Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 1, pp 99–110 | Cite as

Historical trends in suicide risk for the residents of mainland China: APC modeling of the archived national suicide mortality rates during 1987–2012

  • Xinguang Chen
  • Yang SunEmail author
  • Zhi Li
  • Bin Yu
  • Ge Gao
  • Peigang Wang
Original Paper
  • 174 Downloads

Abstract

Purpose

Distinctive and dramatic changes in the history of China with a rapid suicide decline in recent years present an opportunity to investigate the risk of suicide. In this study, we investigated suicide risk with a historical perspective with archived data to inform suicide research and prevention policies and strategies.

Method

Documented age-specific suicide mortality rates in 1987–2012 were decomposed into age, period, and cohort effect using APC-modeling method and intrinsic estimator (IE) technique. The estimated effects were further analyzed by numerical differentiation.

Results

The data satisfactorily fit the constructed APC models. Cohort effect indicated that suicide risk in China fluctuated at very high levels during 1903–1967, followed by a sharp decline during 1968–1977, and reached the lowest level in 1983–1987 before increased again. Period effect confirmed the declining trend since 1987. Three sunny cohorts with reduced suicide risk and four cloudy cohorts with increased risk were, respectively, associated with significant cultural, social, political, and economic events in China since the 1900s.

Conclusions

The mega trends in the suicide risk at the population level are closely related to significant historical events in China. Suicide is anticipated to increase because of the growing risk for the young cohorts (particularly young females) as the country further develops. Study findings suggest the significance of national strategies for suicide prevention and control, including maintenance of social harmony and stability, provision of more opportunities for development, enhancement of social integration, and restriction of suicide facilitating factors.

Keywords

Suicide research Social determinants Historical epidemiology China Age–period–cohort modeling 

Notes

Acknowledgements

The study was supported in part by the four participation schools, including Wuhan University, University of Florida, The Pennsylvania State University, and University of Maryland.

Author contributions

XC initiated the idea and worked with the team to establish the framework, guided data analysis, write most of the manuscript. YS participated in framing the research, collected data and participated in data analysis, results interpretation and manuscript development. ZL participated in later-stage in reframing the research topic, collected part of the data, and conducted most of the analysis, contributed much for manuscript preparation. BY and GG assisted in literature search, data analysis, results tabulation and graphing, manuscript writing and reviewing. PW participated in results interpretation and manuscript development.

Funding

The study was supported by the Humanities and Social Sciences Project of China Ministry of Education (17YJCZH155) and National Natural Science Foundation of China (71573192, 71303012). In addition, author Chen X was supported in part by the Clinical and Translational Science Institute (CTSI) at the University of Florida.

Compliance with ethical standards

Conflict of interest

None of the authors has a conflict of interest associated with the reported research.

Availability of data and material

The data sets generated and/or analyzed during the current study are available in the NHFPC (National Health and Family Planning Commission of the People’s Republic of China) repository, http://www.nhfpc.gov.cn/zwgk/tjnj1/ejlist.shtml, and published on Annual China Health Statistical Yearbook, which renamed as China Health and Family Planning Statistics Yearbook from year 2014.

Supplementary material

127_2018_1593_MOESM1_ESM.tif (969 kb)
Supplementary material 1 (TIF 968 KB)
127_2018_1593_MOESM2_ESM.docx (29 kb)
Supplementary material 2 (DOCX 28 KB)

