The Acceptability of Suicide Among Rural Residents, Urban Residents, and College Students from Three Locations in China
A Cross-Sectional Survey
Abstract
Background: Community attitudes about suicide and their relationship to suicidal behavior have not been adequately investigated in low- and middle-income countries. Aims: To compare the acceptability of suicide in different population cohorts in China, identify factors that affect the degree of acceptability, and assess the relationship of cohort-specific acceptability of suicide and suicide rates. Methods: A multistage stratified random sample of 608 rural residents, 582 urban residents, and 629 college students were administered a 25-item scale studying the likelihood they would consider suicide (on a 5-point Likert scale) if they experienced a variety of stressors ranging from “being disciplined at work” to “developing a chronic mental illness.” The internal consistency and test-retest reliability for the scale are excellent (Cronbach’s α = 0.92, ICC = 0.75). Results: College students had the most permissive attitudes about suicide, and urban residents were significantly more accepting of suicide as a response to serious life stressors than were rural residents. Multivariate analysis found that the overall acceptability score was higher in women, decreased with age, and increased with years of education. Conclusions: There was no clear relationship between cohort-specific acceptance of suicide and reported rates of suicide, highlighting the complexity of the relationship between attitudes about suicide (of which acceptability is only one component) and suicidal behavior.
References
(1998). The approval of suicide: A social-psychological model. Suicide and Life-Threatening Behavior, 28, 205–225.
(2004). Knowledge and attitudes about suicide in 25-year-olds. Australian and New Zealand Journal of Psychiatry, 38, 260–265.
(2007). Suicide and changing values and beliefs in Ireland. Crisis, 28, 82–88.
(2007). Ethnocultural aspects of suicide in young people: A systematic literature review, Part 2: Risk factors, precipitating agents, and attitudes toward suicide. Suicide and Life-Threatening Behavior, 37, 222–237.
(1988–89). Factors affecting the acceptability of suicide. Omega, 19, 315–326.
(1992). Religiosity and attitudes toward suicide. Omega, 25, 271–282.
(2004). The effects of religious versus secular education on suicide ideation and suicidal attitudes in adolescents in Turkey. Social Psychiatry and Psychiatric Epidemiology, 39, 536–542.
(1998). Attitudes toward suicide among medical students: Comparison between Madras (India) and Vienna (Austria). Social Psychiatry and Psychiatric Epidemiology, 33, 104–110.
(1989). Attitudes toward suicide. In , Suicide and its prevention: The role of attitude and imitation (pp. 281–298). Leiden: Canberrs, Brill.
(2007). Suicide rates in rural Tamil Nadu, South India: Verbal autopsy of 39,000 deaths in 1997–1998. International Journal of Epidemiology, 36, 203–207.
(2006). Suicidal ideation and attitudes toward suicide. Suicide and Life-Threatening Behavior, 36, 12–18.
(2002). Reducing suicide: A national imperative. Washington DC: Institute of Medicine, National Academies Press.
(2006). A review of the literature on rural suicide: Risk and protective factors, incidence, and prevention. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 27, 189–199.
(2008). Self-reported suicidal behavior and attitudes toward suicide and suicide prevention among psychology students in Ghana, Uganda, and Norway. Crisis, 29, 20–31.
(2007). Suicide acceptability is related to suicide planning in US adolescents and young adults. Suicide and Life-Threatening Behavior, 37, 165–178.
(2006). Rural suicide-people or place effects? Australian and New Zealand Journal of Psychiatry, 40, 208–216.
(2008). Rural-urban differences in Austrian suicides. Social Psychiatry and Psychiatric Epidemiology, 43, 311–318.
(2003). Attitudes toward suicide in Slovenia: A cross-sectional survey. International Journal of Social Psychiatry, 49, 8–16.
(2007). Attitudes toward suicide among Chinese people in Hong Kong. Suicide and Life-Threatening Behavior, 37, 565–575.
(2009). Suicide rates in the world: 1950–2004. Suicide and Life-Threatening Behavior, 39, 204–213.
