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Self-Stigma and Its Relationship With Rates of Depression Diagnosis

A Study of Suicide Notes in Shanghai and Wuhan, China

Published Online:May 04, 2021https://doi.org/10.1027/0227-5910/a000780

Abstract

Abstract.Background: Self-stigma about suicide might impede people seeking help from mental health professionals. There is little research about self-stigma expressed by suicide decedents. Aims: We aimed to explore (a) self-stigma about suicide through examination of suicide notes; and (b) whether the expression of self-stigma was associated with the formal diagnoses of depression. Method: Data were extracted from notes left by people who died by suicide in two major Chinese cities (Shanghai, 2004–2017; Wuhan, 2005–2019). Note content was examined and self-stigma items were coded. Demographics associated with self-stigma were reported. Rates of depression were compared between note-leavers who expressed self-stigma, and those who did not. Results: Notes were left by 567 suicide decedents (representing about 19% all suicides). Approximately 25% notes contained at least one self-stigma item. Older people made fewer self-stigma references, as did people from Wuhan. Depression was not associated with self-stigma. Limitations: Not all people dying from suicide leave notes, and suicide notes variably report self-stigma, thus self-stigma about suicide may be underestimated. Conclusion: Self-stigma items varied across regions and age groups, but not with depression. Therefore, self-stigma expressed by suicide decedents may not reflect help-seeking behaviours from professional mental health services.

References

  • Batterham, P. J., Calear, A. L., & Christensen, H. (2013). The stigma of suicide scale [Database record]. APA Psyc Tests. First citation in articleGoogle Scholar

  • Chadda, R. K., Agarwal, V., Singh, M. C., & Raheja, D. (2001). Help seeking behaviour of psychiatric patients before seeking care at a mental hospital. International Journal of Social Psychiatry, 47(4), 71–78. 10.1177/002076400104700406 First citation in articleCrossref Medline, Google Scholar

  • Demirel, B., Akar, T., Sayin, A., Candansayar, S., & Leenaars, A. A. (2008). Farewell to the world: Suicide notes from Turkey. Suicide and Life-Threatening Behavior, 38(1), 122–127. 10.1521/suli.2008.38.1.122 First citation in articleCrossref Medline, Google Scholar

  • Downs, M. F., & Eisenberg, D. (2012). Help seeking and treatment use among suicidal college students. Journal of American College Health, 60(2), 104–114. 10.1080/07448481.2011.619611 First citation in articleCrossref Medline, Google Scholar

  • Eskin, M., Kujan, O., Voracek, M., Shaheen, A., Carta, M. G., Sun, J.-M., Flood, C., Poyrazli, S., Janghorbani, M., Yoshimasu, K., Mechri, A., Khader, Y., Aidoudi, K., Bakhshi, S., Harlak, H., Ahmead, M., Moro, M. F., Nawafleh, H., Phillips, L., … Tsuno, K. (2016). Cross-national comparisons of attitudes towards suicide and suicidal persons in university students from 12 countries. Scandinavian Journal of Psychology, 57(6), 554–563. 10.1111/sjop.12318 First citation in articleCrossref Medline, Google Scholar

  • Gupta, S., Goren, A., Dong, P., & Liu, D. (2016). Prevalence, awareness, and burden of major depressive disorder in urban China. Expert Review of Pharmacoeconomics & Outcomes Research, 16(3), 393–407. 10.1586/14737167.2016.1102062 First citation in articleCrossref Medline, Google Scholar

  • Han, J., Batterham, P. J., Calear, A. L., Wu, Y., Shou, Y., & Van Spijker, B. A. J. (2017). Translation and validation of the Chinese versions of the suicidal ideation attributes scale, stigma of suicide scale, and literacy of suicide scale. Death Studies, 41(3), 173–179. 10.1080/07481187.2016.1214633 First citation in articleCrossref Medline, Google Scholar

  • Harwood, D. M. J., Hawton, K., Hope, T., & Jacoby, R. (2000). Suicide in older people: Mode of death, demographic factors, and medical contact before death. International Journal of Geriatric Psychiatry, 15(8), 736–743. 10.1002/1099-1166(200008)15:8<736::aid-gps214>3.0.co;2-k First citation in articleCrossref Medline, Google Scholar

  • Hegarty, D., & Wall, M. (2014). Prevalence of stigmatization and poor self-esteem in chronic pain patients. Journal of Pain & Relief, 3(2), 3–6. 10.4172/2167-0846.1000136 First citation in articleCrossref, Google Scholar

  • Ho, T. P., Yip, P. S. F., Chiu, C. W. F., & Halliday, P. (1998). Suicide notes: What do they tell us? Acta Psychiatrica Scandinavica, 98(6), 467–473. 10.1111/j.1600-0447.1998.tb10121.x First citation in articleCrossref Medline, Google Scholar

  • Im, J. S., Park, B. C. B., & Ratcliff, K. S. (2018). Cultural stigma manifested in official suicide death in South Korea. Omega (Westport), 77(4), 386–403. 10.1177/0030222816675262 First citation in articleCrossref Medline, Google Scholar

  • Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30(2), 111–116. 10.1177/0840470416679413 First citation in articleCrossref Medline, Google Scholar

  • Kodaka, M., Poštuvan, V., Inagaki, M., & Yamada, M. (2011). A systematic review of scales that measure attitudes toward suicide. International Journal of Social Psychiatry, 57(4), 338–361. 10.1177/0020764009357399 First citation in articleCrossref Medline, Google Scholar

  • Li, A., Huang, X., Hao, B., O'Dea, B., Christensen, H., & Zhu, T. (2015). Attitudes towards suicide attempts broadcast on social media: An exploratory study of Chinese microblogs. PeerJ, 3, e1209. 10.7717/peerj.1209 First citation in articleCrossref Medline, Google Scholar

