Research On Risk Factors And Interaction Network For Suicidal Behavior Among Chinese University Students

Suicide is one of the leading causes of death among youth. It has become a major social and public health problem worldwide. According to the world health organization, suicide has become the second or the third cause of death in 15-29-year-olds in many countries. In the period of social transition of our country, the various social contradictions and competitive pressures increased. While getting more opportunities, today’s young people bear more pressure. Some students have kinds of serious mental health problems, especially suicidal behavior among college students. Suicidal behavior among college students brought great negative impact and serious economic and social burden on family, society and country. Life is irreversible, just like the slogan "One suicide is too many" of the first "world suicide prevention day". How to prevent college students from suicidal behavior and to early detect individuals at high risk of suicide are critically important.In recent years, a large number of studies on suicidal behavior have been conducted. However, these results were inconsistent because of the different measurements, populations, regions, et al. Social, psychological, cultural and other factors could interact to lead a person to suicidal behavior. Previous researchers have tried to find rules of suicide and its effective prevention methods. However, the risk factors of suicide are complicate, and these studies also have different concerns. How to delve into these connections between all the factors and the mechanism of suicidal behavior is the major problem. Thus, this study aimed to assess the following aspects:1. Because of few studies for suicidal behavior based on large sample of population, in the present study,5972 students were randomly selected from 6 universities attached directly to the ministries of the P. R. China in Wuhan city to assess prevalence and distribution of suicidal behavior among university students.2. Available studies have delved into the individual effect of social network or of coping skills on suicide risk; rarely has any study attempted to investigate the interplay of these two factors and to moreover elucidate possible underlying mechanisms of these factors on suicidality. In the present study, we want to assess the relative importance of social contacts and coping skills on risk for suicidal ideation, and to probe their possible pathways of their effects in the context of personal psychopathology. Logistic regression was performed to estimate individual effect of social contacts and coping skills on risk for suicidal ideation. A partial least squares path model (PLSPM) was used to probe possible paths of their effects in the context of psychopathology.3. Previous studies have delved into the individual effect of stressful life events or of coping skills on suicide risk; rarely has any study attempted to investigate the combined interactive network effects of them. Therefore, in this study, we want to assess the impact of common life stressors and personal coping skills on risk for suicidal behavior. We also want to explore the mechanic role of coping skills on the relationship between life stressors and risk for suicidal behavior in this group of young people. Logistic regression analysis was performed to estimate the effect of stressful life events and coping skills on risk for suicidal behavior. Bayesian network was further adopted to probe their probabilistic relationship.5972 students, randomly selected from 6 universities in China, completed the questionnaire survey for the study. This study have assessed the influences of social contacts and coping skills on risk for suicidal ideation and stressful life events, coping skill on risk for suicidal behavior. The conclusions are as follows:1. Descriptive epidemiology for suicidal behavior:Of the 5972 students,16.39% reported the presence of suicidal ideation,1.91% reported the presence of suicidal attempt, including 7.64% reported the presence of suicidal behavior (attempt or ideation) within the past 12-month period. Female students reported higher presence of suicidal behavior than male students. Young people studying at universities often encounter various negative life events and stressors. Some students might not be able to reasonably analyze the importance and possible consequence of a perceived event, especially those with poor coping skills to handle the event or resolve the stress. Such instances, if occurred, would place them at risk to develop negative or depressive mood, leading to psychological problems and even suicidal behavior in serious cases. These findings further revealed the distribution of suicidal behavior in college students and influence factors, and provided evidence for assessing the relationships of stressful life events, coping skills, social network and psychological factors associated with suicidal behavior in university students.2. Influence of personal social network and coping skills on risk for suicidal ideation. While suicidal behavior of young people is often associated with psychosocial, cultural and environmental factors, personal social network and coping skill are of particular importance in this group of population. The present study found that:(1) Risk of suicidal ideation was highly associated with poor social network, reflected by fewer close friends and without a dating relationship. It is a known fact that for young people friends are an important source of support when needed. Young people are usually more willing to talk with friends, than family members, about their mental state and behavior without the concern of being judged. They are also more prone to share personal feelings and thoughts with their peer friends than with the families. The support and comfort attained from network friends could help them dealing with critical situation and stressors effectively and in a positive way. Efforts encouraging students, especially those who stay isolated, to be more active in social contacts and group activities may have a significant beneficial effect in suicide prevention and mental health care. (2) The influence of coping skills varied by coping styles adapted toward problems. A high score of skills on seeking guidance and support, problem solving as well as seeking alternative rewards was associated with a reduced risk of suicidal ideation; whereas a high score of acceptance or resignation, emotional discharge as well as logical analysis was associated with a significantly increased risk. (3) Modeling the data with PLSPM indicated that the avoidance coping skills conferred the most important dimensional variable in suicidal ideation prediction, followed by the approach coping skills and social network. In the pathways from social network to suicidal ideation, the indirect effect is slightly larger than the direct effect; from avoidance coping to suicidal ideation, the indirect effect contributes a larger proportion; but from approach coping to suicidal ideation, the direct effect accounts for a larger proportion. These findings provide valuable insights for strategies of suicide prevention. Programs targeting on expansion of social network and improvement of approach coping skills may have enduring effects on reducing suicidal ideation in this group of young people.3. The interplay of stressful life event and coping skills on risk for suicidal behavior. Evidence has shown that stressful life events, such as failure in exams, break-up of a love relationship, etc., are important contributors to suicidal behavior among young students.In this study, we used logistic regression analysis to estimate the effect of stressful life events and coping skills on risk for suicidal behavior. Bayesian network was further adopted to probe their probabilistic relationship. The present study found that:(1) Risk of suicidal behavior appears to be greater for individuals with than without stressful, negative or potentially traumatic life experiences in their histories. Therefore, students with recent exposure to life stressors should be on high priority in mental health programs and in strategies for suicide prevention and intervention in university settings. (2) The influence of coping skills varied according to the strategies adapted toward problems with a high score of approach coping skill significantly associated with a reduced risk of suicidal behavior. Hence, activities and training programs aiming to enhance personal approach coping skills is important in the efforts of suicide prevention in young people and would be particularly beneficiary to those recently exposed to negative life events and stress. (3) Bayesian network indicated the probability of suicidal behavior associated with specific life stressors was to a large extent conditional on coping skills. Our study demonstrates that the highest probability of suicidal behavior is the path "Gender→approach coping→have strong conflict with classmate→suicidal behavior". These results offer insights for our understanding of the role of coping skills on suicidal behavior in the young. The Bayesian network could probe the effect of important stressful life events and coping skills on suicidal behavior in qualitative aspect and quantitative aspect. This is a novel method and provides an mportant insight into individuation intervention for suicidal behaviors.