Study On Epidemiological Status Of Suicide Behaviors In Chinese College Students And Three Elements Warning System

BackgroundSuicide is the most prominent mental health problems among college students, it is the most serious, widely affecting public emergencies in universities and is also the first cause of unnatural death of college students. Researches indicate that every single case of suicide will cause sever affect to at least 6 close persons an average and the traumatic affects will lasted at least 10 years. Suicide prevention has become the world wide hot topic that been researched and been given highly attention to, it is also the highlight but difficult point of the work of the mental health education in universities in China currently. There are lots of previous researches concentrate on the features as following:(1) lack of basic information of suicide prevalence and characteristics of nationwide large sample of Chinese college students, most of the researches focus on regional small sample; (2) lack of the researches that study the use of theories as guide of applied models of suicide prevention of college students, besides the existing multiple theories/models; (3) not giving highly attention to the protective factors of suicide, even lots of searches studied the suicidal risk factors but they are scattered, could hardly be used directly for proceeding suicide prevention of college students;(4) early-warning index of the existing suicide warning model in China is single and researches of suicide prevention are relatively weak. Chinese universities do not have unified and easy carrying out suicide warning methods and tools, the existing evaluate tools of suicide are also screening from single aspect, using the single assessment tool will lead to missing the clues of suicide. Thus, it’s quite necessary to carry out the research of suicide warning system of Chinese students that suit for the condition of China.Accordingly, this research intends to undertake the following points:(1) propose the three elements warning model (psychological symptoms, stressful events and susceptible qualities) of suicide of students:according to the previous theoretical model of suicide, especially stress-diathesis model, using the application of practicing of students suicide warning as guidance, building the standard system from three dimensions to categorize the people warningly and previously. (2) Study the warning standards of three factors warning system of suicide:Through national surveys and case-control studies, screening early warning indicators, establishing the national norm and indicators of evaluation and warning. (3) developing and applying the software of three elements of suicide warning system:developing the students suicide warning system based on the three elements suicide warning model and applying preliminary field test. Results of this research will provide a new thought and standardizing processes of early warning suicide of Chinese college students, it has strong practical significance and application value.Section 1 Epidemiological status and characteristics of student suicide in Chinese universitiesObjective To understand the prevalence and distribution of suicidal ideation, suicide plans, suicide attempts and the overall risk of suicide among Chinese university studentsSubjects and methods According to the division level of economic development and geographical distribution, respectively, a total of 8202 students at grade 1 to 5 were sampled from different types of universities in the North, Northeast, East, Middle-South, Southwest, Northwest of China. Suicidal Behaviors Questionnaire-Revised (SBQ-R) and self-made questionnaire on population and sociology relevant factors were used to make a survey. SPSS15.0 was used to process obtained data. Statistical methods included descriptive statistics, student’s t test, Chi-square test and variance analysis.Results (1) The incidence of lifetime suicidal ideation, suicide plans, and suicide attempts were 40.40%,5.40% and 3.00% respectively among Chinese students. The rate of suicidal ideation in nearly a year was 18.10%. The total score of SBQ-R was 4.71±2.13.(2) SBQ-R total score was significantly higher in girls than boys (P<0.05), and so their lifetime suicidal ideation, suicidal plans, suicide attempts, and the rates of suicidal ideation in nearly 1 year and overall suicide risk (P<0.01).(3) There was no significant difference among the students at different grades in SBQ-R total score, lifetime suicide ideation, suicidal plans, suicide attempts (P> 0.05). Freshmen had a comparative highest rate of suicidal ideation in nearly 1 year (P<0.05).(4) SBQ-R total score and the incidences of suicidal ideation and behavior were significantly higher in the minority students than Han students (P<0.05), in those with boy/girl friends than those without (P<0.05), in those from single-child family than those with brothers and/or sisters (P<0.05), and in those from urban areas than those from rural areas (P<0.05). With the economic situation from good to bad, the suicide risk was significantly increased (P<0.05). Those having sought professional help and having history of left-behind during childhood had a significantly higher rate of suicide risk than those with corresponding experience (P<0.05).Conclusion There is a higher risk of suicide in girls than in boys. No significant difference is found in overall suicide risk among those from different grades, the freshmen have obviously higher rate in nearly 1-year suicide risk. For the students from minority nationalities, single-child family, poor economic family, or urban areas, or with boy/girl friend, seeking for professional help or experience of left-behind during childhood, they have a higher rate of suicide risk.Section 2 Study on the warning indexes of three elements suicide warning system in Chinese university studentsObjective To screen and establish norm standards 3 types of suicide warning indexes stressful events, susceptibility of quality and psychological symptoms, and evaluate suicide warning indexes for Chinese university students, and found a basic data for the further development of three elements suicide warning system in Chinese university students.Subjects and methods First sample was from a national sampling including 8202 students (sampling method was the same as in section 1). Reasons for Living Inventory for Adolescents, Self-esteem Scale, Simple Parenting Style Questionnaire, Family Concern Index Questionnaire (APGAR), Social Support Scale, Life Meaning Questionnaire-Chinese version, Life Events Scale for Adolescents, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Life Satisfaction Scale, Suicidal Behavior Questionnaire-Revised and self-made questionnaire on population and sociology relevant factors were used to assess the stressful events, susceptibility quality and psychological symptoms indexes at total levels to establish a national norm for suicide early warning. SPSS15.0 and Amos7.0 were employed to process data. Statistical methods included correlation analysis, multivariate analysis of variance, structural equation modeling.The second samples were 3594 students from a university. Ninety-six of them with history of suicide were assigned into case group after interviews (including group of lifetime suicidal ideation, suicide plans, and suicide attempts). Another 274 matched students served as normal control according to the composition ratio of 1:2. There were totally 370 people in this section. SPSS15.0 and Matlab was used to process the sample data, and statistical methods included descriptive statistics, variance analysis, and integrated model of classification and regression tree.Results1. Screening of the warning indexes of three elements suicide warning system in Chinese university students(1) Indexes of susceptibility of quality① Biological indexes and suicide:Four indexes history of mental illness, severe physical illness, close relatives history of mental illness and sexual orientation were included. Students with history of mental illness, severe physical illness and close relatives history of mental illness had significantly higher SBQ-R total score than those without (P<0.05).Students of homosexuality and uncertain sexual orientation had significantly higher SBQ-R total score than heterosexual students (P<0.05). Structural equation model of relationship between biological indexes and suicide was ideal fitting (RMSEA=0.02, CFI=0.99, NFI= 0.98). Standardized path coefficient was 0.51, R2=0.26 for biological factors to suicidal behavior.② Relationship of attitude and personality indexes with suicide:Three warning indexes reasons for living, suicidal attitude and self-esteem were included. Significant correlation was found in the total score and scores of various factors in Reasons for Living Inventory with the SBQ-R total score (-0.21≤r≤-0.31). Structural equation model of relationship between reasons for living inventory and suicide was ideal fitting (RMSEA=0.04, CFI=0.99, NFI=0.98). Standardized path coefficient was-0.40, R2= 0.16 for reasons for living inventory to suicidal behavior. The higher acceptance of suicide, the higher SBQ-R total score was. Significant difference was found in different levels of suicidal attitude (P<0.05). The girls with obvious acceptance to suicide had highest risk of suicide. Self-esteem was significantly negatively correlated with suicidal behaviors at different dimensions (-0.12≤r≤-0.26), and also negatively correlated with SBQ-R total score, with a relatively highest relevance of -0.26. The higher suicide, risk, the lower the score of self-esteem. The fitting of structural equation model of attitude, and personality factors with suicidal behavior was acceptable (RMSEA=0.06, CFI=0.96, NFI=0.95). The standardized path coefficient were-0.67, R2=0.45 for attitude and personality factors to suicidal behavior.③ Family and social support indexes with suicide:Four indexes family functions, social support and parental rearing patterns were included. Family functions was significant negatively correlated with suicidal behaviors at different dimensions (-0.12≤r≤-0.24), with comparatively higher relevance (r=-0.24). The total score and factor scores of social support was highly positively correlated with the SBQ-R total score (-0.05≤r≤-0.12). Subjective support had the closest correlation.It is significant positive correlated of parental rearing patterns with suicidal behavior total score. That is, the more the refusal and overprotection of parents, and the less emotional warmth, the higher the risk of suicide. Relatively high correlation was found in the parental rearing patterns at different dimensions with SBQ-R total score (0.14≤r≤0.23). Maternal rearing patterns had a closer relationship with the SBQ-R total score than father rearing patterns (father, r=0.23, mother, r= 23).The fitting of structural equation model of family and social support was acceptable (RMSEA=0.03, CFI=0.98, NFI=0.98). Family function, father rearing patterns, maternal rearing patterns and social support showed significant direct effect on suicide, while family function and social support were two mediating variables in the model. Parental rearing pattern exerted significant effect on suicide through the family functions as an intermediary role, and also exerted significant effect on social support through the family functions to support this chain mediation model of suicide. The R2 model was 0.14.④ Faith and suicide:Three indexes meaning of life, political beliefs and afterlife beliefs were included, but religious beliefs were excluded.The total score and two factor scores of meaning of life was negatively correlated with SBQ-R total score.The students with religious beliefs of had higher risk of suicide than those without. The SBQ-R total score of Islam students was relatively lowest, and without gender difference.The girls believing Taoism and Christian had highest risk of suicide.The students of same gender holding belief in Buddhism and Catholicism had no signifi-cant difference in SBQ-R total score compared with those without belief (P> 0.05).The students with political beliefs had lower SBQ-R total score than those without political beliefs (P<0.05).The SBQ-R total score was decreased in order in those with afterlife belief, uncertainty on afterlife and believe no afterlife (P<0.05).(2)The indexes of stressful events and suicide:Three indexes stressful events, suicide history in close relatives and suicide history of acquaintances were included.Relatively high correlation was found in life events total score and factor scores with the SBQ-R total score (0.11≤r≤0.26), and the correlation coefficient between the total score was 0.25. The relational model of life events and suicide had RMSEA of 0.03, CFI of 0.99, and NFI of 0.99. The standardized path coefficient was-0.40, R2 = 0.13 for life events to the suicidal behavior.Students with suicide history in close relatives or suicide history of acquaintance had significantly higher SBQ-R total score than those without (P<0.05)(3)Indexes of psychological symptoms and suicide:Three indexes depression, anxiety and life satisfaction were included.The correlation coefficients were 0.34 and 0.33 respectively in SBQ-R total score with depression and anxiety, were -0.20 with life satisfaction. Model of psychological symptoms to suicide had RMSEA of 0.03, CFI of 0.99, and NFI of 0.99, and standardized path coefficient was -0.40, R2=0.16.2. National norms of 20 warning indicators, including 12 indicators of risk factors and 8 indicators of protective factors, were established.3. Evaluation on the indexes of three elements suicide warning systemImportance of early warning indexes in classification and regression tree model were in order the acceptance of attitudes on suicide, high aggression, depression, low self-esteem, living in the city, high levels of streeefull life events,father parenting style, low level of reasons for living, the father parenting style, low level of maternal education.Conclusion1.22 warning indexes were screened into the three elements suicide warning system.22 indexes were attached to stressful events, psychological symptoms and susceptibility of quality (including biological indexes, personality and attitude indexes, family and social support indexes, faith indexes). Religion is excluded from the indexes.2. We validated the three elements structure of suicide warning system and its close relationship with suicide risk by establishing 6 good fitting structural equation model.3. National norms of 20 warning indicators, including 12 indicators of risk factors and 8 indicators of protective factors, were established.4. Importance of early warning indexes were in order the acceptance of attitudes on suicide, high aggression, depression, low self-esteem, living in the city, high levels of streeefull life events, father parenting style, low level of reasons for living, the father parenting style, low level of maternal education.Section 3 Preliminary establishment of suicidal three elements warning system in Chinese college studentsObjective To develop suicidal three elements warning system in Chinese college students and preliminarily inspect the basic functions of the system.Methods Based on the suicidal three elements warning system for guiding framework, results of pre-national epidemiological survey and interviews,to achieve the dynamic early warning of network application platform,we initially develop suicidal three elements warning system in Chinese college students by system design and demand analysis, software programming and debugging features, field testing system.Results Network platform online testing, assessment tools management of early warning indicators, the generation of early warning information collection form, presented the results and psychological records management of the three-factor model based on the suicide were realized by the suicidal three elements warning system software. Furthermore, we can divide crowd with different suicide risk by the early warning model of the three-factor framework.Conclusion Network-based suicidal three elements warning system for college students had been completed initially, and various functions the warning system work well and achieve the predetermined requirements.Innovation and further research planInnovation and further research planInnovation1.The three elements suicide warning model of college students that be proposed in this research is based on the research of three indicators:stress events, psychological symptoms and susceptible quality. It developed a web-based platform of the three elements suicide warning model of college students and it is an applied innovation of using the theory of suicide in the practice of suicide prevention.2.Concentrate on the role of suicide protective factors played in the suicide warning. The three elements suicide warning model of college students focus on the risk factor and protective factors at mean time, and set up a special assessment and analysis module of suicide protective factors.Further research planIdentify potential suicide susceptible population is the distinguishing feature of the three elements suicide warning model of college students, but what is the suicide risk of suicide susceptible people? What is the trends of their suicide risk? These question needs further follow-up study. In addition, the warning condition and its results of three elements suicide warning model of college students need further verification. The follow-up study needs to focus on the people that been selected by the warning system, using psychological interview, psychological testing, dynamic monitoring etc. to find out the interactive mechanism of indicators of the warning system and to evaluate the effect of the warning system.