Coping Style In Completed Suicide In Rural China: A Case-control Study Using The Psychological Autopsy Method

Objective: This study compared of cases of completed suicide with living controls using psychological autopsy in rural area. Cases and controls were assessed for coping style that used before the suicide. The coping style scores between cases and controls were compared, and also the biology and psychology factors which have an effect on the coping style. This study aims to identify the role of coping style in completed suicide.Methods: Completed suicide cases were from 33 counties of Zhuanghe in Liaoning Province between June 1, 2006 to June 30, 2008. Living controls were selected from the 33 counties. Cases and controls were matched for gender, age and area. For each suicide case, there were two informants. For each normal control, two informants and the control himself/herself served as the sources of information. The subjects were 115 cases of completed suicide and 115 living controls.Results: Cases had higher problem-solving (t=13.120, p=0.000) and help-seeking (t=10.873, p=0.000) coping styles scores than controls; controls had higher self-reproach (t=7.904, p=0.000),fantasy (t=9.588, p=0.000),retreat (t=12.108, p=0.000),rationalization (t=6.045, p=0.000) coping styles scores than controls overall. The results of the case-control comparison in sex, age, physical diseases were consistent with the overall results. Help-seeking coping style score was higher for female than for male in both completed suicide group (t=2.796, p=0.006) and controls (t=2.003, p=0.048); Retreat coping style score (t=3.355, p=0.001) was higher for male than for female in completed suicide group. Problem-solving coping style score (t=3.573, p=0.016) was the lowest for the 70 and over 70 years old group. The retreat coping style score with chronic or serious physical disease in both completed suicide group (t=2.343, p=0.021) and controls (t=2.475, p=0.015) were higher than the healthy persons in the two groups. The multivariate Logistic regression model analysis has found the protective factors contributed for suicide were problem-solving coping style (OR=0.185, 95%CI=0.100-0.341). The risk factors contributed for suicide were mental disorders (OR=20.165, 95%CI=3.511-115.827),fantasy coping styles (OR=2.364, 95%CI=1.308-4.272) and retreat coping styles (OR=3.330, 95%CI=1.727-6.422).Conclusions: Fantasy and retreat coping styles contributed to the increased risk of completed suicide; problem-solving and help-seeking were the protective factor in suicide. Rural people who commit suicide were different in coping styles in gender, women more prone to use help-seeking coping style, while men take the retreat coping style to deal with stressor, coping skills should be strengthened for the male population in rural area. The coping styles is different in age, 70 and over 70 years old were not prone to use the problem-solving coping style. Whether patients with chronic or severe disease in rural areas use different coping styles, the sick is prone to take the retreat coping styles to deal with stressor. Mental disorders was the risk factor for completed suicide.