title: Physical illness and suicide risk in rural residents of contemporary China: a psychological autopsy case-control study.
abstract: BACKGROUND
  Physical illness is linked with an increased risk of suicide; however, evidence from China is limited.
  
  
  OBJECTIVE
  To assess the influence of physical illness on risk of suicide among rural residents of China, and to examine the differences in the characteristics of people completing suicide with physical illness from those without physical illness.
  
  
  METHODS
  In all, 200 suicide cases and 200 control subjects, 1:1 pair-matched on sex and age, were included from 25 townships of three randomly selected counties in Shandong Province, China. One informant for each suicide or control subject was interviewed to collect data on the physical health condition and psychological and sociodemographic status.
  
  
  RESULTS
  The prevalence of physical illness in suicide cases (63.0%) was significantly higher than that in paired controls (41.0%; χ² = 19.39, p < .001). Compared with suicide cases without physical illness, people who were physically ill and completed suicide were generally older, less educated, had lower family income, and reported a mental disorder less often. Physical illness denoted a significant risk factor for suicide with an associated odds ratio of 3.23 (95% CI: 1.85-5.62) after adjusted for important covariates. The elevated risk of suicide increased progressively with the number of comorbid illnesses. Cancer, stroke, and a group of illnesses comprising dementia, hemiplegia, and encephalatrophy had a particularly strong effect among the commonly reported diagnoses in this study population.
  
  
  CONCLUSIONS
  Physical illness is an important risk factor for suicide in rural residents of China. Efforts for suicide prevention are needed and should be integrated with national strategies of health care in rural China.
authors.affiliation: <location>School of Public Health, Shandong University, Jinan, China</location> <location>Center for Suicide Prevention and Research, Shandong University, Jinan, China</location>
authors.forename: Cun-Xian
authors.initials: CX
authors.lastname: Jia
authors.affiliation: <location>School of Public Health, Shandong University, Jinan, China</location>
authors.forename: Lin-Lin
authors.initials: LL
authors.lastname: Wang
authors.affiliation: <location>Shandong Center for Disease Control and Prevention, Jinan, China</location>
authors.forename: Ai-Qiang
authors.initials: AQ
authors.lastname: Xu
authors.affiliation: <location>Heze Medical College, Heze, China</location>
authors.forename: Ai-Ying
authors.initials: AY
authors.lastname: Dai
authors.affiliation: <location>Center for Suicide Prevention and Research, Shandong University, Jinan, China</location> <location>National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway</location>
authors.forename: Ping
authors.initials: P
authors.lastname: Qin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: China; case-control study; physical illness; psychological autopsy; suicide