Incidence and fatality of serious suicide attempts in a predominantly rural population in Shandong, China: a public health surveillance study.
OBJECTIVES
To estimate the incidence of serious suicide attempts (SSAs, defined as suicide attempts resulting in either death or hospitalisation) and to examine factors associated with fatality among these attempters.


DESIGN
A surveillance study of incidence and mortality. Linked data from two public health surveillance systems were analysed.


SETTING
Three selected counties in Shandong, China.


PARTICIPANTS
All residents in the three selected counties.


OUTCOME MEASURES
Incidence rate (per 100 000 person-years) and case fatality rate (%).


METHODS
Records of suicide deaths and hospitalisations that occurred among residents in selected counties during 2009-2011 (5 623 323 person-years) were extracted from electronic databases of the Disease Surveillance Points (DSP) system and the Injury Surveillance System (ISS) and were linked by name, sex, residence and time of suicide attempt. A multiple logistic regression model was developed to examine the factors associated with a higher or lower fatality rate.


RESULTS
The incidence of SSAs was estimated to be 46 (95% CI 44 to 48) per 100 000 person-years, which was 1.5 times higher in rural versus urban areas, slightly higher among females, and increased with age. Among all SSAs, 51% were hospitalised and survived, 9% were hospitalised but later died and 40% died with no hospitalisation. Most suicide deaths (81%) were not hospitalised and most hospitalised SSAs (85%) survived. The fatality rate was 49% overall, but was significantly higher among attempters living in rural areas, who were male, older, with lower education or with a farming occupation. With regard to the method of suicide, fatality was lowest for non-pesticide poisons (7%) and highest for hanging (97%).


CONCLUSIONS
The incidence of serious suicide attempts is substantially higher in rural areas than in urban areas of China. The risk of death is influenced by the attempter's sex, age, education level, occupation, method used and season of year.
['Sun|Jiandong|J|', 'Guo|Xiaolei|X|', 'Zhang|Jiyu|J|', 'Wang|Mei|M|', 'Jia|Cunxian|C|', 'Xu|Aiqiang|A|']
D000293:Adolescent D000328:Adult D000368:Aged D002423:Cause of Death D002648:Child D002681:China D005260:Female D006760:Hospitalization D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D062486:Public Health Surveillance D012307:Risk Factors D012424:Rural Population D012959:Socioeconomic Factors D013405:Suicide D013406:Suicide, Attempted D055815:Young Adult
Incidence Suicide Hospitalisation Mortality