. 2008, 1: 133-154.CrossRef
53.
54.
55.
56.
Miller M, Azrael D, Hepburn L, Hemenway D, Lippmann SJ: The association between changes in household firearm ownership and rates of suicide in the United States, 1981–2002. Injury Prevention. 2006, 12: 178-182. 10.1136/ip.2005.010850.CrossRefPubMedPubMedCentral
57.
King CA, Merchant CR: Social and interpersonal factors relating to adolescent suicidality: a review of the literature. Arch Suicide Res. 2008, 3: 181-96.CrossRef
58.
Hudson JL, Dodd HF, Lyneham HJ, Bovopoulous N: Temperament and family environment in the development of anxiety disorder: two-year follow-up. J Am Acad Child Adolesc Psychiatry. 2011, 12: 1255-64.CrossRef
59.
Shiang J: Does culture make a difference? Racial/ethnic patterns of completed suicide in San Francisco, CA 1987–1996 and clinical applications. Suicide and Life-Threatening Behavior. 1998, 28: 338-354.PubMed
60.
Bagge CL, Sher KJ: Adolescent alcohol involvement and suicide attempts: toward the development of a conceptual framework. Clin Psychol Rev. 2008, 8: 1283-96.CrossRef
61.
Wetzler S, Asnis GM, Hyman RB, Zimmerman J, Rathus JH: Characteristics of suicidality among adolescents. Suicide and Life-Threatening Behavior. 1996, 26: 37-45.PubMed
62.
Latha KS, Bhat SM, D'Souza P: Suicide attempters in a general hospital unit in India: their socio-demographic and clinical profile–emphasis on cross-cultural aspects. Acta Psychiatr Scand. 1996, 1: 26-30.CrossRef
63.
Mann JJ: A current perspective of suicide and attempted suicide. Ann Intern Med. 2002, 136: 302-311.CrossRefPubMed
64.
Eddleston M, Sheriff MHR, Hawton K: Deliberate self-harm in Sri Lanka: an overlooked tragedy in the developing world. British Medical Journal. 1998, 11 (317): 133-135.CrossRef
65.
Cheng AT, Chen TH, Chen CC, Jenkins R: Psychosocial and psychiatric risk factors for suicide. Case–control psychological autopsy study. Br J Psychiatry. 2000, 177: 360-365. 10.1192/bjp.177.4.360.CrossRefPubMed
66.
Hammen C: Stress and depression. Annu Rev Clin Psychol. 2005, 1: 293-319. 10.1146/annurev.clinpsy.1.102803.143938.CrossRefPubMed
67.
Paykel ES: Life events and affective disorders. Acta Psychiatr Scand. 2003, 108: 61-66.CrossRef
68.
Phillips DP, Carstensen LL: Clustering of teenage suicides after television news stories about suicide. N Engl J Med. 1986, 11: 685-9.CrossRef
69.
70.
Rutz W, Wålinder J, Von Knorring L, Rihmer Z, Pihlgren H: Prevention of depression and suicide by education and medication: impact on male suicidality. An update from the Gotland Study International Journal of Psychiatry in Clinical Practice. 1997, 1: 39-46.CrossRefPubMed
71.
Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, et al: Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997, 4: 313-21.CrossRef
72.
Wolitzky-Taylor K, Bobova L, Zinbarg RE, Mineka S, Craske MG: Longitudinal investigation of the impact of anxiety and mood disorders in adolescence on subsequent substance use disorder onset and vice versa. Addict Behav. 2012, 37: 982-5. 10.1016/j.addbeh.2012.03.026.CrossRefPubMedPubMedCentral
73.
Duncan B, Rees DI: Effect of smoking on depressive symptomatology:a reexamination of data fromthe National Longitudinal Study of Adolescent Health. Am J Epidemiol. 2005, 162: 461-70. 10.1093/aje/kwi219.CrossRefPubMed
74.
Costello DM, Swendsen J, Rose JS, Dierker LC: Risk and protective factors associated with trajectories of depressedmood fromadolescence to early adulthood. J Consult Clin Psychol. 2008, 76: 173-83.CrossRefPubMedPubMedCentral
75.
Johnson JG, Cohen P, Pine DS, Klein DF, Kasen S: Association between cigarette smoking and anxiety disorders during adolescence and early adulthood. JAMA. 2000, 284: 2348-51. 10.1001/jama.284.18.2348.CrossRefPubMed
76.
Metadata
Title
Factors associated with suicidal behaviors in mainland China: a meta-analysis
Authors
Ying Li
Yafei Li
Jia Cao
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-524

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