Physical Illness and Suicide Risk in Rural Residents of Contemporary China
A Psychological Autopsy Case-Control Study
Abstract
Background: Physical illness is linked with an increased risk of suicide; however, evidence from China is limited. Aims: To assess the influence of physical illness on risk of suicide among rural residents of China, and to examine the differences in the characteristics of people completing suicide with physical illness from those without physical illness. Method: In all, 200 suicide cases and 200 control subjects, 1:1 pair-matched on sex and age, were included from 25 townships of three randomly selected counties in Shandong Province, China. One informant for each suicide or control subject was interviewed to collect data on the physical health condition and psychological and sociodemographic status. Results: The prevalence of physical illness in suicide cases (63.0%) was significantly higher than that in paired controls (41.0%; χ2 = 19.39, p < .001). Compared with suicide cases without physical illness, people who were physically ill and completed suicide were generally older, less educated, had lower family income, and reported a mental disorder less often. Physical illness denoted a significant risk factor for suicide with an associated odds ratio of 3.23 (95% CI: 1.85–5.62) after adjusted for important covariates. The elevated risk of suicide increased progressively with the number of comorbid illnesses. Cancer, stroke, and a group of illnesses comprising dementia, hemiplegia, and encephalatrophy had a particularly strong effect among the commonly reported diagnoses in this study population. Conclusion: Physical illness is an important risk factor for suicide in rural residents of China. Efforts for suicide prevention are needed and should be integrated with national strategies of health care in rural China.
References
2012). A literature review of suicide in cancer patients. Cancer Nursing, 35(4), E14–26.
(1991). Ethical aspects of psychological autopsy. Acta Psychiatrica Scandinavica, 84(5), 482–487.
(2011). The next generation of psychological autopsy studies. Part I. Interview content. Suicide and Life Threatening Behavior, 41(6), 594–613.
(2012). The next generation of psychological autopsy studies: part 2. Interview procedures. Suicide and Life Threatening Behavior, 42(1), 86–103.
(2000). Completed suicide among older patients in primary care practices: A controlled study. Journal of the American Geriatrics Society, 48(1), 23–29.
(2009). Opinions of the CPC Central Committee and State Council on deepening the health care system reform. Retrieved from news.xinhuanet.com/newscenter/2009-04/06/content_11138803.htm
. (2000). Suicidal ideation and suicide attempts in general medical illnesses. Archives of Internal Medicine, 160(10), 1522–1526.
(2004). Suicide at 50 years of age and older: Perceived physical illness, family discord and financial strain. Psychological Medicine, 34(1), 137–146.
(2010). Validity of proxy data obtained by different psychological autopsy information reconstruction techniques. The Journal of International Medical Research, 38(3), 833–843.
(2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, research version, patient edition (SCID-I/P). New York, NY: Biometrics Research, New York State Psychiatric Institute.
(2003). Suicide attempts in the United States: The role of physical illness. Social Science & Medicine, 56(8), 1783–1788.
(2001). Psychological autopsy studies – a review. European Psychiatry, 16(7), 379–385.
(2010). Myocardial infarction and risk of suicide: A population-based case-control study. Circulation, 122(23), 2388–2393.
(2011). Emerging issues in public health: A perspective on China’s healthcare system. Public Health, 125(1), 9–14.
(2012–2013). Psychometric characteristics of Chinese version of Barratt impulsiveness scale-11 in suicides and living controls of rural China. Omega, 66(3), 215–29.
(2009). Association between suicide and cardiovascular disease: Time series of 27 years. International Journal of Cardiology, 135(2), 261–262.
(2006). Critical issues in psychological autopsy studies. Suicide and Life Threatening Behavior, 36(5), 491–510.
(2011). Allergy is associated with suicide completion with a possible mediating role of mood disorder – a population-based study. Allergy, 66(5), 658–664.
(2013). Hospitalization for physical illness and risk of subsequent suicide: A population study. Journal of Internal Medicine, 273(1), 48–58.
(2007). Suicide-associated comorbidity among US males and females: A multiple cause-of-death analysis. Injury Prevention, 13(5), 311–315.
(2011). Seasonality of suicide in Shandong China, 1991–2009: Associations with gender, age, area and methods of suicide. Journal of Affective Disorders, 135(1–3), 258–266.
(2001). Suicide after a stroke: A population study. Journal of Epidemiology & Community Health, 55(12), 863–866.
(2004). Mortality and causes of death in a national sample of diabetic patients in Taiwan. Diabetes Care, 27(7), 1605–1609.
(2012). Suicide risk in primary care patients with major physical diseases: A case-control study. Archives of General Psychiatry, 69(3), 256–264.
(2009). Attitudes toward suicide: The effect of suicide death in the family. Omega:Journal of Death and Dying Studies, 60(4), 365–382.
(