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      Temporal Trends of Suicide Mortality in Mainland China: Results from the Age-Period-Cohort Framework

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          Abstract

          The aim of this study is to explore the long-term trends of suicide mortality in China. We implemented the age-period-cohort (APC) framework, using data from the Global Burden of Disease Study 2013. Our results showed that the net drift of suicide mortality was −4.727% (95% CI: −4.821% to −4.634%) per year for men and −6.633% (95% CI: −6.751% to −6.515%) per year for women, and the local drift values were below 0 in all age groups ( p < 0.01 for all) for both sexes during the period of 1994–2013. Longitudinal age curves indicated that, in the same birth cohort, suicide death risk increased rapidly to peak at the life stage of 20–24 years old and 15–24 years old for men and women, respectively, and then showed a decelerated decline, followed by a rise thereafter after 54 years old for men and a slight one after 69 years old for women. The estimated period and cohort RRs were found to show similar monotonic downward patterns (significantly with p < 0.01 for all) for both sexes, with more quickly decreasing for women than for men during the whole period. The decreasing trend of suicide was likely to be related to the economic rapid growth, improvements in health care, enhancement on the level of education, and increasing awareness of suicide among the public in China. In addition, fast urbanization and the effective control of pesticides and rodenticides might be the special reasons behind these trends we observed in this study.

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          Most cited references52

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          Suicide rates in China, 1995-99.

          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. 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. 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. 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.
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            Suicide rates in China from 2002 to 2011: an update.

            The aims of this study were: (1) to present the time trend of suicide rate among people aged 15 or above in China over the period 2002-2011 and (2) to examine the current profile of completed suicides during 2009-2011. Data on suicide rate in 2002-2011 were provided by the Chinese Ministry of Health (MOH). The trends of region-, gender-, and age-specific suicide rates were examined using Poisson regression models. The mean number of completed suicides for each cohort during 2009-2011 was calculated and a mean national suicide rate was estimated. The overall suicide rate decreased significantly over the past decade, but rates in young males and rural older adults did not reduce and in fact increased among older adults in both urban and rural areas towards the end of the study period. For 2009-2011, 44 % of all suicides occurred among those aged 65 or above and 79 % among rural residents. The estimated mean national suicide rate was 9.8 per 100,000 and was slightly higher for males than females. The benefits of economic growth, such as higher employment and more educational opportunities for the rural population in particular, may have contributed to the reduced suicide rate in China. However, the recent rapid changes in socioeconomic conditions could have increased stress levels and resulted in more suicides, especially among the elderly. Despite the significant reduction reported here, the latest figures suggest the declining trend is reversing. It will be important to continue monitoring the situation and to examine how urbanization and economic changes affect the well-being of 1.3 billion Chinese.
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              Prevalence of suicidal ideation and suicide attempts in the general population of China: A meta-analysis.

              The objective of this meta-analysis is to estimate the pooled prevalence of suicidal ideation and suicide attempts in the general population of Mainland China.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                03 August 2016
                August 2016
                : 13
                : 8
                : 784
                Affiliations
                [1 ]School of Public Health, Wuhan University, Wuhan 430071, China; wongzhenkun@ 123456gmail.com (Z.W.); jinjinyao456@ 123456163.com (J.W.); junzhe_bao@ 123456126.com (J.B.); gaoxudongne@ 123456163.com (X.G.)
                [2 ]Center for Injury Research and Policy & Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH 43210, USA
                [3 ]College of Medicine, The Ohio State University, Columbus, OH 43210, USA
                [4 ]Global Health Institute, Wuhan University, Wuhan 430071, China
                Author notes
                [* ]Correspondence: yuchua@ 123456163.com (C.Y.); huiyun.xiang@ 123456nationwidechildrens.org (H.X.); Tel.: +86-27-6875-9299 (C.Y.); +1-614-355-5893 (H.X.)
                Article
                ijerph-13-00784
                10.3390/ijerph13080784
                4997470
                27527195
                5aa16aef-3dc7-4165-9828-867064c3df9b
                © 2016 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 12 May 2016
                : 01 August 2016
                Categories
                Article

                Public health
                suicide,apc framework,temporal trend,china
                Public health
                suicide, apc framework, temporal trend, china

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