Jiang Chunling, Li Xianyin, Phillips Michael R, Xu Yongchen
WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing Huilongguan Hospital, Beijing, China ; The Fifth Hospital of Fushun City, Fushun, Liaoning Province, China.
WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing Huilongguan Hospital, Beijing, China.
Shanghai Arch Psychiatry. 2013 Feb;25(1):22-31. doi: 10.3969/j.issn.1002-0829.2013.01.006.
Suicide rates in rural China are two-fold to three-fold those in urban China but the reasons for this large difference remain unclear.
Assess the characteristics and risk factors of medically serious suicide attempts in rural China.
A comprehensive 2 to 3 hour structured interview was administered by psychiatrists to 297 medically serious suicide attempters (defined as those who remained in hospital for 6 hours or longer) treated in the emergency room of the People's Hospital of Yuncheng County in Shandong Province and, separately, to their accompanying co-resident family members. A parallel interview was administered to control subjects matched for age and gender from the same village who had never made a suicide attempt and to their co-resident family members. Risk factors for attempted suicide were identified using Cox regression models.
Among the 297 suicide attempters, 74% were female, 78% were farmers, their mean (sd) age was 33.2 (14.6) years, their mean length of formal schooling was 4.8 (3.1) years, 80% had attempted suicide by ingesting pesticides, 57% reported considering suicide for five minutes or less before acting, 76% had a score of less than 50 (range, 0 to 100) on the planning subscale of the Suicide Intent Scale, 11% had made prior attempts, and only 38% met DSM-IV criteria for a current mental disorder. After controlling for gender, age, location of residence and prior suicide attempt (in the matched analysis), risk factors identified in the multivariate analysis included a low level of education, having relatives or associates with prior suicidal behavior, experiencing four or more negative life events in the prior year, a low quality of life and low family cohesion over the prior month, high depressive symptom scores over the prior two weeks, and (only assessed in a subsample) high impulsivity and aggression.
Many of the medically treated suicide attempts in rural China are low-intent attempts by the ingestion of pesticides in persons who do not meet criteria of a mental disorder but have high levels of impulsiveness and aggression. This profile is different from that seen in high-income countries so it will require a different approach to the prevention of suicidal behavior, an approach that is less focused on the identification and treatment of mental disorders and more focused on limiting access to agricultural poisons and training impulsive individuals about self-regulation of their emotions and behaviors.
中国农村的自杀率是城市的两到三倍，但造成这种巨大差异的原因尚不清楚。
评估中国农村严重自杀未遂案例的特征及风险因素。
精神科医生对山东省郓城县人民医院急诊科收治的297例严重自杀未遂者（定义为住院6小时及以上者）及其陪同居住的家庭成员进行了为期2至3小时的全面结构化访谈。同时，对来自同一村庄、年龄和性别匹配且从未有过自杀未遂行为的对照对象及其家庭成员进行了平行访谈。使用Cox回归模型确定自杀未遂的风险因素。
在297例自杀未遂者中，74%为女性，78%为农民，平均（标准差）年龄为33.2（14.6）岁，平均受教育年限为4.8（3.1）年，80%通过服用农药自杀，57%报告在采取行动前考虑自杀的时间为5分钟或更短，76%在自杀意图量表的计划子量表上得分低于50（范围为0至100），11%曾有过自杀未遂史，仅有38%符合当前精神障碍的DSM-IV标准。在控制性别、年龄、居住地点和既往自杀未遂史（在匹配分析中）后，多变量分析确定的风险因素包括教育水平低、有亲属或同伴曾有自杀行为、前一年经历四次或更多负面生活事件、前一个月生活质量低和家庭凝聚力低、前两周抑郁症状评分高，以及（仅在一个子样本中评估）高冲动性和攻击性。
在中国农村，许多接受治疗的自杀未遂案例是由不符合精神障碍标准但具有高冲动性和攻击性的人通过服用农药进行的低意图自杀未遂行为。这种情况与高收入国家不同，因此需要采取不同的方法来预防自杀行为，这种方法应减少对精神障碍识别和治疗的关注，更多地关注限制获取农业毒药以及培训冲动个体进行情绪和行为的自我调节。
