Cun-Xian Jia

Sleep Patterns and Problems Among Chinese Adolescents

OBJECTIVES. Little is known about sleep patterns and problems in Chinese adolescents. This study was designed to examine sleep/wake patterns and problems and their associations with parent sleep among adolescents in China. METHODS. This report represents part of an epidemiological study of sleep and health in 6 high schools in Jinan city, China. A total of 1056 adolescents and 838 parents completed a questionnaire in March or April 2005. Participants consisted of 625 boys and 441 girls, 557 seventh-graders (mean age: 13.5 ± 0.6 years) and 509 tenth-graders (mean age: 16.4 ± 0.7 years), and 603 mothers and 235 fathers. Adolescents and parents reported their own sleep/wake patterns and problems. RESULTS. Average morning rising time (5:56 am vs 8:13 am) and sleep duration (7.5 hours vs 9.4 hours) differed significantly between weekdays and weekends. Compared with seventh-graders, 10th-graders went to bed later and awoke earlier, resulting in ∼1 hour of sleep less. Of the adolescents, 18.8% reported their sleep quality as poor, 26.2% were not satisfied with their sleep, 16.1% had insomnia, and 17.9% had daytime sleepiness. Significant but low adolescent-parent correlations were observed for sleep/wake patterns and perceived sleep quality. Difficulty initiating sleep in adolescents was significantly associated with history of insomnia in mothers and fathers. CONCLUSIONS. Sleep insufficiency, insomnia, and daytime sleepiness are prevalent in Chinese adolescents. Sleep insufficiency on weekdays may be attributable to earlier morning rising to meet school schedules. Parental history of insomnia is associated with elevated risk for insomnia symptoms in adolescent offspring, although adolescent-parent correlations in sleep/wake patterns are relatively low.

Characteristics of young rural Chinese suicides: a psychological autopsy study.

BACKGROUND Patterns of suicide rates in China differ in many ways from those in the West. This study aimed to identify the risk factors characteristic for young rural Chinese suicides. METHOD This was a case-control psychological autopsy (PA) study. The samples were suicides and living controls (both aged 15-34 years) from 16 rural counties of China. We interviewed two informants for each suicide and each control with pretested and validated instruments to estimate psychosocial, psychiatric and other risk factors for suicides. RESULTS The prevalence of mental disorders was higher among the young Chinese who died by suicide than among the living controls, but was lower than among suicides in the West. Marriage was not a protecting factor for suicide among young rural Chinese women, and never-married women who were involved in relationships were about three times more likely to commit suicide than single women who were unattached. Religion/religiosity was not a protecting factor in Chinese suicide, as it tended to be stronger for suicides than for controls. Impulsivity was significantly higher for suicides than for controls. Psychological strain, resulting from conflicting social values between communist gender equalitarianism and Confucian gender discrimination, was associated significantly with suicide in young rural Chinese women, even after accounting for the role of psychiatric illness. CONCLUSIONS Risk factors for suicide in rural China are different from those in the West. Psychological strain plays a role in suicide. Suicide prevention programs in China should incorporate culture-specific considerations.

Suicide rates in Shandong, China, 1991-2010: Rapid decrease in rural rates and steady increase in male-female ratio

BACKGROUND China has one of the highest suicide rates in the world; however, the recent trends in suicide have not been adequately studied. This study aimed to examine the potential changes in the rates and characteristics in a Chinese population. METHODS Data on suicide deaths in 1991-2010 were extracted from the Shandong Disease Surveillance Point (DSP) mortality dataset based on ICD-10 codes. The temporal trend in age-adjusted suicide rates for each subpopulation was tested using log-linear Poisson regression analysis. RESULTS From 1991 to 2010, there was a marked decrease in the overall suicide rate in Shandong, with an average reduction of 8% per year. The decrease trend was stronger in rural than in urban areas and more evident in females than in males. Similar decreases were observed for all age groups. Pesticide ingestion and hanging remained the top two methods for suicide. LIMITATIONS There are likely quality concerns in the morality data, such as underreporting and misclassification, as well as low accuracy in determining the underlying causes of deaths. The representativeness of the DSP system may also be problematic due to the rapid changes in economy and demography. CONCLUSIONS Completed suicides in Shandong have sharply declined over the past 20 years. Higher rates in females versus males and in rural versus urban areas, which were previously considered to be distinguishing features of suicide in China, are becoming less pronounced.

Psychometric properties of the Dickman Impulsivity Instrument in suicide victims and living controls of rural China

BACKGROUND We are not aware of any of impulsivity trait for Chinese rural youths. This study evaluated the psychometric properties of Dickman Impulsivity Instrument in suicide cases and living controls in rural China. METHODS The participants, 392 suicide victims and 416 controls were respectively selected, and the psychological autopsy method was used to collect information. The Exploratory Factor Analysis was processed to evaluate the construct validity. The Cronbachs alpha was computed to evaluate the internal consistency, and the Spearman rank correlation coefficients between STAI Trait Anxiety Inventory, Coping Responses Inventory and Dickman Impulsivity Instrument were calculated to evaluate the convergent validity. RESULTS Dysfunctional and Functional impulsivity were extracted for both samples. The mean of DI scores in suicide cases was larger than that in controls, but it was reversed for FI. There were no significant differences between DI and FI in suicide cases, but in controls the mean of DI scores was significantly smaller than that of FI. The Cronbachs alpha was around .863 and .779 respectively for DI and FI scales in suicides, and it was around .746 and .680 in controls. The DI and FI were significantly correlated with each other. Both the DI and FI were correlated with Approach and Avoidance Coping Response Inventory, and both of the scales were grossly independent with Trait Anxiety Inventory in two samples. CONCLUSION The results indicated that the Dickman Impulsