Skip to main content
Research Trends

Understanding the Reasons for Suicide Among Older Adults in Rural China Using In-Depth Interviews

Published Online:https://doi.org/10.1027/0227-5910/a000799

Abstract.Background: Suicide is a complex public health problem. Suicide rates are higher in rural areas than in urban areas and among older adults than any other age group in China. Aims: This study aimed to acquire a comprehensive understanding of rural older adults’ reasons for suicide through qualitative exploration and to provide additional insights for suicide prevention work. Method: In-depth interviews were conducted with people familiar with older adults who had died by suicide (“informants”). The data were analyzed using a thematic approach. Results: Data were available for 242 people who died by suicide. Informants identified two or more reasons for suicide among most people who had died. Physical illness, psychological distress, and interpersonal conflicts were the most common reasons. The rate of mental disorders as diagnosed by psychiatrists was higher than that reported by the informants. Limitations: Information bias is inevitable because of the use of proxy informants. Conclusion: The reasons for suicide are complex and diverse, and research on suicide should focus more on the mechanisms of interaction between reasons. Greater attention should be paid to physical and mental health as well as to improving interpersonal and problem-solving skills for older adults in China.

References

  • Bernier, S., Lapierre, S., & Desjardins, S. (2020). Social interactions among older adults who wish for death. Clinical Gerontologist, 43(1), 4–16. 10.1080/07317115.2019.1672846 First citation in articleCrossref MedlineGoogle Scholar

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. 10.1191/1478088706qp063oa First citation in articleCrossrefGoogle Scholar

  • Cao, R., Jia, C. X., Ma, Z. Y., Niu, L., & Zhou, L. (2019). Disability in daily living activities, family dysfunction, and late-life suicide in rural China: A case-control psychological autopsy study. Frontiers in Psychiatry, 10, 827. 10.3389/fpsyt.2019.00827 First citation in articleCrossref MedlineGoogle Scholar

  • Cheng, L. H., Chen, H., & Zheng, M. L. (2013). Association of suicidal ideation and family factors among rural elderly. Chinese Journal of Public Health, 29(2), 157–159. 10.11847/zgggws2013-29-02-01 First citation in articleCrossrefGoogle Scholar

  • Clarke, L. H., Korotchenko, A., & Bundon, A. (2012). “The calendar is just about up”: Older adults with multiple chronic conditions reflect on death and dying. Ageing & Society, 32(2), 1399–1417. 10.1017/S0144686X11001061 First citation in articleCrossref MedlineGoogle Scholar

  • Fässberg, M. M., Cheung, G., Canetto, S. S., Erlangsen, A., Lapierre, S., Lindner, R., Draper, B., Gallo, J. J., Wong, C., Wu, J., Duberstein, P., & Wærn, M. (2016). A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging & Mental Health, 20(2), 166–194. 10.1080/13607863.2015.1083945 First citation in articleCrossref MedlineGoogle Scholar

  • Harwood, D. M. J., Hawton, K., Hope, T., Harriss, L., & Jacoby, R. (2006). Life problems and physical illness as risk factors for suicide in older people: A descriptive and case-control study. Psychological Medicine, 36(9), 1265–1274. 10.1017/S0033291706007872 First citation in articleCrossref MedlineGoogle Scholar

  • Hjelmeland, H., & Knizek, B. L. (2010). Why we need qualitative research in suicidology. Suicide & Life-Threatening Behavior, 40(9), 74–80. 10.1521/suli.2010.40.1.74 First citation in articleCrossref MedlineGoogle Scholar

  • Ji, J., Kleinman, A., & Becker, A. (2001). Suicide in contemporary China: A review of China's distinctive suicide demographics in their sociocultural context. Harvard Review of Psychiatry, 9(1), 1–12. 10.1080/10673220127875 First citation in articleCrossref MedlineGoogle Scholar

  • Jia, C.-X., Wang, L.-L., Xu, A.-Q., Dai, A.-Y., & Qin, P. (2014). Physical illness and suicide risk in rural residents of contemporary China: A psychological autopsy case-control study. Crisis, 35(5), 330–337. 10.1027/0227-5910/a000271 First citation in articleLinkGoogle Scholar

  • Jiang, H., Niu, L., Hahne, J., Hu, M., Fang, J., Shen, M., Xiao, S., & , Y. (2018). Changing of suicide rates in China, 2002–2015. Journal of Affective Disorders, 240, 165–170. 10.1016/j.jad.2018.07.043 First citation in articleCrossref MedlineGoogle Scholar

