Suicide distribution in mainland China: A systematic review

Background: Although numerous epidemiological reports from all regions of China suggest that suicide is a major public health issue in China, the country does not have a suicide surveillance system. Thus, the true burden of suicide remains largely unknown, and hence the need to critically summarize and determine the extent of the problem. Methods: We searched published literatures in online databases, including Medline/PubMed, EMBASE, CNKI and VIP and systematically analyzed suicide prevalence, distribution, and suicide methods. Results: Twenty-nine reports yielded data on mean annual rates (per 100,000) of suicide in 26 regions of 16 provinces between 1989 and 2007. Although the overall suicide rate decreased from 23.2 during 1995-1999 to 15.5 during 2002-2006, it remains significantly higher than the global average of 11, and the rates in some regions of the country were unacceptably higher. Nationally, suicide rates were higher in rural than urban areas, and the male to female ratio increase from 0.75 in 1992 1.15 in urban area and 1.07 in rural area in 2006. Suicide rates continue to rise among elderly females in some regions, reaching 150.66 in Yang city in Shanxi province in 2006 among individuals over the age of 80 years. Conclusions: The distribution of suicide in China has significant demographic and geographical variations. This calls for the establishment of an effective national surveillance system and risk assessment system that may assist health workers in identifying at-risk populations and thus, targeted suicide prevention strategies.