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Suicide Among the Elderly in Mainland China
Abstract
Suicide in mainland China shows unique demographic patterns with age: the over-65 age group has the highest rate of completed suicide, reaching 44.3-200 per 100,000, which is four to five times higher than the Chinese general population. Rural suicide rates among the elderly are three to five times higher than the urban rates. The gender ratio of suicide in the elderly shows a reversal to those younger than 60 years of age in China. In addition, suicide methods and causes are different from those in Western countries. In the present paper, the profile of suicide among the elderly in China is delineated, including the prevalence, characteristics, underlying reasons and measures of preventing it.
... Year, but increase significantly in the subsequent two months. Existing studies also repeatedly conjectured that, among recent developments such as economic reform and cultural change, also the restrictive fertility policies of the 1970s and 1980s may have contributed to the recent suicide dynamics among the elderly [see, e.g., Li et al. (2009);Wang et al. (2014); Liu et al. (2015)]. In light of the lack of causal evidence for an effect of fertility policies on elderly suicide rates, the present paper contributes novel evidence that is consistent with this long-standing conjecture. ...
... In light of the rural/urban divide in economic living conditions and in view of the significant decrease in suicide rates among the urban elderly relative to those of elderly in rural areas, these findings appear surprising at first sight. Existing work has argued that this relative decrease might have been due to the improvement in long-term care systems in urban areas and the lack of social support in rural areas [see, e.g., Li et al. (2009)]. In addition, the strictness of the LLM policies varied between rural and urban areas, see the discussion above. ...
... Thus, a possible interpretation is that in urban environments, lower fertility and the consequences in terms of a smaller family and reduced companionship with children and kin are potentially felt harder, with the consequence of significantly higher suicide rates among the elderly. 18 This interpretation is consistent with the findings of Chen and Fang (2021) that exposure to restrictive fertility policy had a negative influence on the mental health of the elderly and with earlier findings that suggest that mental health problems are more important as cause of suicide in urban areas than in rural areas, where family conflicts are relatively more important [see, e.g., Li et al. (2009);Dong et al. (2015), and the citations therein]. Column (3) of Table 3 shows the estimation results when allowing for heterogeneity in the policy effect by region. ...
This paper presents an empirical investigation of the hypothesis that exposure to the restrictive fertility policies of the Chinese “Later, Longer, Fewer” campaign in the 1970s contributes to the dynamics and patterns of elderly suicides in China in the period 2004–2017. We apply an identification strategy that exploits variation in exposure to this policy across birth cohorts that is based on the different timing of the implementation of the fertility policies across Chinese provinces. The results show that cohorts with a greater exposure to the restrictive fertility policy in the 1970s exhibit higher suicide rates during old ages.
... The increasing suicide among senior residents in rural China has becoming a significant issue. The unevenly paced development has resulted in growing financial inequality, leading to extra suicide risk for vulnerable subgroups of population (5). Senior residents in rural China represent one of such subgroups. ...
... Family separation may exert significant pressure on these left-behind seniors, leading to depression and suicide (6). Furthermore, people in old ages often suffer from chronic diseases with poor health status, exacerbating the risk for suicide (5,8). ...
... Of all 10 variables, depression ranks the first, 3.47 times stronger than the second one (social support), and 3.99 times stronger than the third (QOL). These findings confirm the importance of these factors in affecting suicide among old adults in rural China (5,21). ...
Objectives
To identify mechanisms underpinning the complex relationships between influential factors and suicide risk with psychological autopsy data and machine learning method.
Design
A case-control study with suicide deaths selected using two-stage stratified cluster sampling method; and 1:1 age-and-gender matched live controls in the same geographic area.
Setting
Disproportionately high risk of suicide among rural elderly in China.
Participants
A total of 242 subjects died from suicide and 242 matched live controls, 60 years of age and older.
Measurements
Suicide death was determined based on the ICD-10 codes. Influential factors were measured using validated instruments and commonly accepted variables.
Results
Of the total sample, 270 (55.8%) were male with mean age = 74.2 (SD = 8.2) years old. Four CART models were used to select influential factors using the criteria: areas under the curve (AUC) ≥ 0.8, sensitivity ≥ 0.8, and specificity ≥ 0.8. Each model included a lead predictor plus 8–10 hierarchically nested factors. Depression was the first to be selected in Model 1 as the lead predictor; After depression was excluded, quality of life (QOL) was selected in Model 2; After depression and QOL were excluded, social support was selected in Model 3. Finally, after all 3 lead factors were excluded, marital status was selected in Model 4. In addition, CART demonstrated the significance of several influential factors that would not be associated with suicide if the data were analyzed using the conventional logistic regression.
Conclusion
Associations between the key factors and suicide death for Chinese rural elderly are not linear and parallel but hierarchically nested that could not be effectively detected using conventional statistical methods. Findings of this study provide new and compelling evidence supporting tailored suicide prevention interventions at the familial, clinical and community levels.
... Nonetheless, after 2000s, their proportion dramatically increased to 79.19% (16). SRs among the elderly are highest in China and are approximately five times higher than the SRs among younger people (17). A recent study investigated the SRs among the elderly in China in 2003, 2008, 2013, and 2018 using an annual percentage change (APC) model. ...
... In this study, only data on elderly were included. Here, "elderly" were defined as "people ≥ the age of 65" in line with the CHSYB as well as several previous analogous studies (13,17,19). Age was grouped as ages 65-69, ages 70-74, ages 75-79, ages 80-84, and ≥ the age of 85. ...
The aim of this study was to investigate trends in suicide rates (SRs) among the elderly in China. Annual data on SRs among Chinese people ≥ the age of 65 were collected from China's Health Statistics Yearbook from 2002 to 2020. Then, data were stratified by age, region, and sex. Standardized SRs were calculated and analyzed using a conventional joinpoint regression model. Results revealed that overall, SRs among the elderly in China tended to decline from 2002–2020. Fluctuations in SRs, including in 2004–2005 due to the SARS epidemic, in 2009–2010 due to the economic crisis, and in 2019–2020 due to the COVID-19 pandemic, were also observed. Data suggested a relatively greater crude SR among the elderly (vs. young people), in males (vs. females), and in people living in a rural area (vs. those living in an urban area). SRs tended to rise with age. Joinpoint regression analysis identified joinpoints only for males ages 65–69 and over the age of 85 living in a rural area, suggesting that individuals in these groups are more sensitive to negative stimuli and more likely to commit suicide, necessitating closer attention. The findings from this study should help to make policy and devise measures against suicide in the future.
... Yet, it was those feelings of loneliness, usually resulting from living alone and/or bereavement, together with helplessness and despair, which would inevitably trigger self-harming behaviors. It was those feelings of loss are what Li et al. (34) characterize as a "lost theory, " which suggests that aging is exemplified by continuous loss, including loss of one's health, one's social role, one's relatives and friends and one's life goals. This theory also supports the idea that loss for older people serves as a major crux for desperation ideation, which then leads into depression, social isolation and loneliness. ...
... Unfortunately, this also brings the threat of financial insecurity to a threat of old-age security (40). This is also evident where globalization has exacerbated the "empty nest" syndrome, where grown-up children leave for other cities or indeed other countries (34). ...
Aims
To appraise and synthesize qualitative studies examining older Asian people’s experiences of suicidal ideation.
Design
Qualitative review and meta-aggregation.
Data sources
Four databases were accessed to retrieve papers published between 1990 and 2022 including the grey literature, hand-searching of reference lists of retrieved papers and key journals. The phenomenon of interest included participants older than 60 years old, must have experienced a form of suicidal ideation and/or an unsuccessful attempt, had actively thought about harming themselves and be of Asian ethnicity.
Review methods
This review was conducted according to Consolidated Criteria for Reporting Qualitative Research and the Joanna Briggs Institute’s System for the Unified Management of the Assessment and Review of Information.
Results
Of the 289 potential studies, seven papers met the inclusion criteria. Two synthesized findings resulted from this review–The Suffering Situation: A Life without Meaning in Older Age and The Healing Situation: A Life Worth Living. The experiences of older Asian people varied from feelings of loneliness, despair and isolation to wanting to live a fruitful life into old age.
Conclusion
Suicidal ideation in the older person is a growing concern especially with the rise in suicide in this age group. Rising health care costs and erosion of traditional family values means that the older person views themselves as a burden. However, because of the limited number of qualitative studies from an Asian perspective it is difficult to ascertain the full extent of the issues surrounding suicide in older people.
... Chinese suicide rates were among the lowest globally in 1999, with 5·29 per 100 000 people; however, older Chinese people rank third in the world. 57 Chinese suicides show unique demographic patterns with age: the older group (aged 65 years and over) has the highest rate (44·3-200·0 suicides per 100 000), 4-5 times higher than the general population. 57 The national suicide rate of older adults significantly decreased from 76·6 per 100 000 in 1987 to 30·2 per 100 000 in 2014. ...
... 57 Chinese suicides show unique demographic patterns with age: the older group (aged 65 years and over) has the highest rate (44·3-200·0 suicides per 100 000), 4-5 times higher than the general population. 57 The national suicide rate of older adults significantly decreased from 76·6 per 100 000 in 1987 to 30·2 per 100 000 in 2014. 58 ...
Unlabelled:
Around the world, populations are ageing at a faster pace than in the past and this demographic transition will have impacts on all aspects of societies. In May 2020, the UN General Assembly declared 2021–2030 the Decade of Healthy Ageing, highlighting the importance for policymakers across the world to focus policy on improving the lives of older people, both today and in the future. While rapid population ageing poses challenges, China’s rapid economic growth over the last forty years has created space for policy to assist older persons and families in their efforts to improve health and well-being at older ages. As China is home to 1/5 of the world’s older people, China is often held up as an example for other middle-income countries. This Commission Report aims to help readers to understand the process of healthy ageing in China as a means of drawing lessons from the China experience. In addition, with the purpose of informing the ongoing policy dialogue within China, the Commission Report highlights the policy challenges on the horizon and draws lessons from international experience.
The uniqueness of china’s ageing society:
From a global perspective, China shares some of the economic and social challenges faced by other countries with rapidly ageing populations. China stands out, however, as it already has the world’s largest older population, and China’s ageing burdens will increase further as the ‘second baby boomers’ (those born between 1962 and 1975) start to enter retirement in 2022. In addition, China’s rapid demographic transition over the last four decades will lead to a dramatic decline in the number of living children for each older person in China and bring substantial challenges for both family-based care and social care. Compounding demographic changes, personnel planning in geriatric and rehabilitation medicine has not kept pace with the growth of the older age population, and there is a shortage of medical resources targeted at the ageing population. In Section 1, the report stresses the importance of achieving “healthy ageing” in light of socio-economic progress, urbanization and migration, and China’s demographic transition.