References

  1. 1.
    World Health Organization (2013) Comprehensive mental health action plan 2013–2020: resolution WHA66/8. World Health Organization, GenevaGoogle Scholar
  2. 2.
    Thomas SP (2013) World Health Assembly adopts comprehensive Mental Health Action Plan for 2013–2020. Issues Ment Health Nurs 34(10):723–724Google Scholar
  3. 3.
    Saxena S, Funk M, Chisholm D (2013) World Health Assembly adopts Comprehensive Mental Health Action Plan 2013–2020. Lancet 381(9882):1970–1971Google Scholar
  4. 4.
    World Health Organization (2014) Prevention of Suicide: a global perspective. World Health Organization, GenevaGoogle Scholar
  5. 5.
    Milner A et al (2013) Social-environmental factors and suicide mortality: a narrative review of over 200 articles. Sociol Mind 3(2):137–148Google Scholar
  6. 6.
    Chang BP et al (2016) Biological risk factors for suicidal behaviors: a meta-analysis. Transl Psychiatry 6(9):e887Google Scholar
  7. 7.
    Pandey GN (2013) Biological basis of suicide and suicidal behavior. Bipolar Disord 15(5):524–541Google Scholar
  8. 8.
    Wasserman D, Cheng Q, Jiang GX (2005) Global suicide rates among young people aged 15–19. World Psychiatry 4(2):114–120Google Scholar
  9. 9.
    Furczyk K et al (2013) The neurobiology of suicide—a review of post-mortem studies. J Mol Psychiatry 1(1):2Google Scholar
  10. 10.
    Hsu IC (2008) Recent history of China: struggling and raising of China 1600 to 2000 (6th edn) [In Chinese]. Hou Lang Publication and Counseling Ltd., BeijingGoogle Scholar
  11. 11.
    Qiao J, Pan NG (1995) Beliefs and behaviors of Chinese people. In: Proceedings of the 4th international conference on modernization and chinese culture. People’s Publication Press of Tianjin, TianjinGoogle Scholar
  12. 12.
    Tien H (1989) The great transition: political and social change in the Republic of China. Hoover Institute Press, StanfordGoogle Scholar
  13. 13.
    Ding QJ, Hesketh T (2006) Family size, fertility preferences, and sex ratio in China in the era of the One Child Family Policy: results from national family planning and reproductive health survey. BMJ 333(7564):371–373Google Scholar
  14. 14.
    Lu M, Jiang SQ (2008) Labor market reform, income inequality and economic growth in China. China World Econ 16(6):63–80Google Scholar
  15. 15.
    Maasoumi E, Wang L (2008) Economic reform, growth and convergence in China. Econ J 11(1):128–154Google Scholar
  16. 16.
    Page A et al (2017) Suicide by pesticide poisoning remains a priority for suicide prevention in China: analysis of national mortality trends 2006–2013. J Affect Disord 208:418–423Google Scholar
  17. 17.
    Wang ZK et al (2016) Temporal trends of suicide mortality in Mainland China: results from the age-period-cohort framework. Int J Environ Res Public Health 13(8):784Google Scholar
  18. 18.
    Li Z et al (2016) Age-period-cohort analysis of infectious disease mortality in urban-rural China, 1990–2010. Int J Equity Health 15:55Google Scholar
  19. 19.
    Zhang J et al (2014) The change in suicide rates between 2002 and 2011 in China. Suicide Life Threat Behav 44(5):560–568Google Scholar
  20. 20.
    Sun JD et al (2013) Suicide rates in Shandong, China, 1991–2010: rapid decrease in rural rates and steady increase in male-female ratio. J Affect Disord 146(3):361–368Google Scholar
  21. 21.
    Lu J et al (2013) The suicide rates in the Yunnan Province, a multi-ethnic province in Southwestern China. Int J Psychiatry Med 45(1):83–96Google Scholar
  22. 22.
    Zhang J, Jia CX (2011) Suicidal intent among young suicides in rural China. Arch Suicide Res 15(2):127–139Google Scholar
  23. 23.
    Zhang J et al (2010) Economic growth and suicide rate changes: a case in China from 1982 to 2005. Eur Psychiatry 25(3):159–163Google Scholar
  24. 24.
    Chen X, Wang PG (2014) Social change and the dynamic change in national health status in China (in Chinese). Chin J Popul Sci (in Chinese) 26:63–73Google Scholar
  25. 25.
    Durkheim E (1851) Suicide, a study in sociology. Routledge Classics, LondonGoogle Scholar
  26. 26.
    Phillips MR, Liu HQ, Zhang YP (1999) Suicide and social change in China. Cult Med Psychiatry 23(1):25–50Google Scholar
  27. 27.
    Guan TR et al (2001) Association of socioeconomic status (SES) with suicide death rates (SDR) in mainland China. Am J Epidemiol 153(11):S181–S181Google Scholar
