Prevalence of suicidal ideation in Chinese college students: a meta-analysis

Suicidal Behavior and Associated Factors Among Students in Mettu University, South West Ethiopia, 2019: An Institutional Based Cross-Sectional Study

BACKGROUND

Suicidal behavior is a leading cause of injury and death worldwide. It is a public health issue that is estimated to contribute more than 2.4% to the global burden of disease by the year 2020. University and college students are among groups affected more than the general population. However, there is a scarcity of studies on the magnitude and associated factors of suicidal behavior among University students in Ethiopia, particularly in Mettu University. Therefore, we assessed the prevalence of suicidal behavior and associated factors among Mettu University students.

METHODS

Institution-based multistage stratified cross-sectional study design was conducted among 523 regular main campus students of Mettu University. The Suicidal Behaviors Questionnaire Revised (SBQ-R) was used to screen the presence of suicidal behavior symptoms. Data analysis was done using SPSS version 20.

RESULTS

Lifetime prevalence of suicidal ideation, plan, and attempt was 58.3%, 37.3%, and 4.4%, respectively, with one-year prevalence of suicidal ideation at 34%. The multivariate logistic regression analysis revealed that the odds of suicidal ideation were higher among female gender, students who had poor social support, family history of suicide attempt, lifetime alcohol use, rural residence, and less frequently engaging in religious practice; these factors were significantly associated with suicidality.

CONCLUSION

Nearly one-fourth of respondents report suicidal behavior. Prevalence of suicide was found to be higher. Prevention and coping actions regarding identified factors to reduce burden of suicide are needed.

Suicide ideation, attempt, and determinants among medical students Northwest Ethiopia: an institution-based cross-sectional study

BACKGROUND

Suicide ideation and attempt are more highly prevalent among medical students compared to the general population. Suicidal thought negatively impacts the quality of life, physical, and mental well-being of the students. However, research into suicide ideation and attempt among medical students in low- and middle-income countries is limited. Therefore, this study aimed to explore suicide ideation and attempt and their determinants among medical students in Ethiopia have a crucial role for further intervention.

METHODS

An institution-based cross-sectional study was conducted on 393 medical students from March to June 2019 at the University of Gondar (UoG) in Ethiopia. Simple random sampling technique was used to select study participants. Suicide ideation and attempt were assessed using the World Health Organization Composite International Diagnostic Interview (CIDI) to assess lifetime suicide ideation and attempts during medical school. Data were collected using a self-administered questionnaire. Binary logistic regression analyses were used to identify factors associated with suicide ideation and attempt. An odds ratio (OR) with a 95% confidence interval (CI) was computed to assess the strength of the association.

RESULTS

A total of 393 participants took part with a response rate of 92.9%. The prevalence of suicide ideation and attempt among study participants was found to be 14% and 7.4%, respectively, with 95% CI (10.9-18.1) and (5.1-10.2). Being female (AOR: 5.21, 95% CI 3.42-7.20), co-morbid depression symptoms (AOR: 10.12, 95% CI 6.80-15.52), current khat chewing (AOR: 4.46, 95% CI 3.32-10.02), and poor social support (AOR: 4.46, 95% CI 3.43-9.87) were factors significantly associated with suicide ideation; whereas, female sex (AOR: 8.08, 95% CI 6.04-12.39), depression (AOR: 10.66, 95% CI 8.01-19.01) and history of mental illness (AOR: 5.53, 95% CI 5.20-15.50) were factors significantly associated with suicide attempt.

CONCLUSIONS

In the current study, the prevalence of suicide ideation among medical students was low compared to other studies, but the suicide attempt was high. Ministry of Health should develop a guideline on how to screen and manage suicide ideation and attempt among medical students.

Sense of coherence in Chinese and German students

Background

Mental health and salutogenesis are important topics at universities in China and Germany where heightening stress levels in students can be observed.

Aim

The aim of this article is to determine the profile of the salutogenic concept, sense of coherence (SOC), in Chinese and German students to provide new insights into SOC and mental health in Chinese and German students in higher education institutions (HEIs).

Setting

The study was carried out at universities in China and Germany.

