Akademik

Suicide is a major public health problem for China that is only gradually being recognized. During the period from 1995 to 1999, there were an estimated 287,000 suicides each year, which makes suicide the fifth most important cause of death in the country. Unlike other countries, the female rate is 25 per cent higher than the male rate—primarily because of the large number of suicides of young rural women—and rural rates are three times higher than urban rates. Among young adults between fifteen and thirty-four years of age, suicide is the leading cause of death, accounting for 19 per cent of all deaths. A national study, conducted from 1998 to 2000, that investigated a representative sample of 519 suicides, found that 84 per cent lived in rural villages, 35 per cent never attended school, 62 per cent died by ingesting pesticides or rat poison, 55 per cent had relatives, friends or associates who had shown suicidal behaviour, 63 per cent suffered from a mental illness, and only 7 per cent had ever seen a mental health professional. Financial difficulties, marital conflict and serious illness are the most common negative life events experienced by persons who die by suicide.

The relatively high rate of suicide in China (23 per 100,000), and the unique pattern and characteristics of suicides may be related both to the rapid social changes that have occurred since the economic reforms begun in 1978 and to the low social status of rural women; but the suicide rate in China has been relatively stable over the last fifteen years, and gender inequality is a problem experienced in many developing countries that do not have high female suicide rates, so other explanations also need to be considered. The ready availability of pesticides and rat poisons in rural homes in China, combined with an environment in which there are no strong social or religious prohibitions against suicide make self-poisoning an appealing alternative for persons who are experiencing acute or chronic stress. Of attempted suicides in China, 75 per cent a rate similar to that found in other countries, occur in women; but it appears that a much higher proportion of the attempted suicides in China are impulsive acts following acute interpersonal conflicts. Moreover, the lethality of the poisons used in rural suicide attempts and the lack of well-trained medical personnel in the countryside result in high mortality rates among persons who impulsively ingest these poisons but actually have a low intent to die. This may be one of the main reasons for the higher suicide rate in rural areas and the relatively high rate among females.

Government figures on suicide have been available since 1987, but it is only since the late 1990s that the public have become aware of the magnitude of the problem. Preventive efforts have lagged far behind those of other countries, but there is now increasing momentum to develop a national suicide prevention plan. To be effective, this plan must coordinate the activities of the wide range of agencies and organizations which are needed to develop and test methods to (1) monitor rates of suicide and attempted suicide; (2) identify high-risk individuals or groups; (3) control access to potent poisons, particularly pesticides; (4) provide basic mental health services to rural areas; (5) develop social support networks that give persons experiencing interpersonal crises alternative methods of dealing with their problems; and (6) educate the public about suicide and other mental health issues.

See also: medical insurance; mental health; public health care

Pearson V., Phillips, M.R., He, F.S. and Ji, H.Y.

(2002). ‘Attempted Suicide among Young Rural Women in the People’s Republic of China; Possibilities for Prevention’. Suicide and Life Threatening Behaviour 32.4: 359–69.

Phillips, M.R., Liu, H.Q. and Zhang, Y.P. (1999). ‘Suicide and Social Change in China’. Culture, Medicine and Psychiatry 23:25–50.

Phillips, M.R., Li, X.Y. and Zhang, Y.P. (2002). ‘Suicide Rates in China: 1995–1999’. The Lancet 359:835–40.

Phillips, M.R., Yang, G.H., Zhang, Y.P., Wang, L.J., Ji, H.Y. and Zhao, M.G. (2002). ‘Risk Factors for Suicide in China: A National Case-Control Psychological Autopsy Study’. The Lancet 360:1728–36.

World Health Organization, Department of Mental Health and Substance Dependence (2001). Report on Workshop on Suicide Prevention in China (Beijing, China, 22–24 March). Geneva: WHO.