  28. 28.
    Phillips MR, Li XY, Zhang YP (2002) Suicide rates in China, 1995–99. Lancet 359(9309):835–840Google Scholar
  29. 29.
    Wikipedia (2017) List of countries by suicide rate [cited 2017 Mar 22]. https://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate
  30. 30.
    Wang CW, Chan CL, Yip PS (2014) Suicide rates in China from 2002 to 2011: an update. Soc Psychiatry Psychiatr Epidemiol 49(6):929–941Google Scholar
  31. 31.
    Yip PSF et al (2005) Suicide rates in China during a decade of rapid social changes. Soc Psychiatry Psychiatr Epidemiol 40(10):792–798Google Scholar
  32. 32.
    Hendin H, Xiao S, Li X et al (2008) Suicide prevention in Asia: future directions. In: Hendin H (ed) Suicide and suicide prevention in Asia. World Health Organization, Geneva, Switzerland, pp 97–108Google Scholar
  33. 33.
    Fu WJJ (2000) Ridge estimator in singular design with application to age-period-cohort analysis of disease rates. Commun Stat Theory Methods 29(2):263–278Google Scholar
  34. 34.
    Holford TR (1991) Understanding the effects of age, period, and cohort on incidence and mortality rates. Annu Rev Public Health 12:425–457Google Scholar
  35. 35.
    Mason KO, Winsboro H (1973) Some methodological issues in cohort analysis of archival data. Am Sociol Rev 38(2):242–258Google Scholar
  36. 36.
    Yang Y, Fu WJJ, Land KC (2004) A methodological comparison of age-period-cohort models: the intrinsic estimator and conventional generalized linear models. Sociol Methodol 34:75–110Google Scholar
  37. 37.
    Newman SC, Dyck RJ (1988) On the age-period-cohort analysis of suicide rates. Psychol Med 18(3):677–681Google Scholar
  38. 38.
    ​Wang ZK et al (2016) Age-period-cohort analysis of suicide mortality by gender among white and black Americans, 1983–2012. Int J Equity Health 15:107Google Scholar
  39. 39.
    Legare G, Hamel D (2013) An age-period-cohort approach to analyzing trends in suicide in Quebec between 1950 and 2009. Can J Public Health Revue Canadienne De Sante Publique 104(2):E118–E123Google Scholar
  40. 40.
    Odagiri Y, Uchida H, Nakano M (2011) Gender differences in age, period, and birth-cohort effects on the suicide mortality rate in Japan, 1985–2006. Asia Pac J Public Health 23(4):581–587Google Scholar
  41. 41.
    Keyes KM, Miech R (2013) Age, period, and cohort effects in heavy episodic drinking in the US from 1985 to 2009. Drug Alcohol Depend 132(1–2):140–148Google Scholar
  42. 42.
    Yang Y (2008) Trends in US adult chronic disease mortality, 1960–1999: age, period, and cohort variations. Demography 45(2):387–416Google Scholar
  43. 43.
    ​Chang J et al (2017) The effects of age, period, and cohort on mortality from ischemic heart disease in China. Int J Environ Res Public Health 14(1):50Google Scholar
  44. 44.
    Li XH et al (2016) Urbanization and health in China, thinking at the national, local and individual levels. Environ Health 15:S32Google Scholar
  45. 45.
    Liu S et al (2015) Spatiotemporal variation and social determinants of suicide in China, 2006–2012: findings from a nationally representative mortality surveillance system. Psychol Med 45(15):3259–3268Google Scholar
  46. 46.
    Chang SS et al (2009) Was the economic crisis 1997–1998 responsible for rising suicide rates in East/Southeast Asia? A time-trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Soc Sci Med 68(7):1322–1331Google Scholar
  47. 47.
    Ooe Y et al (2005) The age-period-cohort analysis of suicide in Japan (1980–2003). Gerontologist 45:42–43Google Scholar
  48. 48.
    Ooe Y et al (2001) The age-period-cohort analysis of suicide in Japan. Gerontologist 41:384–384Google Scholar
  49. 49.
    Ji JL, Kleinman A, Becker AE (2001) Suicide in contemporary China: a review of China’s distinctive suicide demographics in their sociocultural context. Harv Rev Psychiatry 9(1):1–12Google Scholar
  50. 50.
    Joe S (2006) Explaining changes in the patterns of Black suicide in the United States from 1981 to 2002: an age, cohort, and period analysis. J Black Psychol 32(3):262–284Google Scholar
  51. 51.
    Ajdacic-Gross V et al (2006) Age-period-cohort analysis of Swiss suicide data, 1881–2000. Eur Arch Psychiatry Clin Neurosci 256(4):207–214Google Scholar
