Background: Each year 100,000 elderly persons in mainland China die by suicide. Persons 55 years of age and older represent 14% of the population but they account for 35% of all suicides in the country. As a first step toward preventing elderly suicides in China, this study aims to describe the characteristics and risk factors for suicide in this high-risk age group.
Methods: We use data from the national psychological autopsy study of accidental deaths conducted in 23 geographically representative Disease Surveillance Points around China that identified 304 suicides (cases) and 167 accidental deaths (controls) in persons 55 years of age and older. A detailed interview survey and structured psychiatric examination that took 2-3 hours to complete was independently administered to family members and associates of each identified subject.
Findings: Among the 304 identified suicides, 58% were male, 80% lived in rural villages, 61% had never attended school, 52% died by ingesting pesticides, 50% had relatives or associates who had had suicidal behavior, 65% had a mental illness at the time of the suicide, 25% had made a prior suicide attempt, and only 5% had ever seen a mental health professional. The most common negative life events experienced by these individuals in the year prior to death were serious physical illness (72%), illness or death of a relative (43%), financial problems (35%), conflict with children (29%) and marital problems (22%). Many variables differed between cases and controls in the univariate analysis, but after adjusting for gender, age (55-69 versus 70 and over), location of residence (village versus other), and research site, only seven independent predictors of suicide remained in the unconditional logistic regression equation (in order of importance): prior suicide attempt, severity of depressive symptoms in the two weeks prior to death, severe interpersonal crisis in the two days prior to death, chronic stress due to long-standing negative life events, acute stress at the time of death, low quality of life in the month prior to death, and having friends or associates who had had suicidal behavior. Suicide risk increased substantially with exposure to multiple risk factors: 7.3% (8/110) of the subjects exposed to one or fewer of the seven risk factors died of suicide, but 60.9% (78.128) with 2 or 3 risk factors, 92.6% (188/203) with 4 or 5 risk factors, and 100% (30/30) with 6 or 7 risk factors died by suicide.
Interpretation: The characteristics of elderly suicides in China are substantially different from those reported in other countries. Suicide prevention programs for the elderly in China must focus on rural areas and be tailored to the identified characteristics of elderly suicides: the high rates of pesticide ingestion, the importance of acute precipitating stressors and serious illnesses, the substantial proportion without a mental illness, the very low utilization of mental health services among those with a mental illness, and the cumulative increase in suicide risk with exposure to multiple risk factors.
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