Indepth Interviews with 244 Female Suicide Attempters and Their Associates in Northern China
Understanding the Process and Causes of the Attempt
Abstract
Background: Attempted suicide, a deliberate self-directed behavior situated within the unique social world of an individual, is a major risk factor for suicide. Efforts aimed at addressing female suicide must be based on understanding their perceived causes and the meaning of this behavior. Aims: This study describes the perceived causes of suicidal behaviors to determine preventive measures of female suicide in China. Methods: An in-depth interview about the process and causes of suicidal behavior as well as a detailed structured and a standardized diagnostic interview were administered to 244 female attempters treated at general hospitals and, separately, to their relatives. Results: The perceived three most frequent causes of the attempts were interpersonal conflict (87%), psychological problems (33%), and conflict between others that affected the subject (27%). On average 2.2 causes were identified for each case. The identification in the in-depth interviews of psychological problems as a cause of the attempt was concordant with the results of the independent psychiatric exam identifying a current DSM-IV mental disorder in 38% of cases (Kappa = 0.64). Conclusions: Preventive measures of improving interpersonal and problem-solving skills should be developed and assessed for addressing female suicide in China besides expansion of psychiatric services.
References
(2000). The Nvivo qualitative project book. London: Sage.
(2003). Group interpersonal psychotherapy for depression in rural Uganda. A randomized controlled trial. The Journal of the American Medical Association, 289, 3117–3124.
(2005). Cognitive therapy for the prevention of suicide attempts. A randomized controlled trial. The Journal of the American Medical Association, 294, 563–570.
(2006). Psychosocial treatments of suicidal behaviors: A practice-friendly review. Journal of Clinical Psychology, 62, 161–170.
(2007). Low-intent and high-intent suicide attempts in rural China. American Journal of Public Health, 97, 1842–1846.
(2005). Low-planned suicide in China. Psychological Medicine, 35, 1197–1204.
(2002). Suicide among the elderly: The long-term impact of a telephone support and assessment intervention in northern Italy. British Journal of Psychiatry, 181, 226–229.
(2004). Self poisoning with pesticides. British Medical Journal, 328, 42–44.
(2005). Risk factors for suicidal behavior: Translating knowledge into practice. In , Prevention and treatment of suicidal behavior: From science to practice (pp. 161–182). New York: Oxford University Press.
(2002). Reducing suicide: A national imperative. Washington DC: Institute of Medicine, National Academies Press.
(2003). Suicide by intentional ingestion of pesticides: A continuing tragedy in developing countries. International Journal of Epidemiology, 32, 902–909.
(2005). Psychosocial treatments following attempted suicide: Evidence to inform clinical practice. In , Prevention and treatment of suicidal behavior: From science to practice (pp. 197–219). Oxford: Oxford University Press.
(2001). Suicide notes of Chinese youth. Perceptual and Motor Skills, 93, 317–318.
(2000). General population strategies of suicide prevention. In , The international handbook of suicide and suicide attempt (pp. 597–616). Chichester: Wiley.
(1980). Patients and healers in the context of culture. Berkeley: University of California.
(2007). Pesticide self-poisoning: Thinking outside the box. The Lancet, 369, 169–170.
(2006). Reaching for the bottle of pesticide – A cry for help. Self-inflicted poisonings in Sri Lanka. Social Science and Medicine, 62, 1710–1719.
(2007). Community uptake of safe storage boxes to reduce self-poisoning from pesticides in rural Sri Lanka. BMC Public Health, 7, 13.
(2002). World report on violence and health. Geneva: WHO.
(2008). Using indepth interviewing methods with suicide attempters and their associates to assess their ideas about the characteristics and causes of the attempt. Chinese Mental Health Journal, 22, 43–50 (in Chinese).
(2004). Why is the suicide attempt rate higher in women? Chinese Mental Health Journal, 18, 191–195 (in Chinese).
(2004). Current attitudes and knowledge about suicide in community members: A qualitative study. Chinese Journal of Epidemiology, 25, 296–301 (in Chinese).
(2003). The comparison of impulsive and nonimpulsive attempted suicide. Chinese Journal of Nervous and Mental Diseases, 29, 27–31 (in Chinese).
(2002). Characteristics of serious suicide attempts treated in general hospitals. Chinese Mental Health Journal, 16, 681–684 (in Chinese).
(2001). A case-control study of the risk factors in attempted suicide. Chinese Journal of Epidemiology, 22, 281–283 (in Chinese).
(2002). Rebellion and revenge: The meaning of suicide of women in rural China. International Journal of Social Welfare, 11, 300–309.
(2005). Suicide prevention strategies: A systematic review. The Journal of the American Medical Association, 294, 2064–2074.
(2001). A Randomized controlled trial of postcrisis suicide prevention. Psychiatric Services, 52, 828–833.
(2007). Restrictions in means for suicide: An effective tool in prevention suicide: The Danish experience. Suicide and Life-Threatening Behavior, 37, 688–697.
(2002). Ling’s death: An ethnography of a Chinese woman’s suicide. Suicide and Life-Threatening Behavior, 32, 347–358.
(2004). Suicide and attempted suicide – China, 1990–2002. MMWR. Morbidity and Mortality Weekly Report, 53, 481–484.
(2000). Causes of schizophrenia reported by patients’ family members in China. British Journal of Psychiatry, 177, 20–25.
(2002). Suicide rates in China, 1995–99. The Lancet, 359, 835–840.
(2007). Resources for mental health: Scarcity, inequity, and inefficiency. The Lancet, 370, 878–889.
(2006). Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: Randomized controlled study. British Medical Journal, 332, 1241–1245.
(2008). Safe storage of pesticides in Sri Lanka – identifying important design features influencing community acceptance and use of safe storage devices. BMC Public Health, 8, 276.
(2006). Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior. Journal of Clinical Psychology, 62, 201–210.
(2005). “Gambling for qi”: Suicide and family politics in a rural north China county. The China Journal, 54, 7–27.
(2005). Understanding the unique characteristics of suicide in China: National psychological autopsy study. Biomedical and Environmental Sciences (China CDC), 18, 379–389.
(2002). Make concerted and earnest efforts to comprehensively promote mental health work in the new century. Chinese Mental Health Journal, 16, 4–8. (in Chinese).
(2004). Culture, risk factors and suicide in rural China: A psychological autopsy case control study. Acta Psychiatrica Scandinavica, 110, 430–437.