Health complexity and inequalities among china’s older population:
China completed its epidemiological transition from infectious diseases to non-communicable diseases (NCDs) during the past three decades. As in many other ageing countries, the upward trend in the incidence of NCDs and the presence of multimorbidity pose special challenges for China’s healthcare sector. Even as some older Chinese continue to suffer from such communicable diseases as hepatitis, tuberculosis, and sexually transmitted diseases, chronic conditions, such as cognitive impairments, mental disorders, and frailty, are becoming much more prominent. These chronic conditions are complex to treat and manage and are associated with more functional disability and greater care needs. Along with the emergence of NCDs, substantial gaps in health are apparent by gender, rural versus urban residence, ethnicity, and socio-economic status. Investments in healthy ageing, from promoting education in health literacy to improving access to health care, are promising means of improving the well-being of older adults and reducing the gaps in health across socioeconomic groups in China. Even as China’s population ages, investments in healthy ageing offer a path for older Chinese to play meaningful and productive social roles in society, while limiting burdens on their families. The latest facts on health status and health inequities among China’s older adults are presented in Section 2 of the report.
Modifiable factors of healthy ageing: evidence from china.:
Current evidence on the determinants of health and functioning status of China’s older population is summarized in Section 3. In China, as elsewhere, health at older ages results from the cumulative effects of behaviours and events that occur across the life cycle. These include exposures to unhealthy environments and parental decisions influencing in-utero and childhood health, later health behaviours as teenagers and adults (including decisions on educational investments, smoking, drinking, and physical activity), and decisions over food consumption which influence diet and nutritional status. Many of these decisions and behaviors are influenced by health literacy and socio-economic conditions, but they may also be influenced by policy (Section 5). Finally, Section 3 highlights the health benefits of social connections and participating in leisure activities such as square dancing and promoting age-friendly environments in China.
Integrating medical and social care for chinese older people.:
Older people require access to high-quality health services that include prevention, promotion, curative, rehabilitative, palliative and end-of-life care. An update on China’s policy initiatives regarding healthcare and social care relevant to the ageing population is provided in Section 4. In addition to achieving universal health insurance coverage, China has invested heavily in public health promotion and the consolidation of the primary healthcare system. Further, as the role of the family in providing care for older people is eroded by dwindling family size and changing living arrangements, especially with the outmigration of adult children, China is taking steps to build up institutional and community care infrastructure as both a substitute for, and complement to, family care. Furthermore, long-term care insurance (LTCI) has been piloted in many cities as a financing mechanism. China’s experience with the LTCI pilots suggests that it will be difficult to sustain LTCI under the current pay-as-you-go framework, and that there will be a considerable public financial risk as the population ages. Although China’s government has placed the integration of health care with long-term care (LTC) at the forefront of its policy agenda, the progress for the integration has been slow.
Lessons learned from china and implications for the future.:
An overview of the evidence presented earlier in the report is presented in Section 5, followed by policy recommendations for supporting healthy ageing in China. Policy recommendations outlined here can be generalized to other countries, especially low- and middle-income countries (LMICs). First, health promotion initiatives should focus on changing people’s behavior, especially smoking cessation, weight control, and health literacy education to reduce the incidence of NCDs and care burdens. Second, there is an urgent need to move away from disease-centred care to person-centred care and to increase the supply of health care workers, particularly in geriatric medicine, rehabilitation medicine, and hospice care. Third, innovative measures should be taken to remove obstacles to upgrading community and home environments and thus facilitate mobility and social engagement among older people. There are several other policy areas that should be addressed, given China’s unique institutional environment. These include regional segmentation of health insurance systems and the regulatory environment for healthcare delivery. Specifically, the report suggests that policy in China should focus on: (1) national integration of the health insurance system to eliminate the current segmentation across regions and occupations; (2) capping regionally segmented LTCI initiatives, and striving for a national scheme that is independently funded; (3) switching government subsidies in the aged care sector from subsidising providers to subsidising consumers to facilitate market competition and to help existing care facilities to meet safety regulations; (4) strengthing the capacity to regulate medical service providers, especially in screening for fraud against the national medical insurance schemes and reforming the healthcare delivery sector by lowering barriers to entry and facilitating choice. Older people are an important part of a family and an invaluable asset to society. Healthy ageing will not only enable older people to enjoy their later life to the fullest but has the potential to unleash the intellectual and vocational capacities of society as a whole. Recognizing that China’s older population will continue to grow, it is important to take their needs into account and prepare well in advance by creating an age-friendly environment for the ageing population. As China’s “second baby boomers” start to reach retirement age in 2022, it is imperative to take the window of opportunity afforded by China’s economic growth to make coordinated efforts across sectors to address the concerns of an ageing nation.
... Public Health 2022, 19, 7496 2 of 11 cognitive function of the elderly and increase the risk of cardiovascular and cerebrovascular diseases [9]. When depression persists, it also increases the risk of suicide and death among older adults [10]. Studies have shown that suicide levels among older adults are higher in rural areas than in urban areas, suggesting inequalities in mental health and resource allocation between rural and urban areas [11]. ...
... cognitive function of the elderly and increase the risk of cardiovascular and cerebrovascular diseases [9]. When depression persists, it also increases the risk of suicide and death among older adults [10]. Studies have shown that suicide levels among older adults are higher in rural areas than in urban areas, suggesting inequalities in mental health and resource allocation between rural and urban areas [11]. ...
(1) Background: To explore the relationship between health status, social security status, and the occurrence of depression in older adults and provide a basis for mental health care services for the elderly population; (2) Methods: This study used the 2018 China Health and Senior Care Tracking Survey (CHARLS) data to select 8383 older people aged over 60 years old as the research subjects. The two-category Logistic model was used to analyze the research problem; (3) Results: Older adults with depressive tendencies accounted for 34.1% of the total older adults. The incidence of depression among female older adults reached 41.51%. The risk of depression in the elderly population was 40.3% lower in males than in females (OR = 0.597, 95% CI: 0.539–0.662). Self-rated health status, physical disability, and receipt of pensions affected the incidence of depression in older adults (all p < 0.05); (4) Conclusions: Focus on and intervene in the mental status of elderly females and disabled elderly people. Provide mental and economic support and mental health care services to the elderly at the family and social levels. Promote the healthy development of the mental health of the elderly and promote active aging.
... In one cohort where authors assessed depressive symptoms and mortality risk factors, they found after an eight years follow-up that mortality risk was detected in men only [29]. Whereas we evaluated all-cause mortality, it is known that men have fewer social circles and with that, they look for help less often, what is more, men tend to commit more suicide than women [15,21,27]. Other risk factors well associated with depressive symptoms and mortality are the cerebral and heart ischemia diseases [15,27,28]. ...
... Whereas we evaluated all-cause mortality, it is known that men have fewer social circles and with that, they look for help less often, what is more, men tend to commit more suicide than women [15,21,27]. Other risk factors well associated with depressive symptoms and mortality are the cerebral and heart ischemia diseases [15,27,28]. In our study we included retired veterans and their immediate family, veterans are mostly men so that could not be extrapolated in a general population. ...
... 24 Despite the high prevalence of LLD and associated impairment, elderly patients in China underutilize mental health services because of stigma of mental illness in traditional Chinese culture and poor mental health literacy. 27,28 Although Chinese elderly are more inclined to seek treatment for mental health problems in primary care as less stigma is associated with primary care treatment, 28 the majority of elderly patients treated in primary care or in the community receive inadequate or no treatment for their depression. 27 Depression in the elderly in China and elsewhere is often underdetected, 28,29 and once identified treatment is not always optimal, with more than 60% of patients remaining depressed at 12-month follow-up. ...
... 27,28 Although Chinese elderly are more inclined to seek treatment for mental health problems in primary care as less stigma is associated with primary care treatment, 28 the majority of elderly patients treated in primary care or in the community receive inadequate or no treatment for their depression. 27 Depression in the elderly in China and elsewhere is often underdetected, 28,29 and once identified treatment is not always optimal, with more than 60% of patients remaining depressed at 12-month follow-up. 29 Pharmacotherapy is often the first choice of treatment for LLD worldwide, however, the efficacy of antidepressant medication tends to be modest and a substantial number of patients require additional treatment. ...
Interpersonal psychotherapy (IPT) is a time-limited, structured, interpersonally oriented psychotherapy, with demonstrated efficacy for the treatment of major depression across the lifespan. IPT uses a medical model of illness and links depressed mood to four research-informed interpersonal problem areas: complicated grief, role transitions, role disputes, and interpersonal deficits/sensitivity. The IPT model of vulnerability to depression nicely dovetails with interpersonal issues that are faced by older adults, and this article focuses on the application of IPT for late-life depression in China. The group format of IPT may be a practical and efficient method of improving access to an established depression-focused treatment for China’s rapidly aging population and has the advantage of providing important social support for patients who feel lonely, isolated, and stigmatized. Short-term interventions like IPT are more cost-effective from a public health perspective and can easily be delivered in primary care facilities, where many elderly patients receive care. IPT is effective in different cultures, and possible cultural adaptations of IPT for older adults in China are discussed herein.
... Suicide mortality of rural elderly is 3 to 4 times higher than urban elderly. [9] The rate of elderly suicide is highest in rural areas, which is approximately 5 times the rate in the general population. [9] However, researches on the prevalence and influence factors of suicidal ideation among older people living alone in the rural region are few. ...
... [9] The rate of elderly suicide is highest in rural areas, which is approximately 5 times the rate in the general population. [9] However, researches on the prevalence and influence factors of suicidal ideation among older people living alone in the rural region are few. ...
In China, suicide accounts for twenty-six percent of all suicides worldwide; however, researches on the suicidal ideation among older people living alone in the rural region are few. We performed a cross-sectional study to explore the prevalence and influence factors of suicidal ideation, and provide a theoretical basis for suicide prevention among older people living alone in rural region.
695 older people living alone in rural region were selected by using stratified cluster sampling. Chi-square for categorical variables, T-test for continuous variables, and path analysis were conducted to statistical analysis.
The prevalence of suicidal ideation among the elderly living alone in rural China was 23.6%. Path analyses showed that depression had the most substantial influence on suicidal ideation among the elderly living alone, it was also as a mediator between physical, economic status, social support, anxiety, and suicidal ideation; anxiety and social support had both direct and indirect influence on suicidal ideation; physical status and economic status had indirection impact.
The incidence of suicidal ideation among the elderly living alone was high in Dangtu county. Psychological disorders (anxiety and depression) had the strongest impact on suicidal ideation. Strategies and measures targeting these relevant factors (economic status, physical status, and social support) should be taken to reduce the burdens of suicidal ideation among the elderly living alone in China.
