Suicide rates in China, 1995–99

doi:10.1016/S0140-6736(02)07954-0

The Lancet

Volume 359, Issue 9309, 9 March 2002, Pages 835-840

https://doi.org/10.1016/S0140-6736(02)07954-0 Get rights and content

Summary

Background

A wide range of suicide rates are reported for China because official mortality data are based on an unrepresentative sample and because different reports adjust crude rates in different ways. We aimed to present an accurate picture of the current pattern of suicide in China on the basis of conservative estimates of suicide rates in different population cohorts.

Methods

Suicide rates by sex, 5-year age-group, and region (urban or rural) reported in mortality data for 1995–99 provided by the Chinese Ministry of Health were adjusted according to an estimated rate of unreported deaths and projected to the corresponding population.

Findings

We estimated a mean annual suicide rate of 23 per 100 000 and a total of 287 000 suicide deaths per year. Suicide accounted for 3·6% of all deaths in China and was the fifth most important cause of death. Among young adults 15–34 years of age, suicide was the leading cause of death, accounting for 19% of all deaths. The rate in women was 25% higher than in men, mainly because of the large number of suicides in young rural women. Rural rates were three times higher than urban rates—a difference that remained true for both sexes, for all age-groups, and over time.

Interpretation

Suicide is a major public-health problem for China that is only gradually being recognised. The unique pattern of suicides in China is widely acknowledged, so controversy about the overall suicide rate should not delay the development and testing of China-specific suicide-prevention programmes.

Introduction

The official report on mental health by the Chinese government,¹ presented at a WHO-Ministry of Health collaborative meeting held in Beijing in November, 1999, identified suicide as one of the priorities for mental-health work in China, and reported a national suicide rate for 1993 of 22·2 per 100 000. When applied to China's large population, this rate translates to over 250 000 suicide deaths per year and makes suicide one of the leading causes of death for the country. The Ministry of Health has provided WHO with official mortality statistics that include deaths from suicide since 1987,² but the 1999 report represented the first high-level recognition of the public-health importance of suicide for China.

Despite the availability of official figures, reported estimates of China's suicide rate vary over a wide range; for example, reported rates for 1990 range from 13·9³ to 30·3⁴ per 100 000. This disparity stems from two separate causes. Like many developing countries, China does not have a complete vital registration system; the official mortality figures provided to WHO are based on data from about 10% of the population (more than 100 million individuals). This sample is collected from locations that have relatively good reporting mechanisms, so it has a much higher proportion of urban residents than is true of the population as a whole. Given the large differences in urban versus rural suicide rates (rural rates are three-fold higher than urban rates), presentation of the suicide rate in the overall sample as China's national rate, as is done in some of the WHO statistical annuals² and by several authors,5, 6, 7 seriously underestimates China's suicide rate.

The second reason for the confusion is that the Global Burden of Disease (GBD) study4, 8 and the 1999 WHO World Health Report⁹ estimate much higher suicide rates for China than the official figures from the Chinese Ministry of Health published in the WHO statistical annuals.² The GBD study applied several adjustments to mortality data from China's Disease Surveillance Points system to estimate 343 000 suicides in 1990 (30·3 per 100 000), and WHO used similar methods to estimate 413 000 suicides in 1998 (32·9 per 100 000). On the basis of these results—which are about 40% higher than official Chinese figures—China accounts for 21% of the world's population but for 44% of all suicides in the world and for 56% of all female suicides in the world.¹⁰

In this paper, we aim to present an accurate picture of the current pattern of suicides in China on the basis of conservative estimates of the rates of suicide in different sex, age, and region cohorts. We use the most recent mortality data for China provided by the Ministry of Health, and detailed population and mortality estimates from China's Bureau of Statistics, to estimate the numbers and rates of suicide in China for 1995–99. The reliability of these figures and the reasons for the differences between these conservatively adjusted “official” suicide rates and the much higher rates estimated by the GBD study and WHO are discussed.

Section snippets

Methods

The statistical division of the Chinese Ministry of Health provided mortality data (with categories from the 9th revision of the International Classification of Diseases) for 1995–99 from its vital registration system. These data provide the rates of death by cause and sex for 18 5-year age-groups for urban and rural residents (a total of 72 cohorts). Over the 5 years, this system recorded 3·53 million deaths and 78 000 suicides from a sample population of, on average, 110 million individuals

Results

As shown in table 1 and the figure, we found that rural suicide rates were an average of three-fold higher than urban rates, and that these differences held true for men and women and in all age-groups. Moreover, the increase in suicide rates from middle age onwards was much more striking in rural areas than in urban areas, and started at an earlier age in the rural areas. Given these high rural rates and the large proportion of the population that lives in rural areas, 93% of all suicides

Discussion

China is one of a very few countries that report higher rates of completed suicide in women than in men (others include Kuwait and Bahrain¹²). Rates in women are only 25% higher than in men, but much press attention¹³ has focused on the contrast between China and Western countries, in which the male-to-female ratio of completed suicide is almost always greater than 2:1 and frequently greater than 3:1.¹⁴ In fact, the sex reversal seen in China is an extension of the lower male-to-female ratio of

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ArticlesSuicide rates in China, 1995–99

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Methods

Results

Discussion

Soc Sci Med

Current status of mental health work in China: problems and recommendations

Chin Ment Health J

World Health Statistics Annual

What is the Chinese suicide rate?

Percept Mot Skills

Global Health Statistics: a compendium of incidence, prevalence, and mortality estimates for over 200 conditions

Suicide in the People's Republic of China catergorized by age and gender: evidence of the influence of culture on suicide

Acta Psychiatr Scand

World mental health: problems and priorities in low-income countries

The gender difference in Chinese suicide rates

Arch Suicide Res

The Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020

The World Health Report 1999

Suicide and social change in China

Cult Med Psychiatry

China population statistics yearbook

Suicide in Asia and the Far East

No way out

New Scientist

Suicide in the Western World

Attempted suicide in west London, I: rates across ethnic communities

Psychol Med

Articles
Suicide rates in China, 1995–99