Zhou Qin, Li Ning, Zhang Jie, Fan Libo
School of Public Administration and Policy, Renmin University of China, China.
Institute of Population Research, Peking University, Beijing, China.
Depress Anxiety. 2023 Sep 16;2023:1797697. doi: 10.1155/2023/1797697. eCollection 2023.
Suicide remains an important public health issue in China. Existing literature on the relationship between individual-familial variables and suicide risk mainly focused on family socioeconomic status, and few studies analyzed the effect of position in family on suicide. In this study, we aimed to explore the association between position in family and suicide among Chinese rural youths.
We conducted a case-control psychological autopsy study. The data collection yielded 392 suicide cases aged 15-34 years and 416 community living controls within the same age range. Personal position in family was assessed by the question "How do you evaluate his/her position in the family?" and categorized as high, general, and low to reflect the relative position in family. Logistic regression models were conducted to explore the association between position in family and suicide risk.
The results showed that compared with females (males) having a high position in family, females (males) with a low position in family were 7.1 (9.1) times more likely to commit suicide ( < 0.01). Mental disorders, social support, and coping strain were potentially important mediating factors linking position in family to suicide, with certain heterogeneity among males and females. Low coping strain played the most important role in underlying the association between a low position in family and suicide for both females and males, accounting for 55% (28%) of the contribution to the total effect for females (males). Subgroup analysis revealed that low position in family had more significant impacts on suicide risk among married youths and those with low education levels.
The effect of position in family on suicide should receive greater consideration when predicting suicide in rural China. Possible mechanisms underlying the effect of position in family on suicide include mental status, social support, and coping strain.
自杀在中国仍是一个重要的公共卫生问题。现有关于个体-家庭变量与自杀风险关系的文献主要集中在家庭社会经济地位，很少有研究分析家庭中的地位对自杀的影响。在本研究中，我们旨在探讨中国农村青年家庭地位与自杀之间的关联。
我们开展了一项病例对照心理解剖研究。数据收集得到392例15 - 34岁的自杀案例以及416例同年龄范围的社区居住对照。通过“你如何评价他/她在家庭中的地位？”这一问题评估个人在家庭中的地位，并分为高、一般和低三类以反映在家庭中的相对地位。采用逻辑回归模型探讨家庭地位与自杀风险之间的关联。
结果显示，与家庭地位高的女性（男性）相比，家庭地位低的女性（男性）自杀可能性高7.1（9.1）倍（<0.01）。精神障碍、社会支持和应对压力是将家庭地位与自杀联系起来的潜在重要中介因素，男女之间存在一定异质性。低应对压力在家庭地位低与自杀之间的关联中对女性和男性都起最重要作用，分别占女性（男性）总效应贡献的55%（28%）。亚组分析显示，家庭地位低对已婚青年和低教育水平者的自杀风险影响更大。
在中国农村预测自杀时，应更多考虑家庭地位对自杀的影响。家庭地位影响自杀的可能机制包括心理状态、社会支持和应对压力。
