Risk Factors For Rural Attempted Suicide With Different Suicide Intent Levels

1、Introduction1.1BackgroundSuicide is a serious public health and social problem. According to the WHO report, from1950to1995, the worldwide suicide rate had increased by60%. In2002, there were about877000people died of suicide around the world. The number of attempted suicide was about10to20times of suicide, namely every forty seconds there was one person died of suicide, meanwhile there was one attempted suicide per three seconds. In recent years, people take more cares of suicide. Generally speaking, suicide could be divided into three styles:completed suicide, attempted suicide and suicide ideation. Completed suicide is a spontaneous and deliberate action, and the person himself fully understands or expects the consequence of the action. Attempted suicide means the person has taken action to hurt himself, but not died successfully. Suicide ideation is occasional experiencing the motivation of suicide, in other word, the individual thinks about suicide incidentally or often, but no overt behavior was taken to attempt or complete suicide. According to China’s Ministry of Health, every year there are about250million people died of suicide,2billion people attempted suicide. History of attempted suicide is an important risk of completed suicide, Meta analysis showed that its risk is30-40times of general people. Therefore, to study the epidemiological characters and risk factors of attempted suicide in rural areas has important practical significance.Attempted suicide is not caused by single reason, but caused by individual factors, family factors, social factors and psychological factors collectively. In addition, physical diseases, family history of suicide or attempted suicide and some biological reasons are all important risk factors.Suicide intent is the intensity of the target person to end his life. It is an important component of suicide risk factors. Suicide intent scale, which was designed for attempted suicide by Beck A.T. in1974, reflects that whether the individual really wants to die or not. To assess psychological intent of people who have this intent by acquiring the relevant circumstance of before, that time and after the attempted actions. The aim people were divided into three groups:low, middle and high suicide intent group based on the score of the front eight items of Suicide Intent Scale. Our research was to explore epidemiological characteristics and risk factors of attempted suicide with different suicide intent, to analyze the interaction between risk factors, and to provide theoretical evidence to formulate pertinent prevention strategy and effective measure for attempted suicides.1.2Objectives1.2.1To test the reliability and validity of the scales which were used in this rural attempted suicide research;1.2.2To explore epidemiological characteristics of attempted suicide with low, middle and high suicide intent;1.2.3To explore the influencing factors of low, middle and high suicide intent groups from demographic factors, social and family factors, individual psycho-mental factors, and then to make interactive analysis of the influencing factors which entered multi-factor logistic regression model in every group.1.3Significance of research To explore distribution characteristic of attempted suicides, and risk factors of attempted suicide with different levels of suicide intent, and the interaction of risk factors. It is important to formulate pertinent prevention strategy and effective measure for attempted suicide in Shandong Province rural area. We try to provide reliable basis to measure suicide intent for rural people.2. Subjects and Methods2.1SubjectsFrom chronic disease surveillance points of Shandong Province, we selected six cities, Zoucheng, Tengzhou, Lijin, Junan, Ningyang, Penglai. In all towns of these six cities, we collected data of attempted suicides which happened from Oct.1st,2009to Mar.31th,2011. At the same time, we selected matching control people randomly with the same age (±3years old), the same gender and the same living area. Finally, we collected409pairs of data of attempted suicides and their paired controls.2.2MethodsIn this study,1:1paired case-control study and questionnaire-investigation were adopted to collect data by face-to-face and one-by-one interview, and to explore risk factors of attempted suicide with different suicide intent levels in rural Shandong Province.2.3Instruments2.3.1Demographic information:Included age, gender, education level, marital status, family status, employment status, family economic status, religion, party and league members, physical disease, mental disease, family history of suicide or attempted suicide and suicide behavior situation.2.3.2Psychological scale:Suicide Intent Scale, Life Events Scale, Life Satisfaction Index A, Duke Social Support Index, Self-esteem Scale, Dickman Impulsivity Inventory, Simplified Coping Style Questionnaire, Trait Anxiety Inventory, Beck Hopelessness Scale.2.3.3SCID:Structured Clinical Interview for DSM-Ⅳ, is dedicated in diagnosis of psychological disorders in psychiatric department.3. Results3.1Characters of attempted suicide behaviorsIn this study, we collected data of409pairs of attempted suicide and controls, in which the male were132(32.3%), and the female were277(67.7%), the male/female ratio