  • KjøLseth, I., Ekeberg, Ø., & Steihaug, S. (2010). Why suicide? Elderly people who committed suicide and their experience of life in the period before their death. International Psychogeriatrics, 22(2), 209. 10.1017/S1041610209990949 First citation in articleCrossref MedlineGoogle Scholar

  • Li, F., Li, S., Zhou, C., & Wang, F. (2019). Mental health literacy among Chinese rural residents: A survey from Hubei Province in Central China on people's perception of mental illnesses. The Journal of Nervous and Mental Disease, 207(10), 875–883. 10.1097/nmd.0000000000001043 First citation in articleCrossref MedlineGoogle Scholar

  • Li, H., Xu, L., & Chi, I. (2015). Factors related to Chinese older adults’ suicidal thoughts and attempts. Aging & Mental Health, 20(7), 752–761. 10.1080/13607863.2015.1037242 First citation in articleCrossref MedlineGoogle Scholar

  • Li, M., & Katikireddi, S. V. (2019). Urban–rural inequalities in suicide among elderly people in China: A systematic review and meta-analysis. International Journal of Equity Health, 18(1), 2. 10.1186/s12939-018-0881-2 First citation in articleCrossref MedlineGoogle Scholar

  • Li, X. Y., & Phillips, M. R. (2008). Yùn yòng shēn rù fǎng tán tàn jiū zì shā wèi suí zhě jí qí qīn y䙬u duì zì shā wèi suí fā shēng yuán yīn de kàn fǎ [Using in-depth interviewing method with suicide attempters and their associates to assess their ideas about the characteristics and causes of the attempts]. Chinese Mental Health Journal, 22(2), 43–50. 10.3321/j.issn:1000-6729.2008.01.015 First citation in articleCrossrefGoogle Scholar

  • Li, X., Phillips, M. R., & Cohen, A. (2012). Indepth interviews with 244 female suicide attempters and their associates in Northern China: Understanding the process and causes of the attempt. Crisis, 33(2), 66–72. 10.1027/0227-5910/a000108 First citation in articleLinkGoogle Scholar

  • Lin, J., Su, Y., Lv, X., Liu, Q., Wang, G., Wei, J., Zhu, G., Chen, Q., Tian, H., Zhang, K., Wang, X., Zhang, N., WangYu, Y.X., Yu, X., & Si, T. (2020). Perceived stressfulness mediates the effects of subjective social support and negative coping style on suicide risk in Chinese patients with major depressive disorder. Journal of Affective Disorders, 265, 32–38. 10.1016/j.jad.2020.01.026 First citation in articleCrossref MedlineGoogle Scholar

  • Liu, S., Page, A., Yin, P., Astell-Burt, T., Feng, X., Liu, Y., Liu, J., Wang, L., & Zhou, M. (2015). Spatiotemporal variation and social determinants of suicide in China, 2006–2012: Findings from a nationally representative mortality surveillance system. Psychological Medicine, 45(15), 3259–3268. 10.1017/S0033291715001269 First citation in articleCrossref MedlineGoogle Scholar

  • Lu, C. F., Jia, C. X., Ma, J. X., Zhang, J. Y., Xu, A. Q., Wang, X. X., & Wang, D. F. (2011). Shè huì zhī chí yѨ nóng cūn zì shā sī wáng guān xì bìng lì duì zhào yán jiū [Social support and rural suicides: A matched case-control study]. Chinese Journal of Public Health, 27(3), 62–64. CNKI:SUN:ZGGW.0.2011-03-028 First citation in articleGoogle Scholar

  • National Bureau of Statistics of China. (2020). National economic and social development statistics of the People's Republic of China in 2019. http://www.stats.gov.cn/tjsj/zxfb/202002/t20200228_1728913.html First citation in articleGoogle Scholar

  • Oliffe, J. L., Broom, A., Rossnagel, E., Kelly, M. T., Affleck, W., & Rice, S. M. (2020). Help-seeking prior to male suicide: Bereaved men perspectives. Social Science & Medicine, 261, 113173. 10.1016/j.socscimed.2020.113173 First citation in articleCrossref MedlineGoogle Scholar

  • Patel, V., Xiao, S., Chen, H., Hanna, F., Jotheeswaran, A. T., Luo, D., Parikh, R., Sharma, E., Usmani, S., Yu, Y., Druss, B. G., & Saxena, S. (2016). The magnitude of and health system responses to the mental health treatment gap in adults in India and China. The Lancet, 388(10063), 3074–3084. 10.1016/s0140-6736(16)00160-4 First citation in articleCrossref MedlineGoogle Scholar

  • Phillips, M. R., Li, Y., Stroup, T. S., & Xin, L. (2000). Causes of schizophrenia reported by patients' family members in China. The British Journal of Psychiatry, 177(1), 20–25. 10.1192/bjp.177.1.20 First citation in articleCrossref MedlineGoogle 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. Lancet, 360(9347), 1728–1736. 10.1016/S0140-6736(02)11681-3 First citation in articleCrossref MedlineGoogle Scholar

  • Rasmussen, M. L., Haavind, H., & Dieserud, G. (2018). Young men, masculinities, and suicide. Archives of Suicide Research, 22(2), 327–343. 10.1080/13811118.2017.1340855 First citation in articleCrossref MedlineGoogle Scholar

  • Wang, G., Hu, M., Xiao, S.-Y., & Zhou, L. (2017). Loneliness and depression among rural empty-nest elderly adults in Liuyang, China: A cross-sectional study. BMJ Open, 7(10), e016091. 10.1136/bmjopen-2017-016091 First citation in articleCrossref MedlineGoogle Scholar

  • Wong, D. F. K., Cheng, C.-W., Zhuang, X. Y., Ng, T. K., Pan, S.-M., He, X., & Poon, A. (2017). Comparing the mental health literacy of Chinese people in Australia, China, Hong Kong and Taiwan: Implications for mental health promotion. Psychiatry Research, 256, 258–266. 10.1016/j.psychres.2017.06.032 First citation in articleCrossref MedlineGoogle Scholar

  • World Health Organization. (2014). Preventing suicide: A global imperative. https://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ First citation in articleGoogle Scholar

  • World Health Organization. (2018). Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health First citation in articleGoogle Scholar

  • World Health Organization. (2019). Suicide prevention. https://www.who.int/health-topics/suicide#tab=overview First citation in articleGoogle Scholar

  • Yang, G. H., Phillips, M. R., Zhou, M. G., Wang, L. J., Zhang, Y. P., & Xu, D. (2005). Understanding the unique characteristics of suicide in China: National psychological autopsy study. Biomedical and Environmental Sciences, 18(6), 379–389. 10.1159/000082719 First citation in articleCrossref MedlineGoogle Scholar

  • Yeh, S. T., Ng, Y. Y., & Wu, S. C. (2019). Association of psychiatric and physical illnesses with suicide in older adults in Taiwan. Journal of Affective Disorders, 264, 425–429. 10.1016/j.jad.2019.11.070 First citation in articleCrossref MedlineGoogle Scholar

  • Zhang, J., Conwell, Y., Wieczorek, W. F., Jiang, C., Jia, S., & Zhou, L. (2003). Studying Chinese suicide with proxy-based data: Reliability and validity of the methodology and instruments in China. The Journal of Nervous and Mental Disease, 191(7), 450–457. 10.1097/01.NMD.0000081613.03157.D9 First citation in articleCrossref MedlineGoogle Scholar

  • Zhang, J., Conwell, Y., Zhou, L., & Jiang, C. (2005). Culture, risk factors and suicide in rural China: A psychological autopsy case control study. Acta Psychiatrica Scandinavica, 110(6), 430–437. 10.1111/j.1600-0447.2004.00388.x First citation in articleCrossrefGoogle Scholar

  • Zhang, J., Sun, L., Liu, Y., & Zhang, J. (2014). The change in suicide rates between 2002 and 2011 in China. Suicide and Life-Threatening Behavior, 44(5), 560–568. 10.1111/sltb.12090 First citation in articleCrossref MedlineGoogle Scholar

  • Zhang, J., & Xu, H. (2007). The effects of religion, superstition, and perceived gender inequality on the degree of suicide intent: A study of serious attempters in China. Omega (Westport), 55(3), 185–197. 10.2190/OM.55.3.b First citation in articleCrossref MedlineGoogle Scholar

  • Zhang, W.-C., Jia, C.-X., Zhang, J.-Y., Wang, L.-L., & Liu, X.-C. (2015). Negative life events and attempted suicide in rural China. PLoS One, 10(1), e0116634. 10.1371/journal.pone.0116634 First citation in articleCrossref MedlineGoogle Scholar

  • Zhou, L., Wang, G., Jia, C., & Ma, Z. (2018). Being left-behind, mental disorder, and elderly suicide in rural China: A case-control psychological autopsy study. Psychological Medicine, 49(3), 458–464. 10.1017/S003329171800106X First citation in articleCrossref MedlineGoogle Scholar