With 21 percent of the world’s population, China has between 30 and 40 percent of the world’s suicides. Suicide is the leading cause of death for young people in China between 15-34 years of age. Three quarters of the suicides are in rural China where the suicide rates are three times the urban rates. Suicide prevention and treatment services are generally not available in the rural areas of China, largely due to a shortage of doctors and trained health care providers particularly in the villages and towns. SPI is helping to implement two projects in rural China that address this problem.
Developing a Mental Health Service Network in Rural China
This project is building on the existing health care system in rural China to develop a mental health service network. The network is based on training personnel in the villages and towns to recognize and refer individuals with depression, and/or risk for suicide to the county mental hospital for specific treatment and subsequently to provide community mental health care for these patients. Specialized training will also be provided to the county psychiatrists. The network will be evaluated based on comparison to a control region. More people who are at high suicide risk will receive adequate treatment/intervention and it is expected there will be a significant reduction in suicide and attempted suicide. A major goal of the project is to establish a cost effective model for providing care for these patients that could be adopted by the Chinese government. With this in mind SPI is consulting with Chinese officials in the Ministry of Health and is keeping them informed of our progress during the course of this project.
Social Intervention with Suicide Attempters in Rural China
Because of the large role that social factors play in contributing to suicide in China, the development of social support networks for individuals who make an initial suicide attempt is another potential approach to reduce the suicide rate in rural China. SPI is working with Chinese investigators on a project designed to help patients find alternative ways of dealing with interpersonal conflicts and other stresses and, thus, reduce the risk of repeated suicidal behavior.
Brief mental health education will be provided to suicide attempters at the time of their treatment in the emergency departments of general hospitals followed by a series of home-visits over 12 months after the emergency visit. These visits will be aimed at strengthening patients’ social support networks with a view to significantly reducing hopelessness, the severity of depressive symptoms, and the level of suicidal ideation.
Suicide attempters will be recruited from emergency rooms in two county hospitals. These patients will be randomly assigned to an intervention group or to a control group. In the intervention group, a trained clinician (either a psychiatrist or an emergency room doctor) from the county hospital will make home visits to the patients’ village 1,2,3,6,9, and 12 months after the index admission. At the time of the visits they will meet with the patients, with co-resident family members and with a ‘guardian’ (often a relative or close friend) who has been identified as someone the subject can confide in. They discuss interpersonal conflicts and other stresses experienced by the subject, attempt to mobilize social support in the family and the village to help the subject, discuss different methods of reducing stress, and establish a ‘crisis warning system’ to ensure that appropriate actors are notified if the subject starts to deteriorate psychologically. The project is designed to demonstrate that, with minimal input of mental health professionals, it may be possible to reduce suicide attempts and suicide in rural areas where medical services are lacking.
Suicide Prevention in China 