Method

A non-experimental, cross-sectional, survey-based research design and convenience sampling was utilised to obtain the sample (n = 356). The sample was derived at a selected Chinese (n = 255) and a selected German university (n = 101). Data were gathered using the 7-point Likert SOC dimension scales based on the Life-Orientation Questionnaire (LOQ) research instrument. The internal consistency levels of the SOC sub-scales were of acceptable levels. Descriptive and inferential statistics were used to analyse the data. Cronbach’s alpha coefficients were calculated to determine the reliability of the LOQ research instrument. General linear modelling techniques.

Results

The results showed the Chinese students scored significantly lower in all three SOC scales than the German students, with the largest practical significant difference in the sub-score of meaningfulness. In general, female Chinese and German students scored higher than their male counterparts. No significant differences could be found between German female and male, and Chinese female and male students.

Conclusion

Conclusions and recommendations for future research and HEI practice are provided.

Internet addiction and poor quality of life are significantly associated with suicidal ideation of senior high school students in Chongqing, China

Background

Adolescence is a vulnerable period of life, and many mental health and behavioral problems emerge during this particular period, including depression, internet addiction (IA), and suicidal behaviors. Poor quality of life (QOL) and IA have been found to be significantly associated with suicidal ideation (SI) among Chinese university students, of whom most have been adults. Nevertheless, their associations with SI are rarely studied among Chinese adolescents. The objective of this study was to examine these relationships in a representative adolescent sample of Chinese senior high school students, who are experiencing an enormous transition from childhood to adulthood.

Methods

By using multi-stage sampling, a total of 26,688 students were successfully recruited from 29 senior high schools of a very large City in western China, Chongqing municipality. In this cross-sectional online survey, students’ demographic and lifestyle characteristics were collected with a standardized questionnaire. The Young’s IA Test, the Chinese Six-item QOL questionnaire, and item 15 of the Symptom Checklist-90-R were used to measure IA, QOL, and SI, respectively.

Results

The 1-month prevalence of SI was 11.5% among students of senior high schools in Chongqing, China. Students with SI had significantly higher QOL scores (17.3 ± 3.7 vs. 13.7 ± 3.8, P < 0.001) and higher prevalence of IA (49.6% vs. 25.6%, P < 0.001) than those without SI. After controlling for demographic, lifestyle, and clinical covariates, IA (odd ratio (OR) = 1.15, P = 0.003) and a high QOL score (OR = 1.09, P < 0.001) remained significantly associated with SI.

Conclusion

Suicidal ideation is prevalent among Chinese adolescents and it is associated with IA and poor QOL. Measures aimed at reducing IA and improving QOL may help prevent suicidal behaviors among Chinese adolescents.

Prevalence of suicidal behaviour among nursing and midwifery college students in Ghana

AIM

To provide exploratory and descriptive evidence on the prevalence estimate and some demographic correlates of suicidal behaviour among nursing and midwifery college students in Ghana.

DESIGN

We used a cross-sectional survey design.

METHOD

An anonymous survey involving a randomly selected sample of 305 nursing and midwifery college students was conducted in March-May 2017. The Suicide Behavior Questionnaire-Revised was used to assess suicidal behaviour (i.e., ideation, planning, threat and attempt) and suicidal behaviour risk.

RESULTS

The lifetime prevalence of suicide ideations (15.4%; 95% confidence interval [CI] = 0.11-0.20), plans (6.6%; 95% CI = 0.04-0.10), attempts (2.3%; 95% CI = 0.01-0.05), threats (13.4%; 95% CI = 0.10-0.18) and 12-month prevalence of ideations (21.3%; 95% CI = 0.17-0.26) are comparable to estimates found in both high-income and low- and middle-income countries. However, associations between the demographic variables studied and suicidal behaviour risk were not statistically significant.

Prevalence of mental health problems among medical students in China: A meta-analysis

BACKGROUND

The prevalence of mental health problems in medical students has continuously increased and is higher than the prevalence of mental health problems in students with other majors, which could lead to undesirable consequences for the students and their future patients. In China, the current states of medical education and healthcare workplaces differ in certain areas from those in Western or other Asian countries. However, the mental health status of Chinese medical students has not been systematically analyzed.

