Global Health Institute, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, Hubei, China.
Department of Epidemiology, University of Florida, Gainesville, FL, USA.
Soc Psychiatry Psychiatr Epidemiol. 2019 Jan;54(1):99-110. doi: 10.1007/s00127-018-1593-z. Epub 2018 Aug 31.
Distinctive and dramatic changes in the history of China with a rapid suicide decline in recent years present an opportunity to investigate the risk of suicide. In this study, we investigated suicide risk with a historical perspective with archived data to inform suicide research and prevention policies and strategies.
Documented age-specific suicide mortality rates in 1987-2012 were decomposed into age, period, and cohort effect using APC-modeling method and intrinsic estimator (IE) technique. The estimated effects were further analyzed by numerical differentiation.
The data satisfactorily fit the constructed APC models. Cohort effect indicated that suicide risk in China fluctuated at very high levels during 1903-1967, followed by a sharp decline during 1968-1977, and reached the lowest level in 1983-1987 before increased again. Period effect confirmed the declining trend since 1987. Three sunny cohorts with reduced suicide risk and four cloudy cohorts with increased risk were, respectively, associated with significant cultural, social, political, and economic events in China since the 1900s.
The mega trends in the suicide risk at the population level are closely related to significant historical events in China. Suicide is anticipated to increase because of the growing risk for the young cohorts (particularly young females) as the country further develops. Study findings suggest the significance of national strategies for suicide prevention and control, including maintenance of social harmony and stability, provision of more opportunities for development, enhancement of social integration, and restriction of suicide facilitating factors.
近年来，中国历史上出现了明显而剧烈的变化，自杀率迅速下降，这为研究自杀风险提供了机会。本研究利用存档数据从历史角度探讨自杀风险，为自杀研究和预防政策及策略提供信息。
采用 APC 模型和固有估计器（IE）技术，对 1987-2012 年的年龄特异性自杀死亡率进行分解，得到年龄、时期和队列效应。通过数值微分进一步分析估计结果。
数据很好地符合构建的 APC 模型。队列效应表明，中国的自杀风险在 1903-1967 年期间波动在非常高的水平，随后在 1968-1977 年急剧下降，1983-1987 年达到最低水平，然后再次上升。时期效应证实自 1987 年以来呈下降趋势。三个阳光队列的自杀风险降低，四个多云队列的自杀风险增加，分别与中国自 20 世纪以来的重大文化、社会、政治和经济事件有关。
人口水平上自杀风险的主要趋势与中国的重大历史事件密切相关。随着国家的进一步发展，年轻队列（特别是年轻女性）的风险增加，预计自杀率将会上升。研究结果表明，国家制定自杀预防和控制战略的重要性，包括维护社会和谐稳定、提供更多发展机会、增强社会融合以及限制自杀促成因素。
