| 1. BackgroundSuicide is defined as the act of deliberately killing oneself, with full awareness and expectations of the lethal consequences. Every year approximately 1,000,000 people commit suicide. In China, a total of 287,000 die by suicide per year, accounting for 29% of all deaths in the world. The suicide rate (2002-2006) was 15.05/100,000, and suicide is the fifth important cause of death in China. Compared to Western countries, there are three characteristics in Chinese suicide:1) the female/male ratio is 1.25, more women commit suicide than men. Yang GH et al (2004) reported that in China, suicide rate (1991-2000) in male was 15.69/100,000 while that in female was 17.94/100,000 and the female/male ratio was 1.14, and the rates maintained a stable level during the last decade. Female/male ratio in suicide (2006) in city was 115.9%, while that in rural was 106.8%.2) The suicide rates in rural are higher than in urban, the rural/urban ratio is 3.27.3) There are two peaks (15-34 age group and 60 or older age group) in the curve of suicide rate amomg different ages, and the suicide rate of the 60 or older age group is highest with suicide rate (2000) being 74.73/100,000.There are four characteristics of suicide in the elderly. First, compared with other age groups, the elderly population suicide rate is highest. Second, whether urban or rural, elderly population suicide rates have been rising with increasing age. Third, the rural suicide rate is significantly higher than the urban and the differences in suicide rates between urban and rural continue enlarging. Fourth, the male suicide rate is significantly higher than that of the female.Suicide is not caused by one single reason and it's a result of multiple risk factors. Risk factors among different populations are dissimilar. We have known suicide risk factors among rural elderly people mainly concentrated in the following:incurable or severe diseases, family conflicts, economical status, lack of family and social supports. There are limited Psychological autopsy (PA) studies for rural elderly suicides carried out in China. In this study, we investigated rural elderly people, explored characteristics and risk factors for the rural elderly suicides, established high risk assessment score screening model and provide some suggestions for the elderly suicide prevention.2. Objectives2.1 To investigate epidemiological characteristics of suicide in rural elderly population.2.2 To explore risk factors associated with socio-demographic variables, psychological traits, psychosocial stress, and mental disorders for completed suicide in rural old people, and analyze the interaction between these factors.2.3 To initially establish risk assessment score model for screening high-risk population of elderly suicide, so that the model can provide some guideline for suicide prevention.3. MethodsIn this study, paired case-control study was used to obtain risk factors of rural elderly suicides. Reasonably scored of risk factors, risk assessment score screening model would be achieved for high-risk population of rural elderly. Receiver Operating Characteristic (ROC) curve was used to get suitable value for distinguishing high or low risk population.of rural elderly.4. Main results4.1 Characteristics of suicidal behaviors for rural elderly suicidesThis study investigated 112 cases of rural elderly suicides, in which male suicides were 69 cases (61.6%), female suicides were 43 cases (38.4%), and the male/female ratio was 1.60:1. The peak suicide seasons for rural elderly people were in spring and autumn. The peak suicide times for rural elderly suicides focused on 6:00a.m,9:00a.m and 1:00-3:00p.m. Most rural elderly suicides were more likely to commit suicide at home,88 cases (78.5%) was found at home.56 cases (50.0%) committed suicide by taking pesticide,44 cases (39.3%) by hanging, and there were no significant difference in the suicide patterns between the male and female suicides (P>0.05). The mean value of Suicide Intent Scale (SIS) scores in cases was 5.83±2.51, and cases were divided into subgroups according to low intent (<3), intermediate intent (3-6), and high intent SIS>6). The rural elderly suicides were major in high intent (49.1%), intermediate intent (39.3%), low intent (11.6%).4.2 Risk factors for rural elderly suicides4.2.1 Basic information(1) Individual circumstances:comparing to controls, rural elderly suicides had significantly higher proportion of living alone (P<0.01) and believed in afterlife (P<0.01), but the proportion of the rural elderly elderly suicides who married was significantly less (P<0.01).(2) Family conditions:there were significant differences between suicide and control groups in family cohesion (74.83±13.14 vs.65.82±14.64) and adaptability (57.46±9.59 vs. 50.72±14.17).4.2.2 Psychological traits:comparing to controls, suicides had relatively higher level of hopelessness, trait anxiety (P<0.01).There were significant differences between suicide and control groups in self-esteem (19.31±5.05 vs.22.68±5.34, P<0.01) and impulsivity (41.61±18.13 vs.31.45±14.29, P<0.01). Comparing to controls, suicide group were in lower level of positive and negative coping skills.4.2.3 Social stress:compared to controls, the scores of social support and perceived social support of elderly suicides were lower (P<0.01), and there were 102 (91.1%) old people followed the negative life events,82 (73.1%) people experienced twice and above negative life events. Compared to controls, the frequency of four negative life events were significantly higher among the suicides than those of controls, there were "incurable or severe diseases", "been in hospital", "change living habits" and "spouse or cohabitant passed away" (P values were 0.000,0.001,0.001,0.045, respectively).4.2.4 Multivariate conditional Logistic regression model analysis showed that hopelessness, self-esteem, experiencing negative life events were rural elderly suicide influence factors, their OR values (95% CI) were 1.214 (1.099～1.341),0.848 (0.730～0.986), 112.887 (7.080～180.035), respectively. 4.3 Analysis of interaction between risk factors of rural elderly suicidesThere were positive interactions between negative life events and hopelessness, negative interactions between negative life events and self-esteem for rural elderly suicide, their OR values (95%CI) were 1.125 (1.056～1.198) and 0.908 (0.833～0.990).4.4 Initial establishment of high risk assessment score screening model for rural elderlyY=2.7×religion+1.3×family status+3.5×anxious+3.1×hopelessness+3.5×negative life events-family economic status-2.2×social support level.The ROC area of this model was 0.90. The model's sensitivity and specificity were 0.848 and 0.786, and the power of its prediction was middle.5. Conclusions and Suggestions5.1 Conclusions5.1.1 The suicides of rural elderly were major in intermediate and high intent, and tended to commit suicide at home by taking poison and hanging.5.1.2 Hopelessness, negative life events, and high self-esteem were predicting factors of rural elderly suicide. There were positive interactions between hopelessness and negative life events, negative interactions between high self-esteem and negative life events for rural elderly suicide.5.1.3 The risk assessment score model for screening high-risk population of the elderly suicide had certain practical value which might be used in the population prevention and intervention in old people. However, the source of data is some limited, so, extrapolating of this model has certain limitations which should be further verified and improved.5.2 SuggestionsPrevention should be more paid attention to in prevention and control of suicide. We have to become aware of special physical and psychological of the elderly, and take positive and effective control measures. Society should try all means to care more for the rural elderly population and strengthen the research of senile disease, chronic and mental health. Guarantee the old people's legal rights, extend and carry forward the culture of filial piety, build harmonious family. Attach great importance to spiritual civilization, improve the rural elderly social and family status. Social security system needs to become mature to provide basic medical security and living allowance for elder people in rural. |
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