... Por fim, a taxa de urbanização apresentou coeficiente estimado negativo, de 0,561%, ou seja, municípios mais urbanizados apresentam menores taxas de suicídios em relação aos seus pares. Também analisando dados chineses, Li et al. (2009) encontraram relação negativa entre urbanização e taxas de suicídios, ou seja, residentes em áreas rurais estão mais vulneráveis em relação ao suicídio, sendo a principal motivação referente a falta de apoio social que as pessoas dessas localidades estão condicionadas. Além disso, a renda média tende a ser mais baixa na zona rural, além de os serviços de assistência social e de saúde, sobretudo de saúde mental, serem menos acessíveis a este público. ...
O presente estudo tem como objetivo analisar como os investimentos com assistência social se relacionam com as taxas de suicídios por 100 mil habitantes, considerando-se a metodologia de dados em painel dinâmico a partir de dados extraídos do Índice Mineiro de Responsabilidade Social para o estado de Minas Gerais no período compreendido entre os anos de 2002 e 2017. O referido estado é o segundo mais populoso do Brasil e corresponde a terceira maior participação no Produto Interno Bruto (PIB) do país. Os resultados sugerem que o aumento dos referidos investimentos possibilita diminuição das taxas de suicídios. Além disso, verifica-se a persistente e discreta elevação das taxas de suicídios entre os anos 2002-2014, quando há aumento muito expressivo, corroborando com a literatura de que as crises econômicas são catalisadoras desse comportamento. Por fim, conclui-se que as políticas assistenciais são importantes mecanismos de proteção aos indivíduos no tocante às variações dos níveis de renda ao longo do tempo, correspondendo a uma forma eficaz de evitar casos de suicídios, sobretudo quando há efeitos econômicos adversos.
... Past research conducted in South America [44], Europe [45,46], and Asia [47,48], has consistently shown that those over 50 years of age possess the greatest risk. Factors such as chronic illness, family discord, financial difficulty, and mental disorders may contribute significantly to the suicide rates among the elderly in China [49,50]. One study also proposes that the decrease in suicide rates among the elderly may be attributable to enhanced healthcare systems and a reduction in poverty rates [51]. ...
Background
Over the past three decades, China has experienced significant changes in urban-rural, gender, and age-specific suicide mortality patterns. This study aimed to investigate the long-term trends in suicide mortality in China from 1987 to 2020.
Methods
Suicide mortality data were obtained from China’s National Health Commission. Joinpoint regression analysis was used to examine changes in trends and age-period-cohort modeling to estimate age, period, and cohort effects on suicide mortality from 1987 to 2020. Net drift, local drift, longitudinal age curves, and period relative risks were also calculated.
Results
Crude and age-standardized suicide mortality in China showed continuing downward trends from 1987 to 2020, with a more pronounced decrease in rural areas (net drift = -7.07%, p<0.01) compared to urban areas (net drift = -3.41%, p<0.01). The decline curve of urban areas could be divided into three substages. Period and cohort effects were more prominent in rural areas. Suicide risk was highest among individuals aged 20–24 and gradually increased after age 60. Females, particularly those of childbearing age, had higher suicide risk than males, with a reversal observed after age 50. This gender reversal showed distinct patterns in urban and rural areas, with a widening gap in urban areas and a relatively stable gap in rural areas.
Conclusions
Suicide mortality in China has consistently declined over the past three decades. However, disparities in age, gender, and urban-rural settings persist, with new patterns emerging. Targeted suicide prevention programs are urgently needed for high-risk groups, including females of childbearing age and the elderly, and to address the slower decrease and reversing urban-rural gender trends.
... With regard to the elderly population ratio, the suicide rate among the elderly is higher than that of young adults due to loneliness in old age. Risk factors for suicide among the elderly include living alone, loss of a spouse, financial worries, deteriorating health and a high prevalence of mental health issues [18]. Similarly, research investigating suicide rates within the elderly population in China indicated that China ranks third globally in terms of the prevalence of suicide among the elderly. ...
Background: Suicide is a significant cause of death in many countries worldwide. In Thailand, it ranks second in unnatural deaths, following accidents, with an increasing trend. This study aims to 1) describe the spatial distribution of suicide rates and 2) identify the spatial relationships among socioeconomic status, physical geography and suicide rates during the years 2012-2021.
Methods: This study sought to explain the spatial distribution of suicide rates across provinces in Thailand from 2012 to 2021. The spatial relationships were analyzed using LISA and spatial regression.
Results: The result obtained from univariate LISA indicated a concentration of suicide rates in the northern region of Thailand for the period from 2012 to 2021. Spatial regression analysis using OLS, SLM and SEM demonstrated the relationships between suicide rates and various variables, such as divorce rates, poverty rates, elderly proportions and NDWI. These factors exhibited a positive correlation with suicide rates and were statistically significant. Conversely, the NTL density and average rainfall displayed a negative correlation with suicide rates.
Conclusion: Our study observed that the distribution of divorce rates, poverty population proportion, elderly population proportion and the normalized difference water index were likely to be associated with enhancing the suicide rate. However, the intensity of average Night-Time-Light (NTL) was observed to reduce the suicidal rate. Therefore, these present findings can be utilised in the development of policy as well as strategies concerning surveillance, control and prevention of suicide in Thailand.
... A more recent line of research concentrates on micro-level factors such as health literacy and focuses on local social and cultural contexts to account for variation in health-seeking behavior. Scholars exploring this emphasize the importance of the environmental characteristics of local communities and prevalent cultural beliefs that affect older people's understanding of chronic diseases and their use of health services (Li, Xiao, & Xiao, 2009;C. Liu, Li, Ren, & Liu, 2010;Y. ...
... 13 The long-standing urban-rural dichotomous system in China has led to poorer treatment of rural elders compared to urban elders in terms of health insurance and health care, 14 which means that the rural elderly may face higher health risks. In China, the suicide rate among rural elders is three to four times higher than that of urban elders and five times higher than that of the general population, 15 and among rural elders with suicidal ideation, most have varying degrees of health problems. 16 Although China has made considerable efforts to protect the right to health of rural elderly people, and relevant laws and policies involving the protection of the right to health of rural elderly people have been adjusted several times, there are still certain flaws in the legal protection of the right to health of the rural elderly. ...
Older people in rural China enjoy the right to health under Chinese law. However, the problems of economic difficulties, the unbalanced allocation of medical resources between urban and rural areas and the weakening of the traditional function of the family as a provider of old-age care in reality make the elderly in rural areas face a higher risk of health problems. The law is an important tool to mitigate these problems. Although China has made great efforts to legally guarantee the right to health of the rural elderly, it has not yet fully implemented the requirements of Article 12 of the International Covenant on Economic, Social and Cultural Rights, Article 14 of the Madrid Political Declaration and International Plan of Action on Ageing. China needs to further improve the relevant legislation to provide adequate legal support for the exercise of the right to health of the elderly in rural areas.
... Former studies, including those in South America[28], Europe [29,30], and Asia [31,32], have demonstrated that suicide risk is highest among people over 50 years old. Chronic illness, family discord, nancial di culty, and mental disorder are probably the signi cant factors associated with the elderly suicide in China [33,34]. Meanwhile, one study also indicated that the decline in elderly' suicide mortality might be related to the establishment of healthcare systems for the elderly,and the reduction in poverty rates among the elderly [35]. ...
Background: Patterns in urban-rural, gender, and age suicide mortalities in China have shown dramatic changes over the past three decades. This study aimed to explore the long-term patterns of suicide mortality in China from 1987 to 2020.
Methods: Data on suicide mortality were derived from China's National Health Commission. Joinpoint regression analysis was used to explore changes in trends and age-period-cohort modeling to estimate age, period and cohort effects in suicide mortality from 1987 to 2020. Net drift, local drift, longitudinal age curves, and period relative risks were also calculated.
Results: (1) Crude and age-standardized suicide mortality in China showed continuing downward trends from 1987-2020. Rural age-standardized suicide mortality (net drift = -3.41%, p＜0.01) declined to a greater extent than in urban areas (net drift = -7.07%, p＜0.01), whose decline curve could be divided into three substages. Both period and cohort effects regarding rural areas declined more than urban areas; (2) Youngsters aged 20-24 were at the highest suicide risk, and suicide risk gradually increased with age after 60. Females, especially of childbearing age, had higher suicide risk than males, but there existed a trend reversal between genders in groups aged above 50; (3) Gender reversal of suicide risk after age 50 showed different trends in urban and rural areas. The gap in suicide risk between genders widens with age in urban areas, while the gap remains relatively stable in rural areas.
Conclusions: Suicide mortality in China continued to decline over the past three decades. Age, gender, and urban-rural disparities in suicide mortality have been continuing but show new patterns. Females of childbearing age and the elderly are at high risk for suicide. The slower decrease, high-risk groups, and the reversing urban-rural gender trends urgently require close attention and more targeted suicide prevention programs.
... Cho et al. [31] found that most of the patients who had cut their wrists repeatedly were mainly young. Li et al. [18] in their study on the elderly in China found that drowning in rivers or wells (3.2-14.3%) was one of the most reported suicidal methods, and that was also reported in India. ...
Background
Many studies found association between psychosocial factors and suicidal behavior; this association differs from one community to another, and this difference could affect the risk assessment and the management of suicidal behavior. The aim of this work was to evaluate the role of socioeconomic, cultural, and psychosocial profile including psychiatric comorbidity on individuals with suicidal behavior who attended Tanta University emergency hospital.
Results
Family troubles were the commonest cause of suicidal behavior (28%), and drug overdose was the commonest method of attempt (38%). Positive correlation is between age and score of Beck scale for suicidal ideation ( p = 0.000) which indicates that suicidal ideation increases with age. Significant association is between psychiatric comorbidity and Beck’s scale for suicidal ideation ( p = 0.019), with size of association ( η = 0.58).
Regression analysis showed that older age, female sex, illiterates, widows, cases with psychiatric illness, and low socioeconomic status when act altogether are the significant predictor of suicidal ideation of our studied sample.
Conclusions
Our study demonstrated that studying psychosocial factors in individuals who came to emergency hospital of Tanta University could be a reflection of the community visiting this hospital asking for medical emergency service; the comprehensive and multifactorial assessment we have been adopted in this work could help in better understanding of the suicidal risk factors in this community and consequently help in part in tailoring the clinical service for this sector of patient.
... Elderly people have the highest suicide rates in almost every country. [12][13][14][15] While depression, physical illness, and loss are known to precipitate suicidal behaviour in the elderly; only a minority of older people with these risk factors attempt or complete suicide. [16][17][18][19] Suicide by electrocution is also observed more common in the elderly. ...
