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Focus on suicide: Global studies help bring down China’s suicide rate
November / December 2018 | Volume 17, Number 6
Photo by Barcroft Media / Getty Images
A Chinese man attempts to prevent his girlfriend from
jumping off a bridge. Fogarty-funded researchers in China
are studying how to reduce the incidence of self-harm in the
country, where nearly a quarter of the world’s suicides
By Karin Zeitvogel
After a rash of suicides in 2010 at a cellphone factory in Shenzhen, concerns were raised in the media about the mental health of the Chinese workers who leave their rural homes and head to distant cities for work. While many reports told tales of low pay, loneliness, long hours and mismanagement, a Fogarty-supported study conducted by Dr. Eric Caine of the University of Rochester and several of his Chinese trainees found that migrating for work appears to have a protective effect against depression, a risk factor for suicide. They hypothesized that this may be because mobile phones and the internet allow migrant workers to stay connected to their families, and improved transportation enables them to return home regularly.
In all, about 200,000 Chinese take their lives each year, accounting for nearly a quarter of global suicides, according to the WHO. Since the Chinese government recognized the issue as a health crisis in the 1990s, the overall rate has dropped by half, but is rising among some populations, such as the elderly.
To help address the problem, NIH has supported numerous research projects on suicide in China, including two decades of Fogarty-funded studies led by Caine, which have kickstarted self-harm research in the country. Starting in 2001, funding from Fogarty’s International Clinical, Operational and Health Services Research Training Award (ICOHRTA) allowed the University of Rochester (UR) to collaborate with academic institutions in China and set up that country’s first suicide research center. With training programs and curricula adapted from those used at UR’s well-established Center for the Study of Suicide, the China-Rochester Suicide Research Center (CRSRC) has built a cadre of Chinese experts.
Over the years, with funding from ICOHRTA and other Fogarty programs including NCD-Lifespan and the Global Health eCapacity Initiative, some 70 Chinese scientists have been trained and helped to develop China’s suicide research infrastructure. The trainees and their mentors have collaborated on scores of publications covering everything from suicide risk factors in China to suicide ideation among online users. Many of UR’s former trainees now hold senior faculty positions at major universities and research institutions in China. Eight out of 10 long-term trainees went on to hold high-level government posts. “And importantly,” said Caine, “these trainees are the foundation for training future generations of investigators devoted to preventing suicide in China.”
Studies led by UR faculty and the Chinese trainees have identified where research should be focused, and made policy recommendations with proven potential to reduce the suicide burden in China and elsewhere. For instance, when a woman in Hong Kong became the first person documented to have killed herself by asphyxiation, by burning charcoal in a small, sealed room, Fogarty-supported research led to calls for policymakers to restrict access to charcoal and other easily obtainable suicide means. A later study led by Dr. Paul Yip, who worked closely with Caine to set up the CRSRC and has collaborated with him on numerous research projects, found that restricting access to charcoal led to an across-the-board drop in suicide, indicating that people do not switch to alternative methods.
Other research by the team found that women in rural China, where most of the country’s suicides occur, have higher rates of suicide ideation and attempts than men, and were nearly twice as likely as men to die by suicide. The study’s authors said this was likely attributable to the means of suicide - ingestion of highly toxic pesticides, which are ubiquitous in rural farming communities - and a relative lack of immediate access to emergency services. Another study is investigating ways to increase that access through social media and mobile health technology.
Locally focused research has allowed scientists to help reduce China’s suicide rate, said Caine. “Suicide is not a problem that you can fix at a national level,” he said. “Yes, you can set national standards of practice and implement policies in the health care system, but most suicides occur outside the health system, so you have to go back to the community. Research that allows us to understand what’s going on locally leads to the most effective solutions - such as lockboxes to store pesticides or restrictions on charcoal sales - in reducing China’s suicide burden.
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