OBJECTIVES

The purpose of this meta-analysis was to summarize the prevalence of mental health problems in Chinese medical students.

METHODS

All cross-sectional studies that investigated the prevalence of any mental health problem among Chinese medical students were retrieved from the following databases: EMBASE, PubMed, PsycINFO, OVID, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. We accepted each individual trial's inclusion and exclusion criteria for participants. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was adopted to appraise the methodological quality of each study. RevMan (version 5.3) was used to analyze the data.

RESULTS

Ten cross-sectional studies involving a total of 30,817 Chinese medical students were included. The prevalence of depression, anxiety, suicidal ideation, and eating disorders were 29%, 21%, 11%, and 2%, respectively. Subgroup analysis revealed no significant differences in the prevalence of depression and suicidal ideation between genders and no significant difference in the prevalence of depression between individuals of different ages (20 years and older or younger than 20 years).

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Chinese medical students have relatively high prevalence of depression, anxiety, and suicidal ideation but a low prevalence of eating disorders. Mental health problems in Chinese medical students should be taken seriously, and timely screening of and proper intervention in these mental health problems are highly recommended.

[Association of suicidal ideation with family environment and psychological resilience in adolescents]

OBJECTIVE

To study the association of suicidal ideation with family environment and psychological resilience in adolescents.

METHODS

Cluster sampling was used to perform an investigation among 3 230 junior and senior high school students in Xinxiang of Henan Province, China December 2014. A general social information questionnaire, 11-Item Kutcher Adolescent Depression Scale(KADS-11), Family Environment Scale-Chinese Version (FES-CV) and Connor-Davidson Resilience Scale (CD-RISC; Chinese version ) were used for evaluation. A multivariate logistic regression analysis and a case-control study were used to investigate the association of suicidal ideation with family environment and psychological resilience in adolescents.

RESULTS

A total of 2 960 usable questionnaires were received. Among the 2 960 adolescents, 247 (8.50%) had suicidal ideation (98 boys and 149 girls). The multivariate logistic regression analysis showed that after adjustment for age and sex, single-parent/remarried family was associated with an increased risk of suicidal ideation (OR=2.655). Suicidal ideation in boys was negatively correlated with family cohesion (OR=0.750, P<0.001) and organization (OR=0.855, P=0.036) and was positively correlated with family conflict (OR=1.159, P=0.017). Suicidal ideation in girls were negatively correlated with family cohesion (OR=0.771, P<0.001), emotional expression (OR=0.815, P=0.001) and intellectual-cultural orientation (OR=0.915, P=0.037). The adolescents with suicidal ideation had a significantly lower total score of psychological resilience than those without suicidal ideation (P<0.05). Compared with those without suicidal ideation, the adolescents with suicidal ideation had significantly lower scores on 4 factors of the CD-RISC (ability, tolerance of negative emotions, acceptance of changes and control) (P<0.05).

CONCLUSIONS

Family cohesion is a protective factor against suicidal ideation in adolescents. Family organization in boys and family emotional expression in girls are associated with a decreased risk of suicidal ideation. Enhanced psychological resilience may help to reduce the incidence of suicide ideation in adolescents.

Identifying suicide risk among college students: A systematic review

Mental health research highlights the need to focus on suicide risk in college students. However, evidence for associated risk and protective factors in this cohort is mixed. This review synthesizes data from 29 independent studies (N = 11,557 participants). Self-reported depression, cumulative stressful life events, sleep difficulties, a disconnection from others, and a sense of hopelessness demonstrated significant associations with heightened suicide risk. Reasons to live and hope provided significant protective effects. The findings highlight key intervention targets, pointing to the importance of cognitive-behavioral interventions to ameliorate suicidal thoughts but also build dispositional hope and goal-directed thinking.