Suicide is defined as “the act of killing yourself deliberately”. Most common methods of committing suicide in India are hanging, followed by poisoning, drowning and self-immolation. While least common methods include consuming sleeping pills, electrocution, self-inflicting injuries and firearm injury. Considering deaths due to electrocutions, in India as well as globally, suicidal electrocutions are reported to be very rare compared to accidental ones. Existing literature also have scarcity of reports related to suicidal electrocutions. Hence, we hereby report a case of suicidal electrocution due to its rarity.
... Every year, about 800,000 people die by suicide in the world, of which China accounts for about 17% of the total number, ranking second in the world (World Health Organization, 2019). Previous studies have shown that the group with the highest suicide rate is the elderly aged 65 years and above (Li et al., 2009;Wang et al., 2014). The results of China's seventh census show that the aging process of China's population has accelerated significantly and the urban and rural differences are significant (Bulletin of the Seventh National Population Census of the National Bureau of Statistics). ...
Introduction
Social exclusion as well as a sense of belonging and depression have been identified as risk factors for suicide among older adults in pension institutions. In particular, the elderly living in rural pension institutions is more likely to have poor mental health and a higher incidence of suicidal ideation. This study explored the mechanism of social exclusion on suicidal ideation among the elderly in rural pension institutions, and the moderating effect of interpersonal trust.
Methods
The social exclusion experience scale, sense of belonging, depression self-rating scale (CES-D), suicidal ideation scale (BSI-CV), and interpersonal trust scale (ITS) were used to investigate the elderly in rural pension institutions. A total of 1,387 samples (53.35% female) were collected, ranging in age from 65 to 95 years (M = 72.8, SD = 6.173).
Results
The results of the study found that: (1) social exclusion increases the suicidal ideation of the elderly in rural pension institutions, and the sense of belonging and depression play a significant chain-mediated role in the relationship between social exclusion and suicidal ideation in the elderly. (2) Interpersonal trust moderates the impact of social exclusion on the sense of belonging, depression, and suicidal ideation. Specifically, interpersonal trust can alleviate the promotion effect of social isolation on suicidal ideation and depression, and can also reduce the adverse effect of social exclusion on the sense of belonging.
Discussion
This study validates that social exclusion is a risk factor for suicidal ideation in the rural elderly and identifies interpersonal trust as a protective factor against social exclusion and its negative outcomes in the elderly. This study provides a scientific basis for improving the depression status of the elderly in rural China and formulating suicide prevention measures.
... We are witnessing a new phase of aging society, and many aging problems begin to emerge. For example, the difficulties encountered by left-behind elderly or the elderly citizens living alone in their lives have given rise to a series of social problems, such as suicide (2), fraud (3) and low social participation (4), which have imposed new requirements on China's welfare and social governance. Different from western countries, under the influence of the concepts of filial piety culture, raising children for old age, and generation-skipping care, it has become a cultural habitus for the elderlies to live with their children in China. ...
Background
Due to the rapid acceleration of social mobility and the shrinking size of families, China has begun to enter a new form of aging society, with an increasing number of migrant elderlies following their children. How to adapt and assimilate into the new living space profoundly affects those migrant elderlies' mental health. Drawing on the spatial framework proposed by Henry Lefebvre, this paper explores the factors affecting urban assimilation of migrant elderlies following their children in China, and puts forward corresponding strategies to promote the urban assimilation.
Method
Using semi-structured interviews and participatory observation, this study conducted a qualitative study among migrant elderlies following their children who lived in a University Community in Wuhan city, Hubei Province from May 2022 to July 2022. During the survey period, we participated in the gathering activities of the migrant elderly five times a week, and conducted semi-structured interviews with 15 migrant elderlies following their children.
Results
Firstly, this study reveals that family assimilation is the foundation of urban assimilation of migrant elderly following their children; Secondly, we could conclude that the urban life of the migrant elderlies are mostly community-based, so it is especially important for them to reconstruct close neighborhood relations and regain the humanity affection of the traditional acquaintance society. Lastly, the fundamental institutional barrier is a significant factor that influences the ability of these migrant elderlies to live a stable urban life. The Chinese government needs to promote a nationwide unified pension and health insurance system, so that the migrant elderlies can enjoy the same benefits as the local elderly residents in the “inflow” area.
... In the present case, 44% of those who commit suicide are 65 or older; this rate is much higher than 18% in the United States (10, 11). Some adverse social and cultural impacts on older adults in rural China were suggested to be a key factor contributing to SB (12). Therefore, when discussing the factors correlated to SB among MDD patients, the sociocultural contexts should also be carefully considered (13). ...
Objective
Previous studies indicate that more than half of those who died by suicide had a depressive disorder. When discussing the factors associated to suicidal behavior (SB) among patients with major depressive disorder (MDD), sociocultural contexts should also be carefully considered. This case series study explored the factors correlated to SB among MDD patients in Beijing, China.
Methods
The patient information sheets were retrieved from an electronic database that comprised patient medical information. Three forms of binary logistic regression equations were conducted to explore the factors associated to SB among patients with MDD. For the inconsistent variables produced by the three regression models, the propensity score matching (PSM) analysis was done for further verification.
Results
In this retrospective study, 1,091 depressed cases were enrolled. The difference between the SB group and non-SB group in gender, impulsivity, the severity of depression, history of major mental trauma, and family history of suicide were statistically significant in univariate comparisons (P < 0.05); the binary logistic regression analysis and the PSM analysis showed that female gender, history of major mental trauma, impulsivity, family history of suicide and severity of depression were factors correlated to SB among patients with MDD (odds ratios >1).
Conclusions
Female gender, the history of major mental trauma, impulsivity, the severity of depression, and family history of suicide were independently associated with the appearance of SB among MDD patients in Beijing, China. Inevitably, these findings should be viewed with particular caution due to the inherent drawbacks of a retrospective nature. More prospective longitudinal research should be conducted to examine those dynamic alterations in the corresponding confounders.
... Studies have shown that the mental health of some older adults is in a long-term suboptimal healthy or unhealthy state, and this unhealthy state is closely related to isolation, neglect, and mistreatment from the external environment [13,14]. In China, the suicide rate among people over 65 years of age is four to five times higher than that among the general population, reaching 44.3-200 per 100,000 people, demonstrating the negative outcomes of poor long-term mental health [15,16]. In addition, various forms of violence and mistreatment against older adults are prevalent. ...
Older adults’ family networks and social networks are important factors that influence life satisfaction, but their transmission mechanisms have not been adequately discussed. The objective of this study was to examine the mechanisms through which family networks and social networks influence the life satisfaction of older adults. We empirically examined the effects and mechanisms of older adults’ family networks and social networks on their life satisfaction using the 2018 China Longitudinal Aging Social Survey with a sample size of 11,418 older adults aged 60 years and older. In the research sample, 6.47% of older adults were subjected to at least one form of mistreatment. The research results indicate that family networks (β = 0.0060, p < 0.05) and social networks (β = 0.0122, p < 0.01) have a significant positive effect on older adults’ life satisfaction. The mechanism-of-action test found that family networks and social networks enhance older adults’ life satisfaction, mainly by reducing the level of physical mistreatment they experience, but these networks cannot improve the life satisfaction of the elderly by reducing their emotional mistreatment. Further research found that community-provided medical escorts, home chores, and meal delivery services can all alleviate the decline in life satisfaction among older adults due to emotional mistreatment. This study deepens our understanding of how older adults’ family and social networks affect their life satisfaction as we examine the mediating role of the physical and emotional mistreatment of older adults and discuss the effects of potential policy interventions.
... We would like to emphasize that the mental health status of the elderly is of first-order policy importance. China's national elderly suicide rates (ESR) are four to five times higher than the Chinese general population and more than twice the global average of the ESR (Li et al., 2009). The share of suicides committed by the elderly aged 65 or above monotonically increases from 16.9% in 198716.9% in to 41.2% in 201416.9% in (Zhong et al., 2016. ...
... In India, drowning, hanging, and poisoning are ranked the common methods of suicide (63%) [112,114]. This finding contradicts Western countries, where firearms, hanging, and drug ingestion are adopted in suicide, with the former being the commonest [115]. Despite the significance of depressive disorder in elderly suicide, most studies report considerably insufficient/inept use of antidepressants before death [57,116]. ...
Background: There has been an increase in deaths by suicide in old age in the last decade. Depression and suicide in the elderly, 60 years and above, is a major global public health concern. Determining the prevalence of depression, and correlates of death by suicide in the geriatric population, is an important first step toward addressing this public health concern. This literature review aims to determine the prevalence of major depressive disorders and the correlates of death by suicide in the geriatric population. Methods: This general review of the literature was performed using relevant search terms to determine both the prevalence of depression and the correlates of death by suicide among the geriatric population. Databases such as MEDLINE, PsycINFO, CINAHL, and PubMed were searched. Relevant and current articles were extracted, reviewed, and analyzed. The elderly population was defined as individuals 60 years and above. Only full texts articles in English were reviewed. Findings: The prevalence estimates of major depressive disorder in the elderly ranged from 5.37 to 56%. Adults aged 60 years and older have a high risk of depression that exposes them to suicide. Moreover, elderly women are more likely to experience depression than elderly men, but successful suicide is more common in men. Depression and other mental health conditions (schizophrenia, anxiety disorders) and perceived stress were found to be predictors of suicide in the elderly. Other predictors included physical illnesses such as malignancies, financial constraints, cuckoldry, and sexual dysfunction, and also social factors like living alone triggers depressive symptoms and increases suicidal risk in the elderly. Hanging was found to be the most common method of death by suicide for both sexes. While elderly women preferred poisoning, elderly men in Western countries preferred firearms. Differences in gender, the aging process and social issues were also contributing factors to methods used for suicide. Conclusions: Depression and debilitating physical illnesses were identified as significant contributors to suicide risk in the elderly population, and emphasis should be placed on identifying these factors early and treating them. Recognizing and addressing factors that predict suicide in the elderly will help to improve the mental wellbeing of the elderly.
... This may be a result of the imbalances in economic and social development brought about by the Rural-Urban Dual Society System, for example, the unevenness in education and job opportunities, housing subsidies, health care, social welfare, etc. Suicide methods in China are different from those of other countries. As with the general population, the most common method of suicide among the elderly in China is ingestion of pesticides, compared with firearms in Western countries (59,60). ...
Background: High suicide rate in the elderly is an important global public health problem but has not received the attention it deserves. This study aimed to examine time trends of suicide mortality for people aged 70 years and over by sex, age, and location from 1990 to 2017, and to provide predictions up to 2030.
