Risk factors of Suicidal behavior in Chinese adolescents

Introduction: With rapid economic growth, urbanization, and living standard improvement, suicide rate in China has been declining and the high female-male and rural-urban ratios have become less pronounced since early 1990s. These changes are mainly attributed to the decline of suicide rate in rural young women. It is imperative to investigate the risk and protective factors of suicide in rural China for the development of effective prevention and intervention programs of suicide. This study aims to examine the psychosocial risk factors of suicidal behavior, including suicidal thought (ST), suicide plan (SP), and suicide attempts (SA), in a large sample of rural Chinese adolescents.

Methods: This report represents the first wave data of an ongoing longitudinal study, Shandong Rural Adolescent Behavior & Health (SRABH). In November-December 2015, participants completed a structured adolescent health questionnaire, including ST, SP, SA, suicidal characteristics, demographics, substance use, hopelessness, impulsivity, and internalizing and externalizing behavioral problems. Multivariate logistic regression was used to examine psychosocial factors associated with last-year suicidal behavior.

Results: Participants included 11,836 adolescent students from 3 rural counties of Shandong, China. Mean age of participants was 15.0 (SD=1.5) and 51% were boys. The factors that were associated with increased odds of suicidal behavior were very similar across suicide thought, plan, and attempt. After adjusting for potential covariates, female gender, ever smoking, ever drinking, internalizing and externalizing problems, hopelessness, suicide/attempt history of friends and acquaintances, poor family economic status, and poor parental relationship were all significantly associated with elevated risk of the 3 suicidal behaviors. For example, compared with male adolescents, females had approximately 2-fold increased risk of suicide attempt (OR= 1.93, 95%CI=1.53-2.45), suicide plan (OR=2.01, 95%CI=1.56-2.58), and suicidal thought (OR=2.18, 95%CI=1.89-2.52). Chronic disease/ disability, impulsiveness, college or above of father education, and non-famer occupation of father were associated with increased risk of suicide thought and suicide attempt. Family suicide/attempt history was significantly associated with 70% increased risk of suicide plan (OR=1.70, 95%CI=1.19-2,43) compared with those adolescents without family suicide/attempt history.

Conclusions: Multiple child and family factors are associated with suicidal behavior in rural Chinese adolescents. Although longitudinal studies are needed to examine the moderators and mediators and developmental changes of suicidal behavior, our findings are of great importance for early identifying adolescents at risk and developing and implementing suicide prevention and intervention programs for rural