(2007). Research methods in suicide and suicide prevention. In , Epidemiological field research methods for injuries (pp 143–218). Beijing: Peoples Health Publishing House. (in Chinese).
(2004). Current attitudes and knowledge about suicide in community members: A qualitative study. Chinese Journal of Epidemiology, 25, 296–301. (in Chinese).
(1988–89). Structural parameters of sex, race, age, and education and their influence on attitudes toward suicide. Omega, 19, 327–336.
(2003). Urban-rural differences in suicide trends in young adults: England and Wales, 1981–1998. Social Science and Medicine, 57, 1183–1194.
(1997). Identification of suicide risk factors using epidemiologic studies. The Psychiatric Clinics of North America, 20, 499–517.
. (2001). China statistical yearbook 2001. Beijing: China Statistical Press.
(1998). Suicide acceptability in African- and white Americans: The role of religion. Journal of Nervous and Mental Disease, 186, 12–16.
(2000). Age and the lifespan. In , Comprehensive textbook of suicidology (pp. 127–144). New York: Guilford.
(1989). Suicide awareness programs in the schools: Effects of gender and personal experience. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 925–930.
(2007). Further increases in rural suicide in young Australian adults: Secular trends, 1979–2003. Social Science and Medicine, 65, 442–453.
(1997). Older adults’ attitudes toward suicide: Are there race and gender differences? Death Studies, 21, 289–298.
(2002). Suicide rates in China: 1995–1999. The Lancet, 359, 835–840.
(2002). Risk factors for suicide in China: A national case-control psychological autopsy study. The Lancet, 360, 1728–1736.
(1989). A subculture of parasuicide? In , Suicide and its prevention: The role of attitude and imitation (pp. 108–143). Leiden: Canberrs, Brill.
(1985). The prevalence of suicidal behaviors, attitudes and associated social experiences in an urban population. Suicide and Life-Threatening Behavior, 15, 151–167.
(1976). Attempted suicide and cultural change: An empirical investigation. Human Relations, 29, 863–883.
(2008). Building models for the relationship between attitudes toward suicide and suicidal behavior: Based on data from general population surveys in Sweden, Norway, and Russia. Suicide and Life-Threatening Behavior, 38, 661–675.
(2003). Development of a questionnaire on Attitudes Toward Suicide (ATTS) and its application in a Swedish population. Suicide and Life-Threatening Behavior, 33, 52–64.
(1975). Suicidal behavior: Community attitudes and beliefs. Suicide, 5, 158–168.
(2004). Attitudes toward suicide and suicidal risk among younger and older persons. Death Studies, 28, 671–678.
(1995). Attitudes of older people toward suicide and assisted suicide: An analysis of Gallup Poll findings. Journal of the American Geriatrics Society, 43, 993–998.
(1986). Public approval of suicide: A situational analysis. Suicide and Life-Threatening Behavior, 16, 409–418.
(1998). The association between attitudes toward suicide and suicidal ideation in adolescents. Acta Psychiatrica Scandinavica, 97, 195–201.
(1992). The association between adolescents’ attitudes toward suicide and their psychosocial background and suicidal tendencies. Adolescence, 27, 949–959.
(2005). Social and psychiatric influences on urban-rural differentials in Australian suicide. Suicide and Life-Threatening Behavior, 35, 277–290.
. (2002). The injury chartbook. Department of Injuries and Violence Prevention, Noncommunicable Diseases and Mental Health Cluster, World Health Organization, Geneva.
(2005). Understanding the unique characteristics of suicide in China: National psychological autopsy study. Biomedical Environmental Science (China CDC), 18, 379–389.
(2008). Years of life lost from suicide in China, 1990–2000. Crisis, 29, 131–136.
(2005). Suicidal tendencies and attitude toward freedom to choose suicide among Lithuanian schoolchildren: Results from three cross-sectional studies in 1994, 1998, and 2002. BMC Public Health, 5, 83.