Methods: Using data from the Global Burden of Disease study 2017, we presented elderly suicide mortality changes and compared the patterns for the elderly with that for all ages. We estimated associations between socio-demographic index (SDI) and suicide mortality rates using a restricted cubic spline smoother, and predicted suicide mortality rates up to 2030.
Results: In 2017, 118,813 people aged 70 years and over died from suicide, indicating a mortality rate of 27.5 per 100,000, with the highest rates in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, and Central Sub-Saharan Africa, and for countries and territories, the highest were in South Korea, Zimbabwe, Lesotho, Mozambique, and Senegal. Between 1990 and 2017, suicide mortality rate for the elderly aged 70 years and over decreased globally (percentage change −29.1%), and the largest decreases occurred in East Asia, Southern Latin America, and Western Europe. Nationally, the largest decrease was found in Chile, followed by Czech Republic, Hungary, Turkey, and Philippines. For most countries, the elderly mortality rate was higher than the age-standardized rate, with the largest percentage differences in China and countries in Sub-Saharan Africa. The elderly suicide mortality rate decreased as SDI increased, except for a slight rebound at mid to high SDI. According to projections, 10 out of 195 countries were expected to meet the SDGs indicator of a third reduction by 2030.
Conclusions: Variability in suicide mortality rates for the elderly aged 70 years and over by sex, age, region, country, and SDI can guide preventive policies, but causes of the variability need further study. Comprehensive strategies should be adopted to reduce suicide rates and close the gap to the 2030 SDGs.
... The elderly is a group of special concern of Chinese government regarding life satisfactions, as China has the third highest rate of suicide among the elderly in the world (Li, Xiao, & Xiao, 2009) and Chinese elderly has a higher prevalence of suicide than the general population. From 2006 to 2015, the averagely mortality from suicide in the 65-85 age group in China was 2.75-7.08 times that of the general population (Lien et al., 2018). ...
Life satisfaction is a psychological state of an individual, however, a psychological perspective on how life satisfaction is based on cognitive inference-making has been largely neglected in the extant literature on elderly’s life satisfaction. This paper fills the gap by focusing on the psychological determinants of Chinese elderly’s satisfaction with the food domain of life, i.e. satisfaction with food-related life. Data were collected by personal interviews conducted in Beijing with 452 participants above 60 years old from March to May 2018. Based on means-end theory and the “bottom-up” approach to the concept of life satisfaction, this study confirms the hierarchical relationships between beliefs about food safety, taste, naturalness and freshness, the food-related goals of health seeking, enjoyment seeking and variety seeking, satisfaction with food-related life, and overall life satisfaction among Chinese elderly. All the three food-related goals positively affected Chinese elderly’s satisfaction with food-related life with the goal of enjoyment seeking as the strongest predictor. Positive belief about food freshness was related to the importance of all the three goals. Food naturalness belief was negatively related to the goals of health seeking and enjoyment seeking, while belief about food safety did not have any significant impact on either of the two goals. The food taste belief did not significantly affect the goal of enjoyment seeking but affected the goal of variety seeking. Implications for how to improve Chinese elderly’s satisfaction with food-related life and for future research were provided.
... According to World Health Organization (WHO) report, the suicide rate was highest in population aged over 70 years across different regions in the world. Currently, the suicide rate is about 51.5 per 100,000 people among the elderly in China [5,6]. This rate was found to be significantly higher among older people in rural than that in urban areas [7,8]. ...
Background
Previous studies have revealed that single physical chronic condition was associated with suicidal ideation/plans, but few studies have examined the relationship between multimorbidity and suicidal ideation/plans, and no studies have explored the underlying potential mechanism on this relationship in China. This study aimed to explore association between physical multimorbidity and suicidal ideation as well as plans, and further examine the mediating role of psychological distress (PD) on this relationship.
Methods
This study was based on the data from a survey about the health service of rural elderly household in Shandong, China. A total of 3242 adults aged 60 years and older were included in this study. PD was measured by Kessler Psychological Distress Scale (K10). Ordinal and binary logistic regression analyses were employed to explore the association between physical multimorbidity, PD and suicide ideation/plans. Bootstrapping analysis was further used to examine the mediation effect of PD on the association of multimorbidity and suicidal ideations/plans.
Results
The prevalence of multimorbidity, lifetime suicidal ideation, and suicidal plan in rural older adults was 35.2, 10.6 and 2.2%, respectively. Older adults living in rural areas with two or more chronic physical conditions experienced significantly higher risk of suicidal ideation and suicidal plans. The association between multimorbidity and suicidal ideations/plans was partially mediated by PD, of which, the mediating effect of PD accounted for 31.7 and 25.5% of the total effect, respectively.
Conclusion
This study demonstrated the associations between physical multimorbidity and suicidal ideation/plans, and the mediating role of PD on this relationship among Chinese rural elderly. Healthcare providers in rural community should provide regular surveillance for the mental health status among the rural elderly with multimorbidity, and carry out various effective intervention measures to improve the mental health status, so as to reduce the risk of suicide.
... The heavy financial burden leads to the life quality deterioration of the elderly in rural area. Some studies have pointed the rural elderly population even commit suicide in order to end their suffering [6][7][8][9][10][11]. Illness is one of the root causes of poverty in rural China [12]. ...
China’s rural older are the threat from chronic diseases, making it important to evaluate the effect of public health insurance on the health care utilization and expenditures with chronic diseases. In 2003, China initiated a public health insurance, which was called the New Rural Cooperative Medical System (NRCMS). NRCMS is a voluntary program, targeting rural residents with government subsidies and individual contribution. Using the two-stage residual inclusion approach (2SRI), we analyzed the impact of NRCMS on health-care service utilization and expenditure of rural older with chronic diseases by using the 2011 and 2013 China Health and Retirement Survey (CHARLS) data. The results showed NRCMS did not play an effective role on improving the medical services utilization of rural older with chronic diseases. Although NRCMS immediate reimbursement significantly reduced the outpatient service fee, the actual outpatient reimbursement is the opposite. In addition, NRCMS did not significantly decrease their hospitalization expense. Policy makers should pay attention to health management about chronic diseases in rural China, and some measures should be taken to deepen the medical security system reform and improve the public health service system.
... T. Kim et al., 2011), family solidarity (H. S. Kim, 2002), and filial responsibility (Simon et al., 2014) are factors related to suicidal ideation. At the social level, social support (Rowe et al., 2006), social activities (Lee & Lyu, 2017), and place of residence (Li et al., 2009) are included as factors associated with suicidal ideation. ...
This study aimed at assessing gender-specific predictors associated with suicidal ideation among Korean older adults using a longitudinal study. Participants of this study were 926 older adults aged 65 years and above (583 women, 343 men) who completed both 2016 and 2018 surveys on Elderly Life Conditions in Chuncheon, Korea, and reported never having thought about suicide or attempted suicide at baseline. Multivariate logistic regression was used to investigate the predictors (at baseline) of suicidal ideation (at 2-year follow-up) separately for each gender group. The results showed that among women, predictors of suicidal ideation were fearlessness about death (personal factor), filial responsibility (family factor), and social activities (social factor). However, among men, only psychological inflexibility (personal factor) predicted suicidal ideation. Results of this study provide evidence for the need to adopt separate strategies for each gender, taking the different predictors of suicidal ideation into account in the development of suicide prevention programs for older adults in Korea.
... In contrast, Asian women killed themselves more frequently than men, because of the more deathly methods that are preferentially used, such as hanging or taking pesticides. This is in contrast to the less fatal methods such as wrist-slashing or sleeping pills that are mainly used by women in the West (Law and Liu, 2008;Hawton and Van Heeringen, 2009;Li et al., 2009;Hvistendahl, 2012). ...
Stress-related disorders, such as mood disorders and posttraumatic stress disorder (PTSD), are more common in women than in men. This sex difference is at least partly due to the organizing effect of sex steroids during intrauterine development, while activating or inhibiting effects of circulating sex hormones in the postnatal period and adulthood also play a role. Such effects result in structural and functional changes in neuronal networks, neurotransmitters, and neuropeptides, which make the arousal-and stress-related brain systems more vulnerable to environmental stressful events in women. Certain brainstem nuclei, the amygdala, habe-nula, prefrontal cortex, and hypothalamus are important hubs in the stress-related neuronal network. Various hypothalamic nuclei play a central role in this sexually dimorphic network. This concerns not only the hypo-thalamus-pituitary-adrenal axis (HPA-axis), which integrates the neuro-endocrine-immune responses to stress, but also other hypothalamic nuclei and systems that play a key role in the symptoms of mood disorders, such as disordered day-night rhythm, lack of reward feelings, disturbed eating and sex, and disturbed cog-nitive functions. The present chapter focuses on the structural and functional sex differences that are present in the stress-related brain systems in mood disorders and PTSD, placing the HPA-axis in the center. The individual differences in the vulnerability of the discussed systems, caused by genetic and epigenetic developmental factors warrant further research to develop tailor-made therapeutic strategies.
... Compared to their younger counterparts, older adults are usually at a higher risk of developing psychiatric problems, such as depressive symptoms (depression hereafter), which is associated with a range of negative health outcomes, including low quality of life, cognitive decline and even suicide (9,10). Studies found that the prevalence of depression in empty-nest elderly was significantly higher than those living with children (11)(12)(13). ...
Background
Depressive symptoms are common in empty-nest elderly in China, but the reported prevalence rates across studies are mixed. This is a meta-analysis of the pooled prevalence of depressive symptoms (depression hereafter) in empty-nest elderly in China.
Methods
Two investigators independently conducted a systematic literature search in both English (PubMed, EMBASE, PsycINFO, Web of Science, and Cochrane Library) and Chinese (CNKI and Wan Fang) databases. Data were analyzed using the Comprehensive Meta-Analysis program.
Results
A total of 46 studies with 36,791 subjects were included. The pooled prevalence of depression was 38.6% (95%CI: 31.5–46.3%). Compared with non-empty-nest elderly, empty-nest elderly were more likely to suffer from depression (OR=2.0, 95%CI: 1.4 to 2.8, P<0.001). Subgroup and meta-regression analyses revealed that mild depression were more common in empty-nest elderly than moderate or severe depression (P<0.001). In addition, living alone (P=0.002), higher male proportion (β=0.04, P<0.001), later year of publication (β=0.09, P<0.001) and higher study quality score (β=0.62, P<0.001) were significantly associated with higher prevalence of depression.
Conclusion
In this meta-analysis, the prevalence of depression in empty-nest elderly was high in China. Considering the negative impact of depression on health outcomes and well-being, regular screening and appropriate interventions need to be delivered for this vulnerable segment of the population.
