Completed Suicide With Violent and Non-violent Methods by the Elderly in Rural China: A Psychological Autopsy Study

Abstract

Background: Late-life suicide is a severe public health problem in rural China; however, knowledge regarding the specific characteristics and risk factors for completed suicide via violent and non-violent methods among elderly individuals in rural China is limited.Methods: Subjects aged 60 years or older were selected from rural areas in Shandong, Hunan, and Guangxi provinces in China. This study was a 1:1 matched case-control design conducted by using the psychological autopsy method.Results: According to the univariate analyses, the presence of mental disorder, higher degree of depression, loneliness, lack of social support, hopelessness, impulsivity, and increased quantity of life events were associated with suicide in both violent and non-violent methods. For violent suicide, another risk factor was the lack of pesticides at home. For non-violent suicide, other risk factors were not currently married, family suicide history, and alcohol use disorder (P < 0.05). Variables that remained in the logistic regression model were the severity of depressive symptoms for both violent and non-violent suicide. For non-violent suicide, the degree of hopelessness was another independent risk factor. In addition, violent suicides were more likely to lack pesticides at home, choose the spring season and have an increased quantity of life events than those who died by suicide via non-violent methods.Conclusion: The major risk factor for both violent and non-violent suicide was the severity of depressive symptoms. Suicide prevention measures that focus on depression among this vulnerable population are urgently needed. Moreover, the characteristics of suicides via violent methods differed from those via non-violent methods among elderly individuals. Suicide prevention efforts should be tailored to the specific characteristics of the different suicide methods utilized by older adults in rural areas.

Association of Dietary Inflammatory Index With Depression and Suicidal Ideation in Older Adult: Results From the National Health and Nutrition Examination Surveys 2005–2018

“…Diet may have a lesser impact on suicidal ideation than social factors. Indeed, according to earlier surveys, unhappy marriages, inadequate education, and economic poverty are significant social factors contributing to older adults' suicide (24,25). Furthermore, our gender stratification results indicate that both men and women in the High-DII group are at higher risk of developing depression than those in the Low-DII group.…”

“…Diet may have a lesser impact on suicidal ideation than social factors. Indeed, according to earlier surveys, unhappy marriages, inadequate education, and economic poverty are significant social factors contributing to older adults’ suicide ( 24 , 25 ).…”

The short-term effect of ambient particulate matter on suicide death

“…However, Sun et al reported the presence of seasonality among non-violent suicide cases [ 33 ]. A psychological autopsy study comparing violent and non-violent suicides among elderly individuals in rural China found that non-violent suicide cases had higher levels of depression compared to violent suicide cases and emphasized that depression and hopelessness were independent risk factors for non-violent suicide [ 26 ]. Considering that depression and hopelessness are risk factors for suicidal ideation and death [ 34 ], it is possible that non-violent suicide cases may be more vulnerable to environmental factors such as PM.…”

“…Violent methods included hanging, jumping from a height, jumping in front of a car or train, cutting and piercing with sharp objects, using firearms or shotguns, and self-immolation. Non-violent methods included ingestion of pesticides, drug overdose, gas poisoning, and suffocation [ 26 ]. In addition, the main cause of suicide was recorded as the factor that caused severe pain to the person who committed suicide and had the strongest influence on suicide among the stress factors that lasted until death by reviewing the investigation records.…”

Hospital inpatient suicides: A retrospective comparison between psychiatric and non‐psychiatric inpatients in Milan healthcare facilities

“…From a medico‐legal point of view, for suicidal ideation is meant to have expressed verbally to someone the intent to die by suicide; instead, for previous suicide attempts is meant to have put in place concrete self‐harming actions of such severity as to be fatal. As for the method, it was divided into violent and nonviolent (Zhu et al, 2021): violent methods are hanging, drowning, use of a firearm or shotgun, cutting and piercing with sharp objects, jumping from high places, and being hit by a train or other vehicle; nonviolent methods are ingestion of pesticides, gas poisoning, suffocation, and drug overdose. For all the cases, a distinction was made between “simple suicides” and “complex suicides” (Bohnert, 2005; Gentile et al, 2021; Marcinkowski et al, 1974), that is, between suicides implemented through the application of a single injurious modality, and those implemented with the simultaneous or in the chronological succession application of more than one modality.…”