Incidence and fatality of serious suicide attempts in a predominantly rural population in Shandong, China : a public health surveillance study

Sun, Jiandong, Guo, Xiaolei, Zhang, Jiyu, Wang, Mei, Jia, Cunxian, & Xu, Aiqiang (2015) Incidence and fatality of serious suicide attempts in a predominantly rural population in Shandong, China : a public health surveillance study. BMJ Open, 5(2), e006762.

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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.


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


Three selected counties in Shandong, China.


All residents in the three selected counties.

Outcome measures

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


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.


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%).


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.

Impact and interest:

3 citations in Scopus
3 citations in Web of Science®
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ID Code: 79600
Item Type: Journal Article
Refereed: Yes
Keywords: China, completed suicide, epidemiology, fatality, hospitalisation, incidence, serious suicide attempts
DOI: 10.1136/bmjopen-2014-006762
ISSN: 2044-6055
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2015 The Authors
Copyright Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Deposited On: 13 Feb 2015 00:21
Last Modified: 15 Feb 2015 22:59

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