... In China, suicide is the 5th leading cause of death, and the incidence of suicide is estimated to be 6.6/100,000 people per year (2). Moreover, China has the third highest rate of suicide among the elderly worldwide, and adults over 65 years of age had the highest rate of completed suicide: 44.3 to 200 per 100,000 persons (3). However, suicide rates among the elderly have either declined or remained unchanged in the past decades (4). ...
Our study aims to explore the risk factors for suicidal ideation and their interaction among the elderly in nursing homes in Hunan province, China. A cross-sectional study was conducted among the elderly in nursing homes in Hunan Province. Twenty-four nursing homes were selected by multistage cluster random sampling, and 817 elderly residents were investigated using a set of structured questionnaires. The main outcome measures included general information, suicidal ideation, depression symptoms, social support, activities of daily living (ADL), stressful life events, and sleep quality. Multivariate binary logistic regression was performed to explore the risk factors for suicidal ideation among the elderly in nursing homes, and additive interaction was used to analyze the interaction between risk factors. The prevalence of suicidal ideation among the elderly in nursing homes in Hunan province was 17.9% (95% confidence interval(CI): 15.2%, 20.6%). Living in a rural area (odds ratio(OR)=1.88, 95% CI: 1.03, 3.44), infrequent visits from relatives (OR=2.61, 95% CI: 1.42, 4.78), history of chronic disease (OR=2.34, 95% CI: 1.09, 5.01), depression symptoms (OR=8.11, 95% CI: 4.52, 14.54), lower social support (OR=3.85, 95% CI: 1.94, 7.61), and ADL disability status (OR=4.38, 95% CI: 2.10, 9.14) increased the risk of suicidal ideation. Additive interactions were detected between depression symptoms and ADL status, with a relative excess risk due to interaction (RERI) of 8.73 (95% CI: 2.04, 15.43), and between depression symptoms and social support, with an RERI of 5.98 (95% CI: 0.86, 11.10). The prevalence of suicidal ideation among the elderly in nursing homes is relatively high. Both physical conditions and psychosocial factors were associated with suicidal ideation among the elderly. These findings have significant implications for the prediction and prevention of suicidal behaviors.
China introduced its stringent family planning policies in the early 1970 s, known as the “Later, Longer, Fewer” policies, and followed it with the One-Child Policy in 1979. The number of children born to Chinese parents significantly decreased from 5.7 in the late 1960 s to 2.5 in 1988. In Chen and Fang (2021), we show that family planning policies have drastically different effects on older parents’ physical and mental well-being. Whereas parents more exposed to the family planning policies consume more and enjoy slightly better physical health status when they enter their old age, they report more severe depression symptoms. In this paper, we present the heterogeneity of mental health across demographics and socioeconomic status. We pay particular attention to the role of children. Our findings indicate that parents with no or only one child experience faster deterioration in mental health status as they age. This pattern is observed only among older people who are not living with children. Our findings highlight the role of family support for the mental health status among older Chinese.
Middle and old age are two of the most important periods in human life, and people in this period face some physical, sexual and mental disabilities. Due to the increasing population of the middle and old age people in Iran, paying attention to this important period seems necessary. Therefore, the present study was to identify the lived experiences of middle and old age married people. To this end, 16 participants (based on the principle of data saturation) were selected by purposive sampling method among the middle and old age people living in Tehran. Participants were interviewed using semi-structured in-depth interviews to identify their lived experiences. Finally, the interviews were analyzed using the Van Mannen method (interpretive phenomenological approach). Findings were divided into two categories: “challenges” and “developmental tasks”. The main themes in the challenges section were “concerns about family’s future”, “spouse relationship”, “individual challenges”, and “taking new roles by spouses”. The main themes obtained in developmental tasks included “developmental tasks focused on children”, and “developmental tasks focused on couples”. As a result, it can be concluded that the challenges and developmental tasks middle and old age people facing appear to be more focused on family and relationship. Applying the results of the present study, experts can design educational packages based on the challenges and developmental tasks these people facing in their lives, in order to increase the quality of life in middle and old age people. Besides, therapists working in the field of the elderly can take advantages of the findings of the present study to lead the process of therapeutic sessions.
We chose depression as the first BPSD to discuss, not only because of its high prevalence in people with dementia but also because of the challenges in identifying depression in these patients in a busy clinical setting. This difficulty is particularly pronounced because of the overlap of symptoms between the two conditions, the lack of standardized diagnostic criteria, and the low reliability of self-report and informant-based measures. Missing the diagnosis of depression can lead to grave consequences, given its strong association with an increased risk of suicide and the exacerbation of cognitive decline and functional impairment. Moreover, the clinical course, treatment, and prognosis differ significantly between patients with depression and those without. Despite these challenges, there are scales to assist in the assessment and diagnosis of depression in dementia. Additionally, a comprehensive and person-centered treatment approach, integrating both nonpharmacological and pharmacological interventions, can be effective in managing depression in individuals with dementia. Hence, it is crucial for clinicians to possess the necessary knowledge and skills to identify and manage depression in people with dementia.
Hanging is one of the most common suicide methods worldwide. Neck injuries that occur upon such neck compression – fractures of the thyrohyoid complex and cervical spine, occupy forensic pathologists for a long time. However, research failed to identify particular patterns of these injuries corresponding to the force distribution a ligature applies to the neck: the issue of reconstructing the knot in a noose position persists. So far, machine learning (ML) models were not utilized to classify knot positions and reconstruct this event. We conducted a single-institutional, retrospective study on 1235 autopsy cases of suicidal hanging, developed several ML models, and assessed their classification performance in a stepwise manner to discriminate between: 1. typical (‘posterior) and atypical (‘anterior’ and ‘lateral’) hangings, 2. anterior and lateral hangings, and 3. left and right lateral hangings. The variable coding was based on the presence/absence of fractures of greater hyoid bone horns (GHH), superior thyroid cartilage horns (STH), and cervical spine. Subject age was considered. The models’ parameters were optimized by the Genetic Algorithm. The accuracy of ML models in the first step was very modest (c. 60%) but increased subsequently: Multilayer Perceptron – Artificial Neural Network and k-Nearest Neighbors performed excellently discriminating between left and right lateral hangings (accuracy 91.8% and 90.6%, respectively). The latter is of great importance for clarifying probable hanging fracture biomechanics. Alongside the conventional inferential statistical analysis we performed, our results further indicate the association of the knot position with ipsilateral GHH and contralateral STH fractures in lateral hangings. Moreover, odds for unilateral GHH fracture, simultaneous GHH and STH fractures, and cervical spine fracture were significantly higher in atypical (‘anterior’ and ‘lateral’) hangings, compared to typical (‘posterior’) hangings.
Suicide is among the leading causes of death and rates have been steadily increasing over the past two decades in the United States. The COVID-19 pandemic has given rise to a phenomenon known as the “honeymoon effect” which has led to fluctuations in the suicide rate, and this emphasizes the need for continued research to inform targeted interventions. In our study, we investigate changes in the suicide rate from 2017 to 2021 for different classifications of counties. We find that the suicide rate first decreased during the early years of covid, and then slowly increased. Suicide rates are higher in the west relative to the rates in the middle and eastern parts of the United States. Urban areas exhibit rates that follow the national pattern, while rates in rural areas have continued to increase from 2017 to 2021. Moreover, the suicide rate has continued to increase in counties recording population loss, and counties that have their economy focused on mining, Federal/State government, and the recreation industry. There was an initial decrease followed by an increase in counties considered as retirement destinations, and counties having persistent poverty, persistent child poverty, and low employment. These changes in suicide patterns noted from 2017 to 2021 show the continuous need to understand the importance of geographic context and its relationship with potential increases in the odds for suicide.
Objectives
To estimate the prevalence of depression symptoms and quality of life (QoL) and examined the influence of factors in the empty nest elderly.
Methods
This was a cross-sectional study, which was conducted from February 2022 to May 2022. We recruited a convenience sample of no empty-nest elderly and empty-nest elderly (≥60 years) living in Chengdu. QoL was assessed using WHOQOL-BREF, Geriatric Depression Scale (GDS-15) was used to assess depression symptoms. Multivariable logistic regression was used to analyze data between independent variables with depression symptoms.
Results
Two thousand twenty-six participants were included in this study, 39.0% (660/1,082) experienced depression symptoms among empty-nest elderly. Age (aOR, 1.02; 95% CI, 1.00–1.04; P = 0.046), chronic disease≥2 (aOR, 3.29; 95% CI, 2.50–4.33; P < 0.001) were associated with increased risk of depression symptoms, and physical activity (aOR, 0.59; 95% CI, 0.40–0.87; P = 0.008), physical health (aOR, 0.93; 95% CI, 0.88–0.99; P = 0.026), psychological health (aOR, 0.93; 95% CI, 0.87–0.98; P = 0.013), and total score (aOR, 0.97; 95% CI, 0.96–0.99; P < 0.001) were associated with decreased risk of depression symptoms among empty-nest elderly.
Conclusions
Depression symptoms are common mental health problems among empty-nest elderly. We found that age, chronic disease ≥2 and physical activity were important factors that have an impact on depressive symptoms. Empty-nest elderly would have lowered QoL score.
Purpose
Aging has detrimental effects on elders due to their physical health and financial hardship. Elders face neglect, insult and abuse in society due to causes related to physical health and financial issue from caregivers. This study aims to identify the measures of physical health and financial hardship and classifies elders under neglect, insult and abuse categories.
Design/methodology/approach
The propositions of existence and classifying elders under neglect, insult and abuse categories were tested by using discriminant analysis and their profiling was done by perceptual mapping technique.
Findings
The elder neglect category identified as a prominent category due to physical health while elder insult and abuse were caused by physical health and financial hardship both. The present study portrays the multi-dimensional facets related to elders’ ill-treatment. The elder’s ill-treatment categories were profiled to imply the measure of elevating elders’ dignity and care at a personal level and society at large.
Originality/value
This study classifies elders under neglect, insult and abuse categories. This classification may facilitate the medical practitioners, academicians and government and non-government social welfare agencies in understanding elder abuse with new perspectives.
Background
Many previous studies have proved that positive psychology can promote mental health. However, little is known about how and when it promotes mental health in older adults.
Methods
The data of this study were sourced from the 2017 wave of Chinese General Social Survey (CGSS), involving 1,537 older adults aged 60 and above. OLS regression model was used to explore the impact of positive psychology on mental health of the elderly. Moreover, stata 16.0 was used to measure the moderating effect of individualism on the relationship between positive psychology and mental health.
Results
After controlling for demographic characteristics, socio-economic status and lifestyle factors, the regression results suggest that positive psychology was associated with mental health (coefficient = 0.112, p < 0.01). In addition, the positive relationship was significantly stronger for people who were older, married, lived in urban areas, with higher education and higher subjective social class position, and higher exercise frequency. Moreover, the moderating effect analysis results suggest that individualism strengthened the relationship between positive psychology and mental health.