Investigation of the Effects of Purpose in Life, Grit, Gratitude, and School Belonging on Mental Distress among Chinese Emerging Adults

Given the high prevalence of mental distress indicators, such as depression, among emerging adults, it is imperative to identify not only factors that place them at risk for mental distress, but also those that protect against it. This study tested the direct and indirect effects (via purpose in life) of gratitude, two aspects of grit (i.e., consistency of interest and perseverance of effort), and school belonging on three indicators of mental distress (i.e., depression, anxiety, and stress). A total of 468 Chinese university students (58.3% female), aged 18 to 27, in Macao, China responded to an anonymous questionnaire between April to May, 2016. As expected, all psychosocial factors were negatively associated with all three indicators of mental distress (r = -0.15 to -0.42, p < 0.05), with the exception of perseverance of effort, which had a significant, negative association with depression only. The results of path analysis showed that purpose in life significantly mediated the effect of school belonging and perseverance of effort on depression, whereas school belonging, gratitude, and consistency of interest all had direct effects on all three indicators of mental distress (p < 0.05). Our results also suggested that the two components of grit may have differential effects on mental distress among Chinese emerging adults. School-based programs should consider positive psychology interventions in Chinese populations.

The Importance of Coping and Emotion Regulation in the Occurrence of Suicidal Behavior

Research has shown that the use of maladaptive coping strategies and difficulties in regulating mood are linked to increasing risk of suicide. This study measured the impact of coping and emotion regulation on suicidal behavior in a sample of Asian students. The aim was to determine whether different coping strategies and methods of expressive suppression and cognitive reappraisal would be associated with suicidal behavior. One hundred and twenty undergraduate students were recruited from The Open University in Hong Kong and all completed questionnaires that measured coping, emotional regulation, and suicidal behavior. The results showed that increased avoidance coping was associated with increased suicidal behavior, whereas increased cognitive reappraisal was associated with reduced risk of suicidal behavior. Specifically, in an Asian student population, avoidance coping appears to be a risk factor for suicide, while cognitive reappraisal may be seen as a positive, protecting strategy.

Psychological distress and risk for suicidal behavior among university students in contemporary China

BACKGROUND

Psychological distress and suicidal behavior are important mental health problems among university students and warrant research to inform strategies for effective prevention in this young population. The present study aimed to assess psychological distress and suicidal behavior and to unravel their associations among university students.

METHODS

A total of 5972 undergraduate students, randomly selected from six universities in central China, comprised the sample. The Chinese version of the Symptom Checklist-90-revised (SCL-90-R) was used to assess various psychological symptoms. Logistic regression analysis was used to examine the relationship between psychological distress and risk for suicidal behavior.

RESULTS

40.7% of the university students reported positive in a least one of the 9 psychological symptom dimensions assessed by the SCL-90-R. 7.6% of the students reported suicidal behavior in the previous twelve months. The risk of suicidal behavior was significantly associated with psychological symptoms of all types, but there were notable differences by sex. For male students, depression and phobic anxiety increased the risk of suicidal behavior. Meanwhile, depression and obsessive-compulsiveness were positively associated with suicidal behavior in female students. Furthermore, increasing risk of suicidal behavior was associated with increasing positive symptom total (PST) score and a statistically significant trend was observed.

LIMITATIONS

Data collected from a cross-sectional survey does not allow any examination of causal inference.

CONCLUSIONS

Psychological distress and suicidal behavior were both common among university students; and psychological distress was highly associated with suicidal behavior. The findings underscore the importance of mental health care for university students.

The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis

BACKGROUND

Adolescence and young adulthood carry risk for suicidal thoughts and behaviours (STB). An increasing subpopulation of young people consists of college students. STB prevalence estimates among college students vary widely, precluding a validated point of reference. In addition, little is known on predictors for between-study heterogeneity in STB prevalence.

METHODS

A systematic literature search identified 36 college student samples that were assessed for STB outcomes, representing a total of 634 662 students [median sample size = 2082 (IQR 353-5200); median response rate = 74% (IQR 37-89%)]. We used random-effects meta-analyses to obtain pooled STB prevalence estimates, and multivariate meta-regression models to identify predictors of between-study heterogeneity.

