Psychological Medicine

Original Articles

Risk factors for suicide in China's youth: a case-control study

X. Y. Lia1 c1, M. R. Phillipsa1, Y. P. Zhanga1, D. Xua1 and G. H. Yanga2

a1 Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China

a2 Institute of Basic Medical Sciences, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China


Background Suicide is the most common cause of death among youth in China.

Method A case-control psychological autopsy study in 23 geographically representative disease surveillance points around China collected information from family members and close associates of 114 persons aged 15–24 years who died by suicide (cases) and 91 who died of other injuries (controls).

Results Among the 114 suicides 61% were female, 88% lived in rural villages, 70% died by ingesting pesticides (most commonly stored in the home), 24% previously attempted suicide, and 45% met criteria of a mental illness at the time of death. Multivariate logistic regression identified several independent risk factors: severe life events within 2 days before death (OR 31.8, 95% CI 2.6–390.6), presence of any depressive symptoms within 2 weeks of death (OR 21.1, 95% CI 4.6–97.2), low quality of life in the month before death (OR 9.7, 95% CI 2.8–34.1), and acute stress at time of death (moderate: OR 3.1, 95% CI 0.8–11.9; high: OR 9.1, 95% CI 1.2–66.8). A significant interaction between mental illness at time of death and gender indicated that diagnosis was an important predictor of suicide in males (OR 14.0, 95% CI 2.6–76.5) but not in females (OR 0.3, 95% CI 0.0–3.6). Prior suicide attempt was related to suicide in the univariate analysis (OR 57.5) but could not be included in the multivariate model because no controls had made prior attempts.

Conclusions Suicide prevention efforts for youth in China must focus on restricting access to pesticides, early recognition and management of depressive symptoms and mental illnesses, improving resiliency, and enhancing quality of life.

(Received January 30 2007)

(Revised June 12 2007)

(Accepted June 21 2007)

(Online publication September 10 2007)


c1 Address for correspondence: Dr X. Y. Li, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing 100096, People's Republic of China. (Email: