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Cited by 38Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseMental Health Treatment and Access

Factors associated with suicide risk among Chinese adults: a prospective cohort study of 0.5 million individuals

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Yu, Rongqin, Chen, Yiping, Li, Liming, Chen, Junshi, Guo, Yu, Bian, Zheng, Lv, Jun, Yu, Canqing +4 more·2021·PLoS Medicine
DOI 10.1371/journal.pmed.1003545PMC PMC7951865
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Abstract

BACKGROUND: Suicide is a leading cause of death in China and accounts for about one-sixth of all suicides worldwide. The objective of this study was to examine the recent distribution of suicide and risk factors for death by suicide. Identifying underlying risk factors could benefit development of evidence-based prevention and intervention programs. METHODS AND FINDINGS: We conducted a prospective study, the China Kadoorie Biobank, of 512,715 individuals (41% men, mean age 52 years) from 10 (5 urban, 5 rural) areas which are diverse across China in geographic locations, social economic developmental stages, and prevalence of disease patterns. After the baseline measurements of risk factors during 2004 to 2008, participants were followed up for suicide outcomes including suicide and possible suicide deaths. Risk factors, such as sociodemographic factors and physical and mental health status, were assessed by semistructured interviews and self-report questionnaires. Suicide and possible suicide deaths were identified through linkage to the local death registries using ICD-10 codes. We conducted Cox regression to calculate hazard ratios (HRs) for suicide and for possible suicide in sensitivity analyses. During an average follow-up period of 9.9 years, 520 (101 per 100,000) people died from suicide (51.3% male), and 79.8% of them lived in rural areas. Sociodemographic factors associated with increased suicide risk were male gender (adjusted hazard ratios [aHR] = 1.6 [95% CI 1.4 to 2.0], p < 0.001), older age (1.3 [1.2 to 1.5] by each 10-yr increase, p < 0.001), rural residence (2.6 [2.1 to 3.3], p < 0.001), and single status (1.7 [1.4 to 2.2], p < 0.001). Increased hazards were found for family-related stressful life events (aHR = 1.8 [1.2 to 1.9], p < 0.001) and for major physical illnesses (1.5 [1.3 to 1.9], p < 0.001). There were strong associations of suicide with a history of lifetime mental disorders (aHR = 9.6 [5.9 to 15.6], p < 0.001) and lifetime schizophrenia-spectrum disorders (11.0 [7.1 to 17.0], p < 0.001). Links between suicide risk and depressive disorders (aHR = 2.6 [1.4 to 4.8], p = 0.002) and generalized anxiety disorders (2.6 [1.0 to 7.1], p = 0.056) in the last 12 months, and sleep disorders (1.4 [1.2 to 1.7], p < 0.001) in the past month were also found. All HRs were adjusted for sociodemographic factors including gender, age, residence, single status, education, and income. The associations with possible suicide deaths were mostly similar to those with suicide deaths, although there was no clear link between possible suicide deaths and psychiatric factors such as depression and generalized anxiety disorders. A limitation of the study is that there is likely underreporting of mental disorders due to the use of self-report information for some diagnostic categories. CONCLUSIONS: In this study, we observed that a range of sociodemographic, lifestyle, stressful life events, physical, and mental health factors were associated with suicide in China. High-risk groups identified were elderly men in rural settings and individuals with mental disorders. These findings could form the basis of targeted approaches to reduce suicide mortality in China.

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  • Prospective cohort studies of suicide mortality in the general population tend to report more conservative risks for sociodemographic factors, adverse life events, family history of mental disorder, and depression.

    “In contrast, prospective cohort studies of suicide mortality in the general population—which allow for a more reliable measurement of exposures—tend to report more conservative risks for sociodemographic factors, adverse life events, family history of mental disorder, and depression.26–28”

    From Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies (2022) · cites this paper as [26]

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  1. [27]Khawaja IS, Hurwitz TD, editors. Comorbid sleep and psychiatric disorders: a clinical casebook. Cham, Switzerland: Springer; 2019.
  2. [34]Chen H, Zhou P. The treatment rate of patients with mental disorders and the utilization status of health resources in Jiangsu province. Chin J Clin Rehab. 2005; 9: 187– 8.

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Authors
Yu, R., Chen, Y., Li, L., Chen, J., Guo, Y., Bian, Z., Lv, J., Yu, C., Xie, X., Huang, D., Chen, Z., & Fazel, S.
Affiliations
  • University of Oxford (GB)
  • Peking University (CN)
  • China National Center for Food Safety Risk Assessment (CN)
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
Corresponding author
  • Chen, Yiping
  • Fazel, Seena
ORCID
Venue
PLoS Medicine
Publisher
Public Library of Science (PLoS)
Published
2021-03-11
Volume
18
Issue
3
Pages
e1003545
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1003545
PMC
PMC7951865
OpenAlex
W3135028572
Cited by
38
References
59
Citations by year
2026: 5 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 13 · 2021: 1
FWCI
4.74
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Greater South Information System
Funders
Wellcome Trust (202836/Z/16/Z, 212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
suicide, suicide risk factors, suicide prevention, mental illness, depression, anxiety disorders, substance use disorders, life events, physical illness, sociodemographic factors, rural residence, singlehood, China Kadoorie Biobank, Chinese adults, urban-rural differences, gender differences in suicide, family history of suicide
MeSH terms
Adult, Aged, China, Female, Humans, Male, Middle Aged, Prospective Studies, Risk, Risk Factors, Rural Population, Socioeconomic Factors, Suicide, Urban Population

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