Conclusions
This study reveals that positive psychology has a positive effect on mental health among the elderly, and the positive health effect shows significant age, marital status, living areas, education background, social class position and physical exercise inequalities. Furthermore, this study also provides new evidence indicating that individualism positively moderates the relationship between positive psychology and mental health. Promoting positive psychology can be a promising way for China to promote psychological care for the elderly in the future.
How to effectively alleviate mental disorders among elderly individuals is an important issue. Children are important financial and spiritual supporters of parents. However, whether there are upward spillovers from children to parents remains understudied. Using the instrumental variable method and data from the China Health and Retirement Longitudinal Study, this paper estimates the causal effect of children's marriage on the mental health of older parents. The IV estimation results demonstrate that having unmarried children is associated with a significant deterioration in parental mental health, especially in older, less educated, poor and male groups. Further evidence suggests that having unmarried children leads to significant changes in parents' economic behaviors, including labor supply, consumption, and savings; this indicates that parents are more likely to actively respond to their children’s unmarried status by increasing labor supply, reducing consumption and increasing savings rather than by engaging in negative behaviors.
Background
The relationship between impulsivity and suicide is inconsistent in different populations. Hence, the relationship between impulsivity and suicide still needs to be studied among the elderly population. The present study intends to explore the relationship between impulsivity and suicide among the rural Chinese elderly.
Methods
A case-control psychological autopsy study was conducted from February 1, 2014 to December 18, 2015 among rural residents over the age of 60 who died by suicide. The sample consisted of 242 suicides as the case group and 242 living individuals as the control group. Data on demographic characteristics, impulsivity, previous history of suicide attempts, social support, negative life events, and suicidal behavior were collected.
Results
Our study found that impulsivity increased the risk of suicide. The case group showed a higher Barratt Impulsiveness Scale score compared with the control group ( p < 0.001), which indicates that impulsivity was higher among the elderly suicides. In addition, regression analyses show that impulsivity (odds ratio: 1.03, 95% confidence interval: 1.01–1.06) is an independent risk factor of suicide, after controlling for the effects of marital status, education, family annual income, being left behind, social support, and negative life events. Finally, compared with elderly who do not have a history of attempted suicide, elderly with a history of attempted suicide showed higher impulsivity ( p = 0.001).
Psychiatric emergency patients constitute a population at high risk of suicidal thoughts and behaviors (STB). However, the risk factors for STB in this population have not been clearly defined. This study aimed to explore the risk factors for STB in psychiatric emergency patients in China. A cross-sectional analysis was conducted at the emergency department of psychiatry, Anding Hospital, Capital Medical University from 2015 to 2017. The Chinese suicide risk factors scale was used to test the STB of the patients. Multivariable logistic regression analysis was used to determine the risk factors of STB. A total of 12,345 patients were included. Their average age was 36 years. According to the suicide risk scale, 3436 cases (27.83%) were at risk of STB, mainly young adults. The multivariable analysis showed that urban residence, years of education, living in Beijing, ethnic Han, living alone, unemployment, poor relationship with parents, one or more siblings, visit time in the night, family history, disease course, total duration, the total number of psychiatric hospitalizations, a clear diagnosis, Brief Psychiatric Rating Scale total score ≥28.5, Hamilton Depression Rating Scale total score ≥20, and Young Mania Rating Scale total score ≥12 were independent risk factors for STB.
Mental health problems among the elderly have attracted increasing attention. The most serious mental health problems may result in suicide, and lack of family companionship is often speculated to be a major cause. In this paper, we use high-frequency suicide rate data and utilize a novel temporal variation in the lunisolar calendar to provide evidence on the protective effects of the Chinese Lunar New Year (when the elderly people receive unusually high level of family companionship) on elderly suicide. We find that elderly suicide rate decreases by 8.7% during the Chinese Lunar New Year. In addition, the protective effects are stronger in counties where the typical level of daily family companionship for the elderly is lower. By contrast, we do not find similar protective effects for young and middle-age cohorts. We consider a variety of alternative mechanisms, and conclude that family companionship is an important channel for the protective effects of the Chinese Lunar New Year. Our study calls for greater attention to the mental health status and suicide problem of the elderly, especially with the rapid population aging and increasing prevalence of the “empty-nest” elderly in developing countries.
We examine how China's “Later, Longer, Fewer” (LLF) policies in the early 1970s affect the quality of life of the Chinese elderly forty years later. We identify the causal impact of the LLF policies by exploiting the provincial heterogeneity in policy implementation. We find that the LLF policies reduced the total fertility rate by 1.57 from 1969 to 1978, explaining about half of the decline in fertility during this period. Parents do not receive fewer financial support as a consequence, but they have fewer children living close by and receive fewer contacts and visits from children. We find that the impacts of the family planning policies on elderly parents' physical and mental well-being are drastically different: parents more exposed to family planning policies do not suffer from worse physical health status, but report more severe depression symptoms.
Exploration of ways to improve the subjective welfare of residents is an important area of current academic research. Using data from the China Family Panel Studies survey conducted in 2010, this paper investigated the impact of clan culture on the mental health of elderly people in rural China. The results demonstrated that clan culture can significantly decrease the depression score of the rural elderly. Further, there was no gender difference with respect to the impact of clan culture on the depression score of the elderly. At the same time, the positive effects of clan culture on the depression score of the elderly have gradually weakened with economic development. Exploration of the mechanisms involved indicated that in areas with stronger clan culture, older people receive more social support. This study enriches our understanding of the impact of informal institutions on the welfare of rural residents. At the same time, it can also provide a certain decision-making reference for the government to formulate relative poverty relief strategies in a new stage of poverty alleviation.
Intergenerational solidarity plays a significant role in older adults’ psychological well-being, but it remains unclear whether the influence would vary by distance. This study aims to examine the moderating role of geographical proximity between intergenerational solidarity and life satisfaction. We interviewed 1,015 rural older adults in Sichuan, China. Life satisfaction was measured by Satisfaction with Life Scale. Five of the six dimensions of intergenerational solidarity were assessed: structural (geographical proximity), associational (contact frequency), functional (support exchange), affectual (emotional closeness), and normative (filial obligation). Multiple regression with interaction term was used. We found the effect of intergenerational solidarity (except associational solidarity) on life satisfaction was strongest for older adults with children living in the same city. Gender differences existed in the moderating effect of parent–child distance on the relationship between intergenerational solidarity and life satisfaction. Social services could focus on older adults with interprovincial migrant children and protect their well-being.
This empirical study commemorates Durkheim's contribution to suicidology by reviewing his own and his followers' formulation of the relationship between the business cycle and suicide. Three distinctive sociological theories of suicide, including Durkheim's, were identified to link the suicide rate to the socioeconomic environment of the society. A real-income hypothesis of suicide was developed to capture (a) the positive impact of the economy on suicide, (b) the curvilinear impact of the economy on suicide implied by Durkheim's proposition, and (3) the interplay of both economic and sociological variables on suicide. Another implication from the reformulation is that there may exist a positive natural rate of suicide for any society. These two hypotheses were tested using the 1990 census data for the continental states of the United States. Some conclusions and suggestions were drawn for future research.
Using recently available data from China's Disease Surveillance Points system, we estimate that there are over 300,000 suicides in China per year; this makes suicide one of the most important causes of death in the country and makes the suicide rate in China one of the highest in the world. Moreover, the pattern of suicides in China is quite different than in other parts of the world--there are more completed suicides among females than males and rural rates are three-fold urban rates. The lack of reliable suicide data prior to 1987 makes it difficult to determine whether the rates are currently rising, falling, or staying constant. However, reports of suicides in the Chinese press and case studies conducted by the authors suggest (but do not prove) that the high rates of suicide currently experienced are related to the social changes that have occurred with the economic reforms (which started in 1978). Another possible explanation for the high rates of suicide is the large numbers of persons with depressive illness in China who remain untreated. Single-cause models of suicide (i.e., social factors or mental illness) do not do justice to the complexity of the processes involved and, therefore, do not provide useful information about the etiology and prevention of suicide in China or elsewhere. We describe our own dynamic model of suicide that includes five interacting factors which, we believe, collectively determine the suicide rates in a community.
A wide range of suicide rates are reported for China because official mortality data are based on an unrepresentative sample and because different reports adjust crude rates in different ways. We aimed to present an accurate picture of the current pattern of suicide in China on the basis of conservative estimates of suicide rates in different population cohorts.
Suicide rates by sex, 5-year age-group, and region (urban or rural) reported in mortality data for 1995-99 provided by the Chinese Ministry of Health were adjusted according to an estimated rate of unreported deaths and projected to the corresponding population.
We estimated a mean annual suicide rate of 23 per 100,000 and a total of 287,000 suicide deaths per year. Suicide accounted for 3(.)6% of all deaths in China and was the fifth most important cause of death. Among young adults 15-34 years of age, suicide was the leading cause of death, accounting for 19% of all deaths. The rate in women was 25% higher than in men, mainly because of the large number of suicides in young rural women. Rural rates were three times higher than urban rates-a difference that remained true for both sexes, for all age-groups, and over time.
Suicide is a major public-health problem for China that is only gradually being recognised. The unique pattern of suicides in China is widely acknowledged, so controversy about the overall suicide rate should not delay the development and testing of China-specific suicide-prevention programmes.
Suicide is the fifth most important cause of death in China, but the reasons for the high rate and unique pattern of characteristics of those who kill themselves are unknown.
We pretested, and then administered a comprehensive interview to family members and close associates of 519 people who committed suicide and of 536 people who died from other injuries (controls) randomly selected from 23 geographically representative sites in China.
After adjustment for sex, age, location of residence, and research site, eight significant predictors of suicide remained in the final unconditional logistic regression model. In order of importance they were: high depression symptom score, previous suicide attempt, acute stress at time of death, low quality of life, high chronic stress, severe interpersonal conflict in the 2 days before death, a blood relative with previous suicidal behaviour, and a friend or associate with previous suicidal behaviour. Suicide risk increased substantially with exposure to multiple risk factors: none of the 265 deceased people who were exposed to one or fewer of the eight risk factors died by suicide, but 30% (90/299) with two or three risk factors, 85% (320/377) with four or five risk factors, and 96% (109/114) with six or more risk factors died by suicide.
Despite substantial differences between characteristics of people who commit suicide in China and the west, risk factors for suicide do not differ greatly. Suicide prevention programmes that concentrate on a single risk factor are unlikely to reduce suicide rates substantially; preventive efforts should focus on individuals exposed to multiple risk factors.