  52. 52.
    Rodrigues NCP, Werneck GL (2005) Age-period-cohort analysis of suicide rates in Rio de Janeiro, Brazil, 1979–1998. Soc Psychiatry Psychiatr Epidemiol 40(3):192–196Google Scholar
  53. 53.
    ​Snowdon J, Hunt GE (2002) Age, period and cohort effects on suicide rates in Australia, 1919–1999. Acta Psychiatr Scand 105(4):265–270Google Scholar
  54. 54.
    Robertson C, Boyle P (1998) Age-period-cohort analysis of chronic disease rates. I: modelling approach. Stat Med 17(12):1305–1323Google Scholar
  55. 55.
    Yang G et al (2005) Mortality registration and surveillance in China: history, current situation and challenges. Popul Health Metr 3(1):3Google Scholar
  56. 56.
    Riggs JE, McGraw RL, Keefover RW (1996) Suicide in the United States, 1951–1988: constant age-period-cohort rates in 40- to 44-year-old men. Compr Psychiatry 37(3):222–225Google Scholar
  57. 57.
    ​Skegg K, Cox B (1991) Suicide in New-Zealand 1957–1986—the influence of age, period and birth-cohort. Aust N Z J Psychiatry 25(2):181–190Google Scholar
  58. 58.
    Stack S (2000) Suicide: a 15-year review of the sociological literature part II: modernization and social integration perspectives. Suicide Life Threat Behav 30(2):163–176Google Scholar
  59. 59.
    Zhang J et al (2009) Psychological strains found from in-depth interviews with 105 Chinese rural youth suicides. Arch Suicide Res 13(2):185–194Google Scholar
  60. 60.
    Zhang J et al (2011) Psychological strains and youth suicide in rural China. Soc Sci Med 72(12):2003–2010Google Scholar
  61. 61.
    ​Stack S (2000) Suicide: a 15-year review of the sociological literature part I: cultural and economic factors. Suicide Life Threat Behav 30(2):145–162Google Scholar
  62. 62.
    Stack S (1993) The effect of modernization on suicide in Finland—1800–1984. Sociol Perspect 36(2):137–148Google Scholar
  63. 63.
    Matthews K, Zhang NN (2010) Bank productivity in China 1997–2007: measurement and convergence. China Econ Rev 21(4):617–628Google Scholar
  64. 64.
    ​Rubinstein DH (1986) A stress-diathesis theory of suicide. Suicide Life Threat Behav 16(2):182–197Google Scholar
  65. 65.
    Van Heeringen K (2007) Stress-diathesis model of suicidal behavior. In: Dwivedi Y (ed) The neurobiological basis of suicide. CRC Press, Boca Raton, pp 113–124Google Scholar
  66. 66.
    Mann JJ et al (1999) Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 156(2):181–189Google Scholar
  67. 67.
    Hobcraft J, Menken J, Preston S (1985) Age, period, and cohort effects in demography—a review. In: Cohort analysis in social research. Springer, New York, NY, pp 89–135Google Scholar
  68. 68.
    Fogel RW, Costa DL (1997) A theory of technophysio evolution, with some implications for forecasting population, health care costs, and pension costs. Demography 34(1):49–66Google Scholar
  69. 69.
    ​Finch CE, Crimmins EM (2004) Inflammatory exposure and historical changes in human life-spans. Science 305(5691):1736–1739Google Scholar
  70. 70.
    Tao KT (1998) An overview of only child family mental health in China. Psychiatry Clin Neurosci 52:S206–S211Google Scholar
  71. 71.
    Chen ZY, Liu RX (2014) Comparing adolescent only children with those who have siblings on academic outcomes and psychosocial adjustment. Child Dev Res.  https://doi.org/10.1155/2014/578289 Google Scholar
  72. 72.
    ​Parry J (2014) Falling suicide rates in China mask emerging upward trends. Br Med J 349:g4486Google Scholar
  73. 73.
    ​Granizo JJ, Guallar E, RodriguezArtalejo F (1996) Age-period-cohort analysis of suicide mortality rates in Spain, 1959–1991. Int J Epidemiol 25(4):814–820Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Xinguang Chen
    • 1
    • 2
  • Yang Sun
    • 1
    • 3
    Email author
  • Zhi Li
    • 4
  • Bin Yu
    • 2
  • Ge Gao
    • 5
  • Peigang Wang
    • 1
  1. 1.Global Health InstituteWuhan UniversityWuhanChina
  2. 2.Department of EpidemiologyUniversity of FloridaGainesvilleUSA
  3. 3.Department of Public Affairs and Management, School of Political Science and Public AdministrationWuhan UniversityWuhanChina
  4. 4.Department of Sociology and CriminologyThe Pennsylvania State University, University ParkPennsylvaniaUSA
  5. 5.Department of SociologyUniversity of MarylandCollege ParkUSA

Personalised recommendations