title: Incidence and fatality of serious suicide attempts in a predominantly rural population in Shandong, China: a public health surveillance study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A surveillance study of incidence and mortality. Linked data from two public health surveillance systems were analysed.
  
  
  METHODS
  Three selected counties in Shandong, China.
  
  
  METHODS
  All residents in the three selected counties.
  
  
  METHODS
  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.
authors: Queensland University of Technology, Brisbane, Queensland, Australia.
authors: Jiandong
authors: J
authors: Sun
authors: Shandong Provincial Centre for Disease Control and Prevention, Jinan, Shandong, China.
authors: Xiaolei
authors: X
authors: Guo
authors: Shandong Provincial Centre for Disease Control and Prevention, Jinan, Shandong, China.
authors: Jiyu
authors: J
authors: Zhang
authors: Shandong Provincial Centre for Disease Control and Prevention, Jinan, Shandong, China.
authors: Mei
authors: M
authors: Wang
authors: Shandong University, Jinan, Shandong, China.
authors: Cunxian
authors: C
authors: Jia
authors: Shandong Provincial Centre for Disease Control and Prevention, Jinan, Shandong, China Shandong University, Jinan, Shandong, China.
authors: Aiqiang
authors: A
authors: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002681:China / Q000453:epidemiology; 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 / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Hospitalisation; Incidence; Mortality; Suicide