Young age and male gender are considered major demographic risk factors for suicide among people with schizophrenia worldwide. However, in rural China, women and older adults with the disorder are much more likely to commit suicide, a recent report shows.
To examine the demographic and clinical risk factors for suicide in rural Chinese populations, researchers analyzed data from a large epidemiologic study involving 16 rural counties in both agricultural and industrial areas of the country with a wide range of economic prosperity. They identified 392 completed suicides and conducted psychological autopsies on all of them, using extensive in-person interviews with one family member and one friend of each suicide, said Dr. Juncheng Lyu of the Center for Suicide Prevention Research, Shandong University School of Public Health, China, and Jie Zhang, Ph.D., also with the center and with the department of sociology, State University of New York at Buffalo (Schizophr. Res. 2014 March 20 [doi:10.1016/j.schres.2014.02.018]).
The investigators obtained each case’s family history and social situation and assessed their health and mental health status using several measures, including the Beck Hopelessness Scale, the Hamilton Depression Rating Scale, the Beck Suicide Intent Scale, and the Structured Clinical Interview for DSM-IV. A total of 38 cases had schizophrenia, 150 had other psychiatric disorders, and 204 had no psychiatric disorders.
Overall, 9.7% of all suicide completers had schizophrenia, a rate that is nearly twice the 5% rate often reported in Western countries. The average age of people in the schizophrenia group was significantly older (at 29.03 years plus or minus 5.59 years), than the average ages in the other psychiatric disorders group, and the group with no psychiatric disorders (28.53 years, plus or minus 5.96 years; and 25.18 years, plus or minus 6.36 years, respectively). Most of the schizophrenia patients who committed suicide were women (60.5%), as were most of the group with no psychiatric disorders (52.9%); in contrast, nearly 70% of the patients with other psychiatric diagnoses were men, the investigators said.
In the literature, violence is a stigma often ascribed to schizophrenia, and in this study, violent suicide attempts were more common among patients with schizophrenia (15.8%) or other psychiatric disorders (18.0%) than among people with no psychiatric diagnoses (9.3%). However, the majority of suicides in all three groups were nonviolent, usually involving intentional poisoning with pesticides or intentional drug overdoses.
In light of the differences found in suicide rates among different demographic groups, the researchers said suicide preventive measures "should be taken according to the special characteristics of each group." However, they said, a limitation of their study is that it obtained data from rural China. "Future studies on this research topic may be conducted in larger and more diverse samples, such as in urban China [and] in the Western countries," they wrote.
This study was supported by the U.S. National Institute of Mental Health; the Natural Science Foundation of Shandong Province, China; and the Weifang Science and Technology Bureau. No financial conflicts of interest were reported.