Cross-national Prevalence And Influencing Factors Of Suicidal Behavior Among Chinese Rural Adolescents

Objective:The aim of this study was to investigate the epidemiology of suicidal behavior among rural adolescents in China and explore the influencing factors,so as to provide scientific basis for the prevention.Methods: A total of 14581 rural adolescents were recruited using the stratified randomized cluster-sampling method from 5 provinces(Anhui,Yunnan,Guangdong,Heilongjiang,and Hubei)across China,with their age ranging from 11 to 20 years old.Information concerning suicidal behavior,trait aggression,neglect and physical abuse,stressful life events and social support was collected by self-reported questionnaires.The EpiData 3.0 was used to establish a database and input data.Statistical analyses were performed using SPSS 19.0,including descriptive statistics,chi-square test and multivariate logistic regression.Results:(1)Overall,2249 rural adolescents reported having seriously thought about killing themselves during the past 12 months,1071 reported having made detailed plans to kill themselves,and 519 reported having attempted suicide.The prevalence estimates of suicidal ideation,plans and attempts were 15.42%,7.35% and 3.56%,respectively.(2)A gender difference was found in suicidal ideation(female: 16.69%,male: 14.24%,P<0.05),but not in suicide plans and attempts.The rate of suicidal behavior showed an inverted "V" shaped development trend with advancing age.Students aged 14 or15 years reported the highest suicide rate.There were significant differences in the prevalence of suicide among different family types,different levels of parents' education and monthly family income(P<0.05).(3)The results of univariate analysis showed that participants who had higher trait aggression,experienced neglect,physical abuse and 6 different types of stressful life events(such as interpersonal tensions,academic pressure,health adaptation difficulties,punishment,relatives or property loss,other troubles)during the previous 12 months showed greater probability of suicide(P<0.05),while those with high perceived social support were associated with reduced suicide risk(P<0.05).(4)Multivariate logistic regression analysis revealed that gender,age,family type,father's education,trait aggression,history of neglect and physical abuse,interpersonal tensions,academic pressure,health adaptation difficulties and social support were important concomitants of suicidal ideation(P<0.05).The influencing factors of suicide plans were age,family type,father's education,trait aggression,history of neglect and physical abuse,interpersonal tensions,punishment,health adaptation difficulties and social support(P<0.05).while age,family type,mother's education,trait aggression,history of neglect and physical abuse,interpersonal tensions,punishment,health adaptation difficulties and social support were the factors affecting suicide attempts in Chinese rural adolescents(P<0.05).Conclusions:(1)The higher prevalence of suicidal behavior among adolescents living in rural areas of China should be focused by social concern.Trait aggression,history of neglect and physical abuse,stressful life events may be very important risk factors of suicide.(2)Suicide prevention programs should involve the collaboration among family,school and society,and focus on attenuating the severity of trait aggression,changing the unconcerned or crude parenting styles,reducing the pressure force,and highlighting the strength of social support.