Skip to main content
    • Aa
    • Aa

Risk factors for suicide in China's youth: a case-control study

  • X. Y. Li (a1), M. R. Phillips (a1), Y. P. Zhang (a1), D. Xu (a1) and G. H. Yang (a2)...

Suicide is the most common cause of death among youth in China.


A case-control psychological autopsy study in 23 geographically representative disease surveillance points around China collected information from family members and close associates of 114 persons aged 15–24 years who died by suicide (cases) and 91 who died of other injuries (controls).


Among the 114 suicides 61% were female, 88% lived in rural villages, 70% died by ingesting pesticides (most commonly stored in the home), 24% previously attempted suicide, and 45% met criteria of a mental illness at the time of death. Multivariate logistic regression identified several independent risk factors: severe life events within 2 days before death (OR 31.8, 95% CI 2.6–390.6), presence of any depressive symptoms within 2 weeks of death (OR 21.1, 95% CI 4.6–97.2), low quality of life in the month before death (OR 9.7, 95% CI 2.8–34.1), and acute stress at time of death (moderate: OR 3.1, 95% CI 0.8–11.9; high: OR 9.1, 95% CI 1.2–66.8). A significant interaction between mental illness at time of death and gender indicated that diagnosis was an important predictor of suicide in males (OR 14.0, 95% CI 2.6–76.5) but not in females (OR 0.3, 95% CI 0.0–3.6). Prior suicide attempt was related to suicide in the univariate analysis (OR 57.5) but could not be included in the multivariate model because no controls had made prior attempts.


Suicide prevention efforts for youth in China must focus on restricting access to pesticides, early recognition and management of depressive symptoms and mental illnesses, improving resiliency, and enhancing quality of life.

Corresponding author
*Address for correspondence: Dr X. Y. Li, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing 100096, People's Republic of China. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

E Agerbo , M Nordentoft , PB Mortensen (2002). Familial, psychiatric, and socioeconomic risk factors for suicide in young people: nested case-control study. British Medical Journal 325, 7478.

AL Beautrais (2000). Risk factors for suicide and attempted suicide among young people. Australian and New Zealand Journal of Psychiatry 34, 420436.

DA Brent (1989). The psychological autopsy: methodological considerations for the study of adolescent suicide. Suicide and Life-Threatening Behavior 19, 4357.

DA Brent , M Baugher , J Bridge , T Chen , L Chiappetta (1999). Age- and sex-related risk factors for adolescent suicide. Journal of the American Academy of Child and Adolescent Psychiatry 38, 14971505.

TH Chen , FM Hoppe , S Iyengar , D Brent (2003). A hybrid logistic model for case-control studies. Methodology and Computing in Applied Probability 5, 419426.

X Coll , F Law , A Tobias , K Hawton , J Tomas (2001). Abuse and deliberate self-poisoning in women: a matched case-control study. Child Abuse & Neglect 25, 12911302.

KR Conner , MR Phillips , S Meldrum (2007). Predictors of low-intent and high-intent suicide attempts in rural China. American Journal of Public Health Published online: 29 March 2007. doi: 10.2105/AJPH.2005.077420.

E Evans , K Hawton , K Rodham (2005). Suicidal phenomena and abuse in adolescents: a review of epidemiological studies. Child Abuse & Neglect 29, 4558.

MS Gould , P Fisher , M Parides , M Flory , D Shaffer (1996). Psychosocial risk factors of child and adolescent completed suicide. Archives of General Psychiatry 53, 11551162.

MS Gould , T Greenberg , DM Velting , D Shaffer (2003). Youth suicide risk and preventive interventions: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry 42, 386405.

B Groholt , O Ekeberg , L Wichstrom , T Haldorsen (1998). Suicide among children and younger and older adolescents in Norway: a comparative study. Journal of the American Academy of Child and Adolescent Psychiatry 37, 473481.

JBS Haldane (1956). The estimation and significance of the logarithm of a ratio of frequencies. Annals of Human Genetics 20, 309311.

JA Hanley , BJ McNeil (1982). The meaning and use of the area under the receiver operating characteristic (ROC) curve. Radiology 143, 2936.

K Hawton , A James (2005). Suicide and deliberate self harm in young people. British Medical Journal 330, 891894.

M Lynskey , L Degenhardt , W Hall (2000). Cohort trends in youth suicide in Australia 1964–1997. Australian and New Zealand Journal of Psychiatry 34, 408412.

G Martin , HA Bergen , AS Richardson , L Roeger , S Allison (2004). Sexual abuse and suicidality: gender differences in a large community sample of adolescents. Child Abuse & Neglect 28, 491503.

PB Mortensen , EE Agerbo , T Qin , N Westergaard-Nielsen (2000). Psychiatric illness and risk factors for suicide in Denmark. Lancet 355, 912.

NJD Nagelkerke (1991). A note on general definition of the coefficient or determination. Biometrika 78, 691692.

MR Phillips , XY Li , YP Zhang (2002 a). Suicide rates in China, 1995–99. Lancet 359, 835840.

MR Phillips , QJ Shen , XH Liu , S Pritzker , D Streiner , K Conner , GH Yang (2007). Assessing depressive symptoms in persons who die of suicide in mainland China. Journal of Affective Disorders 98, 7382.

MR Phillips , GH Yang , YP Zhang , LJ Wang , HY Ji , MG Zhou (2002 b). Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet 360, 17281736.

D Shaffer , MS Gould , P Fisher , P Trautman , D Moreau , M Kleinman , M Flory (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry 53, 339348.

AEM Speckens , K Hawton (2005). Social problem solving in adolescents with suicidal behavior: a systematic review. Suicide and Life-Threatening Behavior 35, 365387.

L Vijaykumar , S Rajkumar (1999). Are risk factors for suicide universal? A case control study in India. Acta Psychiatrica Scandinavica 99, 407411.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 8
Total number of PDF views: 64 *
Loading metrics...

Abstract views

Total abstract views: 210 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 26th June 2017. This data will be updated every 24 hours.