RESULTS

Pooled prevalence estimates of lifetime suicidal ideation, plans, and attempts were 22.3% [95% confidence interval (CI) 19.5-25.3%], 6.1% (95% CI 4.8-7.7%), and 3.2% (95% CI 2.2-4.5%), respectively. For 12-month prevalence, this was 10.6% (95% CI 9.1-12.3%), 3.0% (95% CI 2.1-4.0%), and 1.2% (95% CI 0.8-1.6%), respectively. Measures of heterogeneity were high for all outcomes (I 2 = 93.2-99.9%), indicating substantial between-study heterogeneity not due to sampling error. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.12-1.67). Higher STB estimates were also found in samples with lower response rates, when using broad definitions of suicidality, and in samples from Asia.

CONCLUSIONS

Based on the currently available evidence, STB seem to be common among college students. Future studies should: (1) incorporate refusal conversion strategies to obtain adequate response rates, and (2) use more fine-grained measures to assess suicidal ideation.

Lifetime prevalence of suicidal ideation among men who have sex with men: a meta-analysis

BACKGROUND

Suicide is a leading cause of death among men who have sex with men (MSM) and suicidal ideation may put individuals at higher risk of suicide. A great disparity of lifetime prevalence of suicidal ideation among MSM was observed across studies, indicating the importance of a reliable estimation of the pooled lifetime prevalence. However, the only one published meta-analysis estimating the pooled lifetime prevalence of suicidal ideation among MSM was conducted in 2008 with only 2 eligible studies. Subsequently, there was a rapid increase of publications about lifetime suicidal ideation among MSM, suggesting that an update on the pooled lifetime prevalence of suicidal ideation among MSM was necessary. Therefore, this study aimed to update the estimation of the pooled lifetime prevalence of suicidal ideation among MSM.

METHODS

Electronic databases of PubMed, CINAHL, Scopus (social science), Embase and PsycInfo were searched until September 2017 to identify relevant studies. Cross-sectional studies exploring the lifetime prevalence of suicidal ideation among MSM were enrolled. Heterogeneity was evaluated using the Cochran Q test and quantified using the I ² statistic. The possibility of publication bias was assessed using both Begg's rank test and Egger's linear test, and an Egger's funnel plot for asymmetry was presented. Subgroup analyses were performed according to the geographic area, sample source and HIV status.

RESULTS

Nineteen studies with a total of 26,667 MSM were included, of which 9374 were identified with suicidal ideation. A high degree of heterogeneity (P ≤ 0.001, I ² =99.2%) was observed among the eligible studies, with the reported prevalence ranging from 13.18 to 55.80%. The pooled lifetime prevalence of suicidal ideation among MSM by a random effects model was 34.97% (95% confidence interval: 28.35%-41.90%). Both the Begg's rank test and Egger's linear test indicated low possibility of publication bias. Subgroup analyses showed that the lifetime prevalence of suicidal ideation among MSM differed significantly by geographic area, sample source and HIV status (P < 0.05).

CONCLUSIONS

The high pooled lifetime prevalence of suicidal ideation among MSM found in this meta-analysis significantly underscores the importance of early assessment of suicidal ideation among MSM, as well as the need for strengthening the psychological interventions.

Addiction to Internet Use, Online Gaming, and Online Social Networking Among Young Adults in China, Singapore, and the United States

The current study investigated the rates of addictions to Internet use, online gaming, and online social networking as well as their associations with depressive symptoms among young adults in China, Singapore, and the United States. A total of 3267 undergraduate students were recruited. Psychological instruments were used to assess various Internet-related addictions and depressive symptoms. Male students were more addicted to Internet and online gaming whereas female students were more addicted to online social networking. Compared with students in the United States, Chinese and Singaporean students were more addicted to Internet use and online social networking but less to online gaming. The odds of depression among students with addiction to various Internet-related addictions were highest in China. Internet-related addiction is a new public health concern of young adults, especially in the Asia-Pacific regions. It is found to associate with depressive symptoms. Strategies should address this phenomenon with attention to specific needs of gender and region while managing mood disturbances.

Psychological strain and suicidal ideation: A comparison between Chinese and US college students

OBJECTIVE

This study was to explore the relation between psychological strains and suicidal ideation among Chinese and American college students. Another secondary purpose of the study was to examine the reliability of the psychological strains scales (PPS: Ref) one more time in China and the United States in college populations.

