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Being left-behind, mental disorder, and elderly suicide in rural China: a case–control psychological autopsy study

  • Liang Zhou (a1), Guojun Wang (a2), Cunxian Jia (a3) and Zhenyu Ma (a4)
Abstract
Background

Suicide rate among rural elderly is the highest among all age groups in China, yet little is known about the suicide risks in this rapidly growing vulnerable population.

Methods

This matched case–control psychological autopsy study was conducted during June 2014 to September 2015. Consecutive samples of suicides aged 60 or above were identified in three provinces (Shandong, Hunan, and Guangxi) in China. Living comparisons were 1:1 matched with the suicides in age (±3 years old), gender, and living location. Risk factors included demographic characteristics, being left-behind, mental disorder, depressive symptoms, stressful life events, and social support.

Results

A total of 242 suicides and 242 comparisons were enrolled: 135 (55.8%) were male, mean (s.d.) age was 74 (8) years. The most frequently used suicide means were pesticides (125, 51.7%) and hanging (95, 39.3%). Independent risks of suicide included unstable marital status [odds ratio (OR) 4.19, 95% confidence interval (CI) 1.61–10.92], unemployed (compared with employed, OR 4.43, 95% CI 1.09–17.95), depressive symptoms (OR 1.34, 95% CI 1.21–1.48), and mental disorder (OR 6.28, 95% CI 1.75–22.54). Structural equation model indicated that the association between being left-behind and suicide was mediated by mental disorder, depressive symptoms, stressful life events, and social support.

Conclusions

Unstable marital status, unemployed, depressive symptoms, and mental disorder are independent risk factors for suicide in rural elderly. Being left-behind can elevate the suicide risk through increasing life stresses, depressive symptoms, mental disorder, and decreasing social support. Elderly suicide may be prevented by restricting pesticides, training rural physicians, treating mental disorders, mitigating life stress, and enhancing social connection.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Author for correspondence: Liang Zhou, E-mail: Liangzhou_csu@vip.163.com
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Abas, MA, et al. (2009) Rural-urban migration and depression in ageing family members left behind. British Journal of Psychiatry 195, 5460.
Chan, AC (1996) Clinical validation of the Geriatric Depression Scale (GDS): Chinese version. Journal of Aging and Health 8, 238253.
Chiu, HF, et al. (2004) Elderly suicide in Hong Kong – a case-controlled psychological autopsy study. Acta Psychiatrica Scandinavica 109, 299305.
Conwell, Y, et al. (1996) Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. American Journal of Psychiatry 153, 10011008.
De Leo, D, et al. (2013) Suicides in older adults: a case-control psychological autopsy study in Australia. Journal of Psychiatric Research 47, 980988.
He, CZ and Ye, JZ (2014) Lonely sunsets: impacts of rural–urban migration on the left-behind elderly in rural China. Population, Space and Place 20, 352369.
He, XY, Xiao, SY and Zhang, DX (2008) Reliability and validity of the Chinese version of geriatric depression scale: a study in a population of Chinese rural community-dwelling elderly. Chinese Journal of Clinical Psychology 16, 473475.
Innamorati, M, et al. (2014) Suicide in the old elderly: results from one Italian county. The American Journal of Geriatric Psychiatry 22, 11581167.
Knodel, J and Saengtienchai, C (2007) Rural parents with urban children: social and economic implications of migration for the rural elderly in Thailand. Population, Space and Place 13, 193210.
Kreager, P (2006) Migration, social structure and old-age support networks: a comparison of three Indonesian communities. Aging and Society 26, 3760.
Li, X, Xiao, Z and Xiao, S (2009) Suicide among the elderly in mainland China. Psychogeriatrics 9, 6266.
Liu, S, et al. (2015) Spatiotemporal variation and social determinants of suicide in China, 2006–2012: findings from a nationally representative mortality surveillance system. Psychological Medicine 45, 32593268.
National Bureau of Statistics of China (2017) China Statistical Yearbook (2016). Beijing, China: China Statistics Press.
Phillips, MR, Li, X and Zhang, Y (2002 a) Suicide rates in China, 1995–99. The Lancet 359, 835840.
Phillips, MR, et al. (2002 b) Risk factors for suicide in China: a national case-control psychological autopsy study. The Lancet 360, 17281736.
Rubenowitz, E, et al. (2001) Life events and psychosocial factors in elderly suicides – a case-control study. Psychological Medicine 31, 11931202.
Sha, F, Yip, PS and Law, YW (2017) Decomposing change in China's suicide rate, 1990–2010: ageing and urbanisation. Injury Prevention 23, 4045.
Waern, M, et al. (2002) Mental disorder in elderly suicides: a case-control study. American Journal of Psychiatry 159, 450455.
Wang, CW, Chan, CL and Yip, PS (2014) Suicide rates in China from 2002 to 2011: an update. Social Psychiatry and Psychiatric Epidemiology 49, 929941.
Wang, SF, et al. (2007) The relationship between physical disease and depression in 304 elderly suicides. Chinese Journal of Gerontology 27, 22122214.
Wang, Z, et al. (2013) Anxiety disorders and its risk factors among the Sichuan empty-nest older adults: a cross-sectional study. Archives of Gerontology and Geriatrics 56, 298302.
Wang, G, et al. (2017) Loneliness and depression among rural empty-nest elderly adults in Liuyang, China: a cross-sectional study. BMJ Open 7, e016091.
Xiao, L and Xu, HL (2008) The development of life events scale for the elderly. Chinese Journal of Behavioral Medical Science 17, 182184.
Yang, G, et al. (2013) Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. The Lancet 381, 19872015.
Zhang, J and Li, Z (2011) Suicide means used by Chinese rural youths: a comparison between those with and without mental disorders. Journal of Nervous and Mental Disease 199, 410415.
Zhang, J, Xiao, S and Zhou, L (2010) Mental disorders and suicide among young rural Chinese: a case-control psychological autopsy study. American Journal of Psychiatry 167, 773781.
Zhang, J, et al. (2003) Studying Chinese suicide with proxy-based data: reliability and validity of the methodology and instruments in China. The Journal of Nervous and Mental Disease 191, 450457.
Zhang, J, et al. (2014) The change in suicide rates between 2002 and 2011 in China. Suicide and Life-Threatening Behavior 44, 560568.
Zhang, D, et al. (2017 a) Characteristics of the Chinese rural elderly living in nursing homes who have suicidal ideation: a multiple regression model. Geriatric Nursing 38, 423430.
Zhang, W, et al. (2017 b) Prevalence and risk factors for attempted suicide in the elderly: a cross-sectional study in Shanghai, China. International Psychogeriatrics 29, 709715.
Zhong, BL, Chiu, HF and Conwell, Y (2016) Rates and characteristics of elderly suicide in China, 2013–14. Journal of Affective Disorders 206, 273279.
Zhou, MG, et al. (2004) Analysis of negative life events among 304 elderly suicide victims. Zhonghua Liu Xing Bing Xue Za Zhi 25, 292295.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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