| BackgroundThe estimated global burden of suicide is a million deaths per year, and annual mortality is 14-15 deaths per 100,000 people, which equates to one death every 40 seconds. Suicide is a major public health problem that ranks the top ten causes of death of all age groups in several countries. Earlier studies indicated that suicide rate was 22-30/100,000 in China. Although suicide rate in China is lower than that in some western countries, it has been estimated that it accounts for 30% to 40% of the global suicides with 21% of the world's population. The rural has been the most serious area of suicide in China because the suicide rate was 3-fold to 5-fold greater than urban area. Suicide is a major public health issue and social problem in our country and has being bring heavy burden to disease and social economic. In order to put forward some preventive interventions, it is necessary to measure and describe the knowledge and attitudes towards suicide accurately in China. The right suicide attitudes can act as a "goal keeper" at anytime and anywhere, instead, inappropriate suicide attitudes will not only bring trouble but also make others worse in a crisis. Therefore, in a sense, the suicide attitudes of the social public can generate or restrain the suicide behavior. But current researches only focused on the medical workers, students, college teachers, lawyers and some special groups, while there were few and superficial researches on rural community people's suicide attitudes. This study aims to investigate the rural population's suicide attitudes and their characteristics, analyze whether one's suicide influence the suicide attitudes of their family members, build the structural equation model of suicide attitude in rural population, and then provide foundations for the rural suicide intervention and future researches on suicide attitude.Objectives1. To describe the characteristics and distribution of knowledge and attitudes towards suicide in rural communities.2. To explore the risk factors of knowledge and attitudes towards suicide on the demographic characteristics, depression and faith, compare the differences and explain the causes and make sure whether one's suicides influence the knowledge and attitudes towards suicide of their family members.3. Try to build the structural equation model of knowledge and attitudes towards suicide in rural population.Methods1. Subjects and MethodsTwenty-five towns of three counties were selected from disease surveillance points of Shandong Province, China. Suicide cases in these 25 towns happened from Sept.1,2008 to Aug.31,2009 were recruited. One informant of each suicide or paired control with same age (no more than 3 years), same gender and same district as suicide was interviewed by trained interviewers.219 suicide cases were recruited. However,19 cases were not interviewed due to some reasons, such as family members refusing to be interviewed or no suitable informants. The informants in this study were mainly family members, relatives, neighbors and friends ultimately. Besides, we also randomly surveyed about the 1/3 of the controls. Two of the nineteen withdraw cases were caused by the unmatched gender successfully, but informants' information can be used in the current study. This study has received 473 informants' information of suicide attitudes and some demographic characteristics (404 informants and 69 themselves of informants).2. InstrumentsGeneral information include:age, gender, educational status, marital status, family finances, religious, superstitious belief, believing in afterlife and relationship of the informants and their target person. Depression:Center for Epidemiologic Studies Depression Scale, CES-D.Suicide intent:Beck's Suicide Intent Scale, SIS.Suicide attitudes:5 items of General Social Survey for suicide reason, GSS. Xiao's Suicide Attitude Questionnaire for Suicidal behavior nature. Li's Suicide Attitude Questionnaire for suicide knowledge and its social damage.Main Results1. Demographic characters of the sampleThe average age of the study population is 49.7±13.6, and the ratios of man and woman are 53.1% and 46.9% respectively.85.2% of the sample have an educational level that below junior middle school,90.5% of them have been married. There are only a minority people that have religion belief or superstitious belief,2.7% and 4.0% respectively.189(40.0%) informants had experienced relative suicide. The annual income of those people who had experienced relative suicide is lower than those people that haven't, and the former group are more likely to be depressed, single or being divorced(P<0.05), there is no difference in other variables between these two groups.2. Distribution of suicide attitudes of rural populationRural population consider that someone can suicide if they are in four situations, 'incurable disease'(24.0%),'bankruptcy'(6.8%),'dishonored his/her family'(6.2%) and 'being tired of living'(9.1%). Most people showed that it is incomprehensible to commit suicide and the median score was 1.00. There was 71.9% of rural population holding disagree, denial, rejection and discriminating attitudes towards suicide. The vast majorities agreed that individual life has positive meaning to family and nation and could accurately understand the social damage of suicide, of which the median score was 7.00.3. Suicide attitudes comparison and the influence factors of suicide attitudesThere were no significant differences between subgroups by demographic characteristics in suicide reason, understanding of suicide, suicide knowledge, suicidal behavior nature and social damage of suicide. Relatives'suicides were influence factors of suicidal behavior nature (positive attitudes as reference) and suicide knowledge. The odds ratios were 0.072 (95%C.I.:0.008～0.674),0.058 (95%C.I.: 0.006～0.528),0.533 (95%C.I.:0.326～0.870) respectively. People experiencing relatives'suicides were more understanding and tolerant to the suicidal behavior nature and agreed more with the suicide knowledge'one who says he/she wants to commit suicide may really suicide'. Other related factors affecting suicide attitudes were gender, age, family finances, depression, religion, superstitious belief, believing in afterlife, etc. There was no significant difference in knowledge and attitudes towards suicide after the classification of relatives or suicide intent score.4. Structural equation model of knowledge and attitudes towards suicideThe evaluation indexes of structural equation model of knowledge and attitudes towards suicide were as follows:GFI=0.90, AGFI=0.88, RMSEA=0.055, CFI=0.86, NNFI=0.84. The model indicated that personal factors (include age, gender) were important influence factors of suicidal behavior nature and social damage of suicide. The influence factors of suicide knowledge were external factors (include relative suicides, depression and family finances) and faith factors (include religion, superstitious belief, believing in afterlife).Conclusions1. Rural community people oppose to commit suicide if they were under the situations of'incurable disease','bankruptcy','dishonored his/her family' and 'being tired of living'. Most people showed that it is incomprehensible to commit suicide. The suicide knowledge is relatively barren in rural population. They hold against, denial, rejection and discriminatory attitude towards suicide and can understand the social damage of suicide. They suggest that government should take some measures to prevent suicides.2. Relatives'suicides may affect knowledge and attitudes towards suicide of their family members. In other words, people experiencing relatives'suicides were more understanding and tolerant to the suicidal behavior nature and agreed more with the suicide knowledge of'one who says he/she wants to commit suicide may really suicide'. 3. The building of structural equation model is the pioneer on suicide attitude research. And it shows that the influence factors of knowledge and attitudes towards suicide are the following:people with the history of relatives'suicides, depression, family finances, religious, superstitious belief, believing in afterlife, etc. Age and gender may affect the suicidal behavior nature and social damage of suicide.SuggestionsAlthough this study shows the positive side of rural knowledge and attitudes towards suicide, it is undeniable that the rural population is lack of suicide knowledge and some people can not understand the suicidal behavior nature and social damage of suicide accurately. Some people approved they can solve problems by committing suicide in certain circumstances. So we suggest that our government should increase the rural health input, improve people's standard of living, enrich people's spiritual and cultural life, strengthen the religious management and eliminate superstition and feudal traditional concepts. On the other hand, governments should strengthen the health education on suicide knowledge and social damage of suicide and correct the misunderstanding of suicidal behavior nature. It must focus on strengthening health education among the elders and those who have experienced relatives'suicides in at the same time. Only this can restore their life courage and confidence. |
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