METHOD

Samples of college students were randomly recruited from China and United States. All of 529 college students (aged 17-27, 68.9% female) completed self-report assessments of psychological strains (Psychological Strain Scale), suicidal ideation (Beck Scale for Suicide Ideation), and indicators of psychological well-being (e.g., depression, anxiety, and stress).

RESULTS

Empirical results show that Psychological Strain Scales (PSS) has a good reliability. Chinese college students reported higher suicide ideation scores than American students whereas there was no statistical difference in psychological strains. Psychological strains and, depression, anxiety, and stress, were positively related to suicidal ideation in both countries. Stepwise multiple regression analysis indicated that psychological strain can significantly predict suicidal ideation.

CONCLUSIONS

These findings provide support for the Strain Theory of Suicide for both Chinese and American college students and some measures can be taken to reduce psychological strains in students. However, future work could extend these findings by utilizing a longitudinal design to determine whether psychological strains are in fact antecedents, and not simply correlates, of suicide ideation.

Family history of suicide and high motor impulsivity distinguish suicide attempters from suicide ideators among college students

Suicide in college students has become an important public health issue in China. The aim of this study was to identify the differences between suicide attempters and suicide ideators based on a cross-sectional survey. Our results indicate that although female gender, positive screening for psychiatric illness, positive family history of suicide, elevated overall impulsivity, and elevated motor impulsivity were correlated with suicidal ideation, only positive family history of suicide and high motor impulsivity could differentiate suicide attempters from suicidal ideators. Future research with a longitudinal and prospective study design should be conducted to confirm these findings.

Interparental Conflict Relative to Suicidal Ideation in Chinese Adolescents: The Roles of Coping Strategies and Meaning in Life

The aim of this study was to explore the paths between interparental conflict and Chinese adolescents’ suicidal ideation. Altogether 931 adolescents (M_age = 17.84, SD = 0.77, females = 531) completed the Dyadic Consensus Scale, Self-Report Coping Scale, Meaning in Life Questionnaire, and Positive and Negative Suicide Ideation questionnaires. Mediation analyses were conducted, focusing on the relations between interparental conflict and suicidal ideation along with coping styles and a sense of meaning in life. The results showed that interparental conflict indirectly predicted adolescents’ suicidal ideation via three mediators: coping-approach strategies, presence of meaning, and the joint serial effects of coping-approach strategies and presence of meaning in Chinese adolescents. In addition, boys were more likely to be at risk for suicidal ideation than girls, so were 10th graders compared to 11th graders. These findings supported a combined distress-to-meaninglessness line of thinking along with the use of coping-approach strategies to depress self-harm ideation. Generally, interparental conflict should be kept out of youngsters’ immediate vicinity as a preventive measure of suicidal ideation.

Suicidal ideation among Chinese cancer inpatients of general hospitals: prevalence and correlates

Cancer patients are at high risk for suicide, particularly when they are informed about the cancer diagnosis or hospitalized for cancer treatment. Therefore, oncology healthcare settings such as large general hospitals in China, may represent an ideal setting to identify and treat suicidality in cancer patients. However, the clinical epidemiology of suicidality of Chinese cancer patients remains largely unknown. This study examined the prevalence and correlates of suicidal ideation among Chinese cancer inpatients of large general hospitals. A total of 517 cancer inpatients were consecutively recruited from two tertiary general hospitals of a metropolitan city in northern China, and administered with standardized questionnaires to collect data on sociodemographics, mental health, and cancer-related clinical characteristics. Suicidal ideation and mental health were measured with a single self-report question "In the past month, did you think about ending your life?" and Hospital Anxiety and Depression Scale, respectively. The one-month prevalence of suicidal ideation was 15.3% in Chinese cancer inpatients. In multivariable Logistic regression, depression, anxiety, moderate-to-severe pain, metastatic cancer, poor performance status, surgery, and palliative care were significantly associated with suicidal ideation. Cancer inpatients of large Chinese general hospitals have high prevalence of suicidal ideation and therefore potentially at high risk for suicide. Suicide prevention efforts for cancer inpatients should include periodic evaluation of suicidality, effective pain management, psychooncological supports, and, when necessary, psychiatric treatment and crisis intervention.

