Factors associated with suicidal behaviors in mainland China: a meta-analysis

BACKGROUND Suicide is a major public health issue in China. Studies of suicide risk factors have reported both inconsistent and inconclusive results. This review aimed to determine suicide risk factors in China. METHODS Medline/PubMed, EMBASE, CNKI (China National Knowledge Infrastructure) and VIP (Chinese Journal of Science and Technology of VIP) were searched for relevant reports. Two investigators independently assessed the eligibility of identified studies and extracted data. Pooled odds ratios (and 95% confidence intervals) were calculated for each factor with Revman 5.0. RESULTS Forty-four studies with 192,362 subjects were included. The pooled results indicated that mood disorders and stressful life events (physical illness, suicide of relatives) increased the risk of suicide ideation among the entire population. Socio-family environment (single or remarried parent, study pressure and academic achievement) and unhealthy behaviors (smoking, alcohol drinking, and drug use) were risk factors for suicide ideation among youth. Unhealthy behaviors (smoking and alcohol drinking), mood disorders, and stressful life events (suicide of relatives) were the main risk factors for attempted suicide. Persons living in rural areas, and those with lower education, mood disorders, and/or a history of negative life events had a higher risk of completed suicide. In China, before 2000, females had a significantly higher rate of completed suicide than males, while after 2000, no significant gender difference was found. CONCLUSIONS Socio-family environment, lifestyle, life events and psychiatric/psychological factors are associated with suicidal behaviors in China. Further case-control or cohort studies are needed to better understand suicide behaviors in China. Meanwhile, there is an urgent need for comprehensive studies of suicide interventions among high-risk populations.