To identify the most common life events that occurred prior to suicide in elderly individuals and the relationship of these life events to depressive symptoms.
A detailed study considering life events in the year prior to death, the presence of mental illness at the time of death and the level of depressive symptoms in the 2 weeks prior to death was undertaken with the family members and other associates of 304 persons at 55 years of age and older who died of suicide.
The three most common negative life events were acute or chronic physical illness or injury (59.2%), major changes in diet, sleeping or other daily routines (37.8%) and financial difficulties (34.5%). The severity of depressive symptoms was significantly greater among persons who had experienced these life events both for persons with or without definite mental illness.
Most elderly persons who died of suicide events had experienced multiple negative life events in the year prior to death and these life events were closely related to the severity of depressive symptoms at the time of death.
Recent research on suicide in China reveals several unique findings: 1) female suicides outnumber male suicides by a 3:1 ratio; 2) rural suicides outnumber urban suicides by a 3:1 ratio; 3) a large upsurge of young adult and older adult suicides has occurred; 4) a comparatively high national suicide rate two to three times the global average is evident; and, most startlingly, 5) a low rate of psychiatric illness, particularly depression, exists in suicide victims. The strongest empirical data suggest that these trends result from a high number of rural, young females who experience acute interpersonal or financial crises and then impulsively attempt suicide using lethal pesticides or poisons. Other suicide risk factors in China are similar to those that are well known internationally. Interactive sociological, cultural, and economic hypotheses unique to China provide further insight. Among those, the cultural-socioeconomic disadvantages of the Chinese rural female and cultural attitudes toward suicide are particularly noteworthy.
Background: The aim of the present study is to show the causative factors of suicide among the elderly (over 65) in Mie Prefecture, Japan, and to discuss the prevention of the suicidal influences in elderly patients.
Methods: We investigated all inquest records during the 14-year period 1989–2002 in cooperation with the First Department of Criminal Investigation of Mie Prefectural Police Headquarters. From all cases classified as suicides, we extracted data on age, sex and background, and we focused on suicide in the elderly group.
Results: During the test period, there were 5048 suicides (3276 male and 1772 female suicides) of which 1513 (691 male and 822 female) were in the elderly group. The rate of suicide in the elderly group was approximately 30% of the total in all age groups. The rate of female suicides in the elderly group was approximately 46.3%. The major causative factors of suicide among the elderly were ‘suffering from physical illness’, and ‘psychiatric disorders’. ‘Physical diseases’ were not negligible backgrounds in middle and elderly groups. Among physical diseases, the number of malignant neoplasm was clearly less than the other diseases. Notably, ‘cardiovascular disease’ and ‘orthopedic disorders’ were most frequent causative factors of suicide other than malignant neoplasm.
Conclusion: It is consequently concluded that improvements in the system of home nursing and health care should be involved in the suicidal prevention of the elderly who ‘suffer from physical illness’. The patients who ‘suffer from physical illness’ should be given physical and mental support. In order to prevent suicide, not only psychiatrists but also general practitioners as well as medical staff and general public should be provided with education regarding depression among ‘psychiatric disorders’.
Suicide rates in the Beijing region increase with age. The rural suicide rate is about two to five times of the urban in various age-sex groups. The elderly suicide rate is very serious, especially in the rural area. The average suicide rate for the Beijing region for the period 1987–1996 was 9.8 per 100,000 (6.0 and 17.3 for urban and rural areas, respectively). A low male-to-female ratio was also observed. The female suicide rate for the 15–34 age group was higher than that of its male counterparts, which is unique in other areas of the world. These phenomena can be explained by some of the distinct cultural and economic traits of China. Also, suicides rates in the Beijing region were shown to be on a decreasing trend among the teenaged and the old-age groups. Our findings suggest that the suicide rate in China should not be as high as the estimated rate (31.0 per 100,000), suggested in the Global Health Statistics by Murray and Lopez (1996b, p. 824).
Suicide is a complex phenomenon--arguably a social and a moral deed--occurring within associated psychological, biological, and cultural contexts. We present data on suicide rates in China for 1988, 1990, and 1992 and provide an analysis of their social context. These figures, from the Chinese Public Health Annuals, have never before been publicly reported. These and other recent data indicate that suicide rates in China, although reportedly low in the past, are by global standards alarmingly high among certain demographic groups. They also reveal distinctive epidemiological patterns of suicide in China that contrast with the patterns characteristic of Western societies-for example, higher rates in rural than in urban areas and, among some demographic groups, higher among women than among men. As in the West, however, suicide among the elderly is a major problem in China. The sociocultural context of these data is examined as a means toward understanding their distinctive patterning.
The aims of this paper are (i) to describe the specific characteristics of suicide in China and compare it with that in a western country, Denmark: and (ii) to discuss the accuracy of suicide data and the possible explanations for suicide behaviour in China.
Data for the study are obtained from the World Health Statistics Annual based on official records in China and the Danish Cause-of-Death Register, and standardized according to the age-specified population of China in 1990.
The specific characteristics of suicide in China differed strikingly from the general pattern of suicide in other western countries as well as in Denmark: suicide rates in females were higher than in males; rural rates were more than three times higher than urban rates; suicide rates peaked for those aged 75 + years, but with a minor peak in females for those aged 15-24 years old.
These specific characteristics of suicide in China may possibly be interpreted in terms of traditional culture, social forces, political environment and economic status.
There are a few reports on the trends of elderly suicide rates in western countries but none from Asian countries.
To describe the trends of elderly suicide rates of Chinese, Malays and Indians in Singapore from 1991 to 2000.
Data obtained from the National Department of Statistics were used in the analysis of sex- and age-standardized suicide rates and relative risks.
Overall, the suicide rates for the elderly showed a decline from 40.1 per 100,000 in 1990 to 17.8 per 100,000 in 2000, with the most pronounced decline occurring from 1995 to 2000. The suicide rate for elderly Chinese was at a peak of 52 per 100,000 in 1995 and declined to 20 per 100,000 in 2000. The rates for elderly Malays were consistently low at 2.2 per 100,000 for the 10 years; for elderly Indians the rates were between the other two ethnic groups.
In the 10-year period, the elderly suicide rates in Singapore declined markedly, especially for elderly Chinese.
China accounts for more than 30% of the world's suicides and displays a unique pattern of suicide rates. Prior research had established the link between macrosocial changes and suicide. Comprehensive surveillance system of suicide in this rapidly developing country is much needed. This paper examined the trends of national-, region-, gender-, and age-specific suicide rates, and male to female ratios in suicide in China for the period of 1991-2000, which was a time that rapid economic and social changes took place.
A regression model was used to detect any variations in national-, region-, gender-, and age-specific suicide rates and gender ratios reported by the most recent mortality statistics from China's Ministry of Health.
National, urban, and rural suicide rates for both men and women decreased significantly for the period of 1991-2000; age-specific suicide rates, however, showed that there were different patterns of changes in suicide rates in rural and urban areas. Although elderly suicide rates showed the most significant decrease in urban areas, younger women showed the largest decrease in rural areas; male to female gender ratio in suicide increased significantly in the urban areas, but no significant change was found in rural areas.
Possible explanations that may account for the downward trends in suicide rates and increase in male to female gender ratio in urban area were provided. Longer historical studies are needed to reveal the relationship between macrosocial changes and the pattern of suicide.
The potential insensitivity to depression of translated diagnostic instruments makes it difficult to assess the relationship of depressive symptoms to suicide in non-Western cultures.
Addition of culturally sensitive probes and other modifications were made to the depression section of the Chinese version of the SCID; the standard SCID probes and the expanded-probes are separately used to assess each symptom of depression, the resultant diagnoses and the overall severity of depression. This modified SCID was included in the psychological autopsy interviews with family members and, separately, close associates of 887 suicides and 721 non-suicidal decedents from 23 regions of mainland China.
Compared to the standard interview, the expanded-probe method increased reported prevalence of major depressive episode among suicide decedents from 26.4% (234/887) to 40.2% (357/887) and for other deaths from 1.0% (7/721) to 2.1% (15/701). The additional 131 cases identified using the expanded-probe method had substantial social impairment and a greatly elevated risk of suicide compared to those with no depressive symptoms (OR=37.0, 95% CI=17.6-77.6). Inter-observer reliability for major depressive episode between the two independent interviews was greater for the expanded probe method (ICC=0.77 vs. 0.67, P<0.001). For both interview methods there was a strong dose-response relationship between suicide risk and the number and severity of depressive symptoms.
This study uses proxy informants to obtain information about the psychological status of deceased subjects; the value of this expanded-probe method for the diagnosis of depression in non-Western cultures needs to be confirmed with living subjects.
Adding culture-appropriate probes about depressive symptoms to standardized diagnostic instruments identifies many Chinese subjects with unrecognized depression. Dimensional measures of depressive symptoms are more powerful predictors of suicide risk than categorical diagnoses.
This is the first community-based epidemiological study examining the prevalence of suicidal behaviors, their transitional pathways, and their relationship with mental disorders in metropolitan China.
Suicidal behaviors, including ideation, plans, and attempts were assessed by face-to-face household interviews among 5201 respondents in Beijing and Shanghai in 2001-2002. Lifetime prevalence and risk factors were examined using multivariate discrete-time survival models.
The lifetime prevalence estimates of suicidal ideation, plans, and attempts were 3.1%, 0.9%, and 1.0% respectively. Among suicide ideators, the conditional probability of ever making a plan and an attempt was 29.5% and 32.3% respectively. Progression from ideation to plan and attempt was the highest during the first year after onset. Suicide attempt was predicted by young adulthood, being unmarried, recent onset of ideation and plan, and the presence of mental disorders, especially mood disorder.
Suicidal behaviors in metropolitan China exhibit a low prevalence and an epidemiological profile resembling that found in Western countries.
To examine some of the risk factors for late life suicide in Hong Kong Chinese using a case-controlled psychological autopsy approach.
Informants of 70 subjects aged 60 or above who had committed suicide as well as a community sample of 100 elderly controls were interviewed. Subjects and controls were assessed for the presence of mental illness, history of suicide attempt and data on health care utilization.
Eighty-six per cent of suicide subjects suffered from a psychiatric problem before committing suicide, compared with 9% of control subjects. Among the psychiatric problems, major depression was the commonest diagnosis. Seventy-seven per cent of suicide subjects had consulted a doctor within 1 month of suicide. One-third of suicide subjects had a history of suicide attempt. Rates of current psychiatric diagnosis, rates of medical consultation and history of suicide attempt are all significantly higher in suicide subjects than controls.
Our findings support the view that depressive disorders and a past history of suicide attempt are risk factors of late-life suicide in the Chinese population of Hong Kong, similar to findings in western studies.
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