  • Li, F., Jia, H., Cai, Z., Liu, S., Lu, X., Zeng, X., & Yip, P. S. F. (2020). Putting the blame on others in suicide notes from Shanghai and Wuhan, China. Crisis, 41(6), 469–474. 10.1027/0227-5910/a000677 First citation in articleLink, Google Scholar

  • Li, F., Liu, J., Yip, P. S., Lu, X., & Liu, S. (2019). Mortalities of methamphetamine, opioid, and ketamine abusers in Shanghai and Wuhan, China. Forensic Science International, 306, 110093. 10.1016/j.forsciint.2019.110093 First citation in articleCrossref Medline, Google Scholar

  • Li, F., Lu, X., & Yip, P. S. (2019). A study of the characteristics of suicide notes in China. Crisis, 41(1), 32–38. 10.1027/0227-5910/a000601 First citation in articleLink, Google Scholar

  • Li, F., Lu, X., & Yip, P. S. F. (2020). Comparing accidental drownings between local permanent residents and internal migrants in Pudong, Shanghai, China (2004–2017). Journal of International Migration and Integration. 10.1007/s12134-020-00770-5 First citation in articleCrossref, Google Scholar

  • Li, F., Zeng, J., Huang, J., Zhang, J., Chen, Y., Yan, H., Huang, W., Lu, X., & Yip, P. S. F. (2019). Work-related and non-work-related accident fatal falls in Shanghai and Wuhan, China. Safety Science, 117, 43–48. 10.1016/j.ssci.2019.04.001. First citation in articleCrossref, Google Scholar

  • Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27(1), 363–385. 10.1146/annurev.soc.27.1.363 First citation in articleCrossref, Google Scholar

  • Neumayer, E. (2003). Socioeconomic factors and suicide rates at large-unit aggregate levels: A comment. Urban Studies, 40(13), 2769–2776. 10.1080/0042098032000191029 First citation in articleCrossref, Google Scholar

  • Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science & Medicine, 57(1), 13–24. 10.1016/s0277-9536(02)00304-0 First citation in articleCrossref Medline, Google Scholar

  • Phillips, M. R., Yang, G., Zhang, Y., Wang, L., Ji, H., & Zhou, M. (2002). Risk factors for suicide in China: A national case-control psychological autopsy study. The Lancet, 360(9347), 1728–1736. 10.1002/1099-1166(200008)15:8<736::aid-gps214>3.0.co;2-k10.1016/s0140-6736(02)11681-3 First citation in articleCrossref Medline, Google Scholar

  • Pitman, A. L., Osborn, D. P. J., Rantell, K., & King, M. B. (2016). The stigma perceived by people bereaved by suicide and other sudden deaths: A cross-sectional UK study of 3432 bereaved adults. Journal of Psychosomatic Research, 87, 22–29. 10.1016/j.jpsychores.2016.05.009 First citation in articleCrossref Medline, Google Scholar

  • Rimkeviciene, J., Hawgood, J., O'Gorman, J., & De Leo, D. (2015). Personal stigma in suicide attempters. Death studies, 39(10), 592–599. 10.1080/07481187.2015.1037972 First citation in articleCrossref Medline, Google Scholar

  • Synnott, J., Ioannou, M., Coyne, A., & Hemingway, S. (2018). A content analysis of online suicide notes: Attempted suicide versus attempt resulting in suicide. Suicide and Life-Threateing Behavior, 48(6), 767–778. 10.1111/sltb.12398 First citation in articleCrossref Medline, Google Scholar

  • Wang, C.-W., Chan, C. L. W., & Yip, P. S. F. (2013). Suicide rates in China from 2002 to 2011: An update. Social Psychiatry and Psychiatric Epidemiology, 49(6), 929–941. 10.1007/s00127-013-0789-5 First citation in articleCrossref Medline, Google Scholar

  • Wang, K., Weiss, N. H., Pachankis, J. E., & Link, B. G. (2016). Emotional clarity as a buffer in the association between perceived mental illness stigma and suicide risk. Stigma and Health, 1(4), 252–262. 10.1037/sah0000032 First citation in articleCrossref Medline, Google Scholar

  • World Health Organization (2019). Suicide. https://www.who.int/news-room/fact-sheets/detail/suicide First citation in articleGoogle Scholar

  • Yap, M. B. H., Wright, A., & Jorm, A. F. (2011). The influence of stigma on young people's help-seeking intentions and beliefs about the helpfulness of various sources of help. Social Psychiatry and Psychiatric Epidemiology, 46(12), 1257–1265. 10.1007/s00127-010-0300-5 First citation in articleCrossref Medline, Google Scholar

  • Zhang, J., & Jia, C.-X. (2010). Attitudes toward suicide: The effect of suicide death in the family. OMEGA – Journal of Death and Dying, 60(4), 365–382. 10.2190/om.60.4.d First citation in articleCrossref, Google Scholar

  • Zhong, B.-L., Chiu, H. F. K., & Conwell, Y. (2016). Rates and characteristics of elderly suicide in China, 2013–14. Journal of Affective Disorders, 206, 273–279. 10.1016/j.jad.2016.09.003 First citation in articleCrossref Medline, Google Scholar

  • Zou, Y., Leung, R., Lin, S., Yang, M., Lu, T., Li, X., Gu, J., Hao, C., Dong, G., & Hao, Y. (2016). Attitudes towards suicide in urban and rural China: A population based, cross-sectional study. BMC Psychiatry, 16(167), 162. 10.1186/s12888-016-0872-z First citation in articleCrossref Medline, Google Scholar