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Given the absence of a complete vital registration system in rural China, a unique large-scale ethnographic study was conducted to examine the incidents, trends, demographic characteristics and motives for suicide. This study was implemented in 55 villages from 23 prefectures in 11 provinces. Family members, relatives, friends, and neighbours of suicide victims, and key informants (cadres, village doctors, funeral/burial coordinators, and primary-school teachers) in a village were interviewed to obtain and verify the detailed life history of each suicide victim since the 1980s. Among 849 suicide victims we investigated, we found more female than male victims, which is reversed gender difference in traditional suicide literature. Both number of elderly suicide victims and suicide motives related to livelihood have dramatically increased in recent years. There were more middle-aged victims during the years 1995–9. This study suggests that suicide in rural China remains an urgent and enormous public health problem. Findings from this research cast doubt on the well-known sex disparity in China’s suicide victims and suggest a possible epidemic of elderly suicides in rural China. The shifting pattern of suicide motives tracks socio-cultural changes in rural China.

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