was1:2.1; the average age of male attempted suicides was46.88±13.81years old, while the average age of the female was42.48±12.86years old; to analyze the distribution of season of attempted suicides which happened in2010(322cases), the results showed that attempted suicide behaviors usually occurred in spring (89cases,27.6%), summer (99cases,30.7%), autumn (86cases,26.7%), but in winter only48cases (14.9%); there were153cases (37.4%) occurred at12:01-18:00;353cases (86.3%) occurred at home or courtyard; taking pesticide was used by most of them (344cases,84.1%).3.2Influencing factors of different suicide intent groups3.2.1Low suicide intent group:Multi-factor logistic regression analysis showed that risk factors of the attempted suicides in low suicide intent group suffered more negative events (OR=3.844,95%CI:2.065-7.157), stronger sensation of hopelessness (OR=4.929,95%CI:1.941-12.515), a protective factor--higher social support inventory score (OR=0.136,95%CI:0.045-0.412). The results of interaction analysis between influencing factors were as follows, negative life event number and social support (OR=0.461,95%CI:0.279-0.760), negative life event number and sensation of hopelessness (OR=5.963,95%CI:2.854-12.458).3.2.2Middle suicide intent group:Multi-factor logistic regression analysis showed that risk factors of the attempted suicides in middle suicide intent group suffered more negative events (OR=4.710,95%CI:2.075-10.688), higher life satisfaction (OR=0.235,95%CI:0.082-0.674), higher negative coping style score (OR=3.729,95%CI:1.366-10.184), stronger sensation of hopelessness (OR=3.640,95%CI:1.428-9.280). The results of interaction analysis between influencing factors were that, sensation of hopelessness and negative life event number (OR=2.919,95%CI:1.898-4.487), sensation of hopelessness and negative coping style (OR=1.893,95%CI:1.241-2.887).3.2.3High suicide intent group:Multi-factor logistic regression analysis showed that risk factors of the attempted suicides in high suicide intent group mental disorder (OR=8.104,95%CI:1.972-33.308), suffered more negative events (OR=2.850,95%CI:1.507-5.391), stronger sensation of hopelessness (OR=5.792,95%CI:1.493-22.469); a protective factors, higher life satisfaction score (OR=0.088,95%CI:0.020-0.385). The results of interaction analysis between influencing factors were that, sensation of hopelessness and mental disorder (OR=6.083,95%CI:2.780-13.309), sensation of hopelessness and negative life event number (OR=1.835,95%CI:1.290-2.611), mental disorder and life satisfaction(OR=0.298,95%CI:0.129-0.692).3.3Comparison with influencing factors of different suicide intent groups3.3.1Risk factors:The common risk factors in different suicide intent groups were mental disorder, suffered more negative events, sensation of anxiety, sensation of hopelessness. Besides, low suicide intent group had another risk factors, higher dysfunctional impulsivity score; middle suicide intent group had other risk factors, physical disease and higher negative coping style score.3.3.2Protective factors:The common protective factors in different suicide intent groups were higher educational level, better family economic status, higher social support inventory score, higher life satisfaction score, higher self-esteem, and higher positive coping style score. Beside, low suicide intent group had the protective factor of higher family status.4. Conclusions4.1Characters of attempted suicide behaviorsCompared to normal controls, attempted suicides were lower educational level, more farmers, lower family status, fewer party and league members, more physical disease and mental disorder. Compare to male attempted suicides, female attempted suicides were younger age, lower educational level, higher marriage percent, more farmers, lower family status, and fewer mental disorder.4.2Risk factors for attempted suicide with different suicide intent levels4.2.1Low suicide intent group:The influencing factors in low suicide intent group were negative life event number, social support, sensation of hopelessness. And negative life event number and sensation of hopelessness had positive interaction; negative life event number and social support had negative interaction.4.2.2Middle suicide intent group:The influencing factors in middle suicide intent group were negative life event number, life satisfaction, negative coping style and sensation of hopelessness. And sensation of hopelessness and negative life event number, sensation of hopelessness and negative coping style both had positive interaction.4.2.3High suicide intent group:The influencing factors in high suicide intent group were mental disorder, negative life event number, life satisfaction and sensation of hopelessness. And sensation of hopelessness and mental disorder, sensation of hopelessness and negative life event number had positive interaction; mental disorder and life satisfaction had negative interaction.5. Innovations and shortcomingsIn this study, we focused on exploring risk factors of15-70years old attempted suicides in different suicide intent groups in rural Shandong Province, so we had a larger sample size; and we took multi-factors logistic regression analysis and interaction analysis to analyze the acquired data. In our research,1:1matched case-control study was used, the recall bias and selection bias might exist.