| BackgroundSuicide is behavior by individuals who fully understand the fatal consequences of this action and choose conscious self-destructive behavior leading to death. Approximately1,000,000people die by suicide every year. The rate of suicide was16per100,000people, or one suicide every40seconds. In China, the suicide rate was23per100,000people over twenty years ago, but the rate has trended down over the past twenty years, from17.65per100,000people in1987to6.60per100,000people in2008. The absolute number of suicides in China ranked the top of the world, with suicide being the fifth common cause of death and the number one cause of death for individuals aged15-34, with more than70%of the suicides occurring in rural areas.Suicide has been a very serious major public health issue and social problem. It is associated with biological, mental psychological factors, as well as being closely related to the individual’s cultural background and social environment. The social factors that have been found related with suicide include economic factors, culture factors, social relation factors, social support factors and community environment factors.At present, most of the studies on suicide were based on western psychological characteristics and social conditions so they could not explain the exact cause and model of Chinese suicide. These studies focused on the specific risk factors and a litany of facts. The studies on the social factors of suicide were mostly metaphysical theory analysis and reasoning based on the concept of sociology or psychology, or the descriptive analysis of social investigations. It’s essential to conduct comprehensive investigation and do deep analysis for social factors of suicides, especially Chinese rural youth suicides.Objectives1. To measure and analyse the social factors of Chinese rural young suicides according to the existing measurement tools and to compare the differences of social factors between rural youth suicide and normal controls.2. To explore the complex relationship between different social factors and suicide, to evaluate the impact of social factors on rural young suicide, and to find the social protect factors and social risk factors.3. To build the social influence model on suicide using structural equation modeling techniques. MethodsTaking the socioeconomic conditions, geographical location, etc into consideration, we conducted this study in Liaoning (Industrial province, in northern China), Shandong (Industrial and agricultural province, in Eastern China) and Hunan (Agricultural province, in southern China). Sixteen counties were randomly selected from these three provinces. From October1,2005to June30,2008, rural youth suicides ranging in age from15-34were selected using sequential sampling. The list of suicide originated from the death monitoring system of Chinese Centre for Disease Control and Prevention. At the same time, people of the same age, living in the neighboring community, were randomly selected as controls. For every suicide and control, two knowledgeable informants were selected to provide their information. The case-control study was adapted and a psychological autopsy method was used for information collection. Totally392suicides and416controls were included in this study by face to face interview using questionnaires.The instruments involved in this study included:1. general information of informants, including gender, age, education years, health condition, mental health, family suicide history, pesticide stored in the family;2. economic factors, including employment, hours working off home per week, hours working home chores per day, personal annual income, family annual income, family asset, family asset value, status of family in village;3. cultural factors, including religion, whether believe in superstition or afterlife, party or league member, Value Conflict Scale, the Criterion of Confucianism Affect on Men, the Criterion of Confucianism Affect on Women, Gender Equality;4. Social Relation, including marital status, spousal relation, number of children, whether or not live alone, whether or not live in dorm, whether or not live with parents/in laws, relation with parents, relation with father-in-law, relation with mother-in-law, status in family;5. social support, measured by Social Support Inventory and whether or not be supported by relations when meeting difficulties,6. community environment, measured by Community Press and Problem, including housing, crime, poverty, etc;7. half-set interview outline, including the process of suicide, the events before and after commit suicide, the causes that led people to commit suicide, etc.For numerical variables, t test or Mann-Whitney U test was applied according to the distribution types of data. For categorical variables, Chi-Square test or Fisher’s exact test were used to estimate probabilities. Univariate and multivariate analysis by conditional logistic regression analysis were used to measure the influence of specific social factors on suicide, and to explore risk social factors and protect social factors of suicide. Social factor influencing suicide structural equation model was established to estimate the influence of different types of social factors on suicide.Result1. There were significant differences between the suicide and control groups in most general information, economic factors, culture factors, social relation factors, social support factors and community factors.2. According to the result of single factor analysis, the social risk factors of suicide include low status of family in village, believe in religion, the criterion of Confucianism effect on women, value conflict, poor spousal relation, live alone, poor relation with parents/father-in-law/mother-in-law, low status in family, community family disputes, community transportation problem, community health care problem, and community job security problem and alcohol abuse problem. The social protect factors of suicide include high family annual income, party or league member, strong concept on gender equality, marriage, higher number of children, high level of social interaction, more perceived social support, more social tool support, support from family/friend/superior/teacher/workmate/schoolmate/neighbor when facing difficulties, and low community pollution.3. For the whole sample, nineteen social factor variables were extracted and included in the multivariate logistic regression equation. Two of them were from economic factors, they were family annual income (OR=0.699), status of family in village (OR=1.429); three of them were from cultural factors, they were religion (OR=2.048), party or league member (OR=0.752), the criterion of Confucianism affect on women (OR=2.997); five of them were from social relation factors, they were marital status (OR=0.260), spousal relation (OR=2.371), number of children (OR=0.619), relation with parents (OR=2.171), status in family (OR=1.667); four of them were’from social support factors, they were social interaction (OR=0.445), perceived social support (OR=0.073), support from family (OR=0.245), support from supervisor/teacher (OR=0.332); two of them were from community factors, they were job security problem (OR=1.440) and alcohol abuse problem (OR=1.479).For male sample, twelve social factors variables were extracted into the multivariate logistic regression equation. Two of them were from economic factors, they were personal annual income (OR=0.839), status of family in village (OR=2.081); two of them were from culture factors, they were religion (OR=8.159), the criterion of Confucianism affect on men (OR=1.972); three of them were from social relation factors, they were marital status (OR=0.110), spousal relation (OR=4.528), relation with parents (OR=2.442); three of them were from social support factors, they were perceived social support (OR=0.017), tool support (OR=0.004), support from workmate/schoolmate (OR=0.204); two of them were from community factors, they were health care problem (OR=1.366) and transportation problem (OR=1.966).For the female sample, thirteen social factors variables were extracted into the multivariate logistic regression equation. None of them were from economic factors. Two of them were from culture factors, they were party or league member (OR=0.221) and the criterion of Confucianism affect on women (OR=1.120); six of them were from social relation factors, they were spousal relation (OR=2.652), number of children (OR=0.315), live alone (OR=7.895), relation with mother-in-low (OR=2.210), status in family (OR=1.327); relation with parents (OR=2.217); three of them were from social support factors, they were perceived social support (OR=0.036), support from friend (OR=0.328), support from supervisor/teacher (OR=0.254); three of them were from community factors, they were job security problem (OR=1.893), alcohol abuse problem (OR=1.717) and superstition (OR=0.620).4. As shown in the Social factor influencing suicide Structural equation model, in the path diagram where factors pointed at suicide, social relation factors had the highest path coefficient which was0.87, followed by social culture factors0.69, social economy factors0.63, social support factors0.49, and community factors0.46. Social economy factors were correlated with social relation factors. Social relation factors were correlated with social support factors. Conclusion1. Among the economic factors, it was the direct reflection index of economic conditions such as personal or family annual income and family value etc. that led to the economic difference between suicides and controls. Low status of family in village was the risk factor of suicide and high family annual income was the protective factors for rural youth suicide. Family conflicts and disputes directly or indirectly caused by economic factors were the main cause of suicide.2. Among culture factors for rural young suicide, the risk factors of suicide included religion, the criterion of Confucianism affect on women and value conflict. The higher the level of religiosity, the higher the identity to criterion of Confucianism affects on woman and the stronger the conflict of value, the more likely rural youth suicide. The protective factors included being party or league member and strong concept on gender equality.3. Among social relation factors for rural young suicide, the risk factors included poor spousal relation, live alone, poor relation with parents/father-in-law/mother-in-law, low status in family. The protective factors included being married and higher number of children. Spousal relation and relation with parents were the two most important social relation factors for rural young suicide. 4. Among social support factors for rural young suicide, the protective factors included social interaction, perceived social support, tool support, family support and friend’s support. The higher the level of social interaction, the more the perceived social support and the tool support, the more the support from family/friend/superior/teacher/workmate/schoolmate/neighbor when meeting difficult, the less likely the rural youth suicide will occur. Among all the support from interpersonal relationship, family support proportion was the highest, accounting for more than70%of all sources of support. It was the most effective protection for suicide prevention.5. Among community factors for rural young suicide, the risk factors included community family disputes, community transportation problem, community health care problem, community job security problem and alcohol abuse problem. The more serious these problems were, the more likely rural youth suicide.6. Among all kinds of social factors for rural young suicide, social relation was the biggest impact factor, followed by culture factors and economic factors. The economic factors might directly lead to suicide or they could indirectly lead to suicide by influencing social relation factors. Social relation factors might directly lead to suicide or they could indirectly lead to suicide by influencing social support factors. |
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