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      Prevalence of Suicide Attempts among College Students in China: A Meta-Analysis

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          Abstract

          Background

          Suicide is the leading cause of death among 15–34 year olds in China, but no national data are available on the suicide and suicide attempts rates of college students, a sub-group of youth with 23 million. Several studies have reported the prevalence of suicide attempts among college students, however, no meta-analysis pooling the prevalence of suicide attempts is found.

          Objective and Methods

          This study aims to estimate the pooled prevalence of suicide attempts among college students in China. The relevant studies up to August 2014 were systematically searched via electronic databases (PubMed-Medline, Embase, Chinese Wanfang database, Chinese National Knowledge Infrastructure and Chinese VIP database). We only selected original articles that either reported the prevalence of suicide attempts or sufficient data for calculating the prevalence.

          Results

          A total of 29 eligible studies, with 88,225 college students, were finally included. The maximum and minimum reported prevalences of suicide attempts among college students in China were 0.4% and 10.5%, respectively. The pooled prevalence of suicide attempts was 2.8% (95% CI: 2.3%–3.3%). Subgroup analyses showed that the pooled estimate of prevalence of life time suicide attempts was 2.7% (95% CI: 2.1%–3.3%), and 12-month suicide attempts was 2.9% (95% CI: 2.0%–3.8%). The prevalence for males was 2.4% (95% CI: 1.8%–3.0%), and for females was 2.7% (95% CI: 1.9%–3.7%). The prevalences among college students in grade 1 through 4 were 2.8% (95% CI: 1.7%–3.8%), 1.8% (95% CI: 1.2%–2.3%), 2.0% (95% CI: 0.8%–3.1%), and 2.9% (95% CI: 0.1%–6.7%), respectively. The prevalences among college students from rural and urban areas were 5.1% (95% CI: 2.8%–7.5%) and 3.7% (95% CI: 1.4%–5.9%), respectively.

          Conclusions

          2.8% prevalence of suicide attempts and more than 600,000 suicide attempters among college students indicate that suicide attempt among college students is an important public health problem in China. More attention should be paid to the current situation.

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          Most cited references32

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          Emerging adulthood. A theory of development from the late teens through the twenties.

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          Emerging adulthood is proposed as a new conception of development for the period from the late teens through the twenties, with a focus on ages 18-25. A theoretical background is presented. Then evidence is provided to support the idea that emerging adulthood is a distinct period demographically, subjectively, and in terms of identity explorations. How emerging adulthood differs from adolescence and young adulthood is explained. Finally, a cultural context for the idea of emerging adulthood is outlined, and it is specified that emerging adulthood exists only in cultures that allow young people a prolonged period of independent role exploration during the late teens and twenties.
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            Suicide and suicidal behavior.

            Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.
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              This article shows that the interpretation of the random-effects models used in meta-analysis to summarize heterogeneous treatment effects can have a marked effect on the results from decision models. Sources of variation in meta-analysis include the following: random variation in outcome definition (amounting to a form of measurement error), variation between the patient groups in different trials, variation between protocols, and variation in the way a given protocol is implemented. Each of these alternatives leads to a different model for how the heterogeneity in the effect sizes previously observed might relate to the effect size(s) in a future implementation. Furthermore, these alternative models require different computations and, when the net benefits are nonlinear in the efficacy parameters, result in different expected net benefits. The authors' analysis suggests that the mean treatment effect from a random-effects meta-analysis will only seldom be an appropriate representation of the efficacy expected in a future implementation. Instead, modelers should consider either the predictive distribution of a future treatment effect, or they should assume that the future implementation will result in a distribution of treatment effects. A worked example, in a probabilistic, Bayesian posterior framework, is used to illustrate the alternative computations and to show how parameter uncertainty can be combined with variation between individuals and heterogeneity in meta-analysis.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                2015
                9 February 2015
                : 10
                : 2
                : e0116303
                Affiliations
                [1 ]Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
                [2 ]Department of Public Health, Fuyang Center for Disease Control and Prevention, Fuyang, China
                Chiba University Center for Forensic Mental Health, Japan
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: LY DY. Performed the experiments: LY ZZ LS. Analyzed the data: LY YS LS. Contributed reagents/materials/analysis tools: LY ZZ. Wrote the paper: LY ZZ.

                ‡ These authors contributed equally to this work.

                Article
                PONE-D-14-45488
                10.1371/journal.pone.0116303
                4321993
                25664661
                2b38e1a2-269c-4e48-83d8-1a40a77f4255
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 15 October 2014
                : 6 December 2014
                Page count
                Figures: 3, Tables: 2, Pages: 13
                Funding
                The work was funded by a grant from the National Natural Science Foundation of China (grant no. 81202224). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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