Ongoing university studies and the risk of suicide: a register-based nationwide cohort study of 5 million young and middle-aged individuals in Sweden, 1993-2011

OBJECTIVES

To investigate the risk of suicide, unnatural death and all-cause death in university students compared with non-students, taking previous educational attainment into account.

DESIGN

Open cohort study of all residents aged 18-39 and living in Sweden at any time between 1 January 1993 and 31 December 2011.

SETTING

We linked data from national registers and calculated person-years during university studies for three time periods (1993-1999, 2000-2005 and 2006-2011). Time as non-student was calculated and categorised according to attained educational level. Incidence rate ratios (IRR) with 95% CIs were calculated with Poisson regression models, controlling for age and period.

PARTICIPANTS

The cohort consisted of 5 039 419 individuals, 51% men and 49% women.

MAIN OUTCOME MEASURES

Incidence of suicide (International Classification of Diseases (ICD)-9: E950-E959, ICD-10: X60-X84) or death with undetermined intent (ICD-9: E980-E989, ICD-10: Y10-Y34), unnatural death (ICD-9: E800-E999 and ICD-10: V01-Y99) and all-cause death.

RESULTS

A total of 7316 deaths due to suicide were identified, of which 541 were registered among university students. The risk of suicide was twofold during ongoing university studies compared with when having attained university education, IRR 2.37 (95% CI 2.07 to 2.72) in men and IRR 2.15 (95% CI 1.77 to 2.61) in women.

CONCLUSIONS

Having ongoing university studies was associated with a higher risk of suicide compared with having attained university-level education. This finding highlights the importance of achieving a deeper understanding of suicidal behaviour during years at university. Further studies should assess risk factors for suicide and suicidal behaviour in university students.

Translation and validation of the Chinese versions of the Suicidal Ideation Attributes Scale, Stigma of Suicide Scale, and Literacy of Suicide Scale

This article reports the validation of the Chinese versions of the Suicidal Ideation Attributes Scale (SIDAS), the short form of Stigma of Suicide Scale (SOSS), and the short form of Literacy of Suicide Scale (LOSS) among 57 Chinese and English bilinguals and 224 Chinese university students. All the translated scales showed high correlations with the original versions. The translated SIDAS and refined SOSS demonstrated robust factor structures, good internal consistency, and convergent validity. Chinese students with self-reported depression symptoms tended to have higher glorification of suicide and lower suicide literacy. These brief scales fill an important gap in evaluating suicide outcomes in Chinese-speaking societies.

Prevalence of Depression among Chinese University Students: A Meta-Analysis

Background

Depression is a major mental health issue worldwide, and university students with heavy burdens of study are at a high risk for depression. While a number of studies have been conducted regarding depression among university students in China, there is a lack of information regarding the national prevalence of depression among Chinese university students. Therefore, we performed a meta-analysis to statistically pool the prevalence of depression among Chinese university students.

Methods

A systematic search of scientific databases was conducted, including Chinese Web of Knowledge, Embase, PubMed, Wanfang (a Chinese database) and Weipu (a Chinese database) to find relevant publications published between 1995 and December 2015. This was supplemented by a secondary review of the reference lists of all retrieved papers to find additional relevant citations. Studies published in either English or Chinese that provided prevalence estimates of depression in Chinese university students were considered. Prevalence estimates of each eligible study were extracted and pooled in our meta-analysis using a random-effects model.

Results

A total of 39 studies conducted between 1997 and 2015 including 32,694 university students were analyzed. Our results indicate that the overall prevalence of depression among Chinese university students is 23.8% (95% CI: 19.9%–28.5%). Substantial heterogeneity in prevalence estimates was noted. Subgroup analysis revealed that the prevalence of depression among medical students is higher than among other students.

Conclusions

Overall, the prevalence of depression among Chinese university students is exceedingly high. This suggests that it is imperative that more attention be given to the development of appropriate mental healthcare strategies for university students in China.

Suicide Communication on Social Media and Its Psychological Mechanisms: An Examination of Chinese Microblog Users

BACKGROUND

This study aims to examine the characteristics of people who talk about suicide on Chinese microblogs (referred to as Weibo suicide communication (WSC)), and the psychological antecedents of such behaviors.

METHODS

An online survey was conducted on Weibo users. Differences in psychological and social demographic characteristics between those who exhibited WSC and those who did not were examined. Three theoretical models were proposed to explain the psychological mechanisms of WSC and their fitness was examined by Structural Equation Modeling (SEM).

RESULTS

12.03% of our respondents exhibited WSC in the past 12 months. The WSC group was significantly younger and less educated, preferred using blogs and online forums for expressing themselves, and reported significantly greater suicide ideation, negative affectivity, and vulnerable personality compared to non-WSC users. SEM examinations found that Weibo users with higher negative affectivity or/and suicidal ideation, who were also using blogs and forums more, exhibited a significantly higher possibility of WSC.

CONCLUSION

Weibo users who are at greater suicide risk are more likely to talk about suicide on Weibo. WSC is a sign of negative affectivity or suicide ideation, and should be responded to with emotional support and suicide prevention services.

The interplay of stressful life events and coping skills on risk for suicidal behavior among youth students in contemporary China: a large scale cross-sectional study

BACKGROUND

Stressful life events are common among youth students and may induce psychological problems and even suicidal behaviors in those with poor coping skills. This study aims to assess the influence of stressful life events and coping skills on risk for suicidal behavior and to elucidate the underlying mechanism using a large sample of university students in China.

METHODS

5972 students, randomly selected from 6 universities, completed the questionnaire survey. Logistic regression analysis was performed to estimate the effect of stressful life events and coping skills on risk for suicidal behavior. Bayesian network was further adopted to probe their probabilistic relationships.

RESULTS

Of the 5972 students, 7.64% reported the presence of suicidal behavior (attempt or ideation) within the past one year period. Stressful life events such as strong conflicts with classmates and a failure in study exam constituted strong risk factors for suicidal behavior. The influence of coping skills varied according to the strategies adapted toward problems with a high score of approach coping skills significantly associated with a reduced risk of suicidal behavior. The Bayesian network indicated that the probability of suicidal behavior associated with specific life events was to a large extent conditional on coping skills. For instance, a stressful experience of having strong conflicts with classmates could result in a probability of suicidal behavior of 21.25% and 15.36% respectively, for female and male students with the score of approach coping skills under the average.

CONCLUSIONS

Stressful life events and deficient coping skills are strong risk factors for suicidal behavior among youth students. The results underscore the importance of prevention efforts to improve coping skills towards stressful life events.

Suicide attempts and emergency room psychiatric consultation

BACKGROUND

Suicidal behaviours are major public health concerns worldwide. They are associated with risk factors that vary with age and gender, occur in combination, and may change over time. The aim of our study was to investigate how frequently patients visiting a hospital emergency room (ER) require a psychiatric consultation for attempted suicide, and to outline the characteristics of this population.

METHODS

Determinants of emergency room visits for psychiatric reasons were studied prospectively from 2008 to 2011 at the "Maggiore" Hospital in Novara.

RESULTS

280 out of 1888 patients requiring psychiatric consultation were referred to the ER because of suicide attempt. Suicide attempters were more often female. The rate of suicide attempters among Italian people was 14.2%, compared to 19.5% in foreigners. Subjects living with parents or own family and those having a permanent job had a higher frequency of suicide attempt. Suicide attempts were more frequent among patients with a history of psychiatric disorders; nonetheless, suicide attempts were more common among those who had not previously been hospitalized in a psychiatric ward or were not under the care of a psychiatrist. The multivariate analysis found that female gender was a risk factor for suicide attempt, while being in the colder months of the year and, surprisingly, unemployment were protective factors.

CONCLUSIONS

A better understanding of patients referring to the ER due to attempted suicide may allow the identification of at-risk subjects and the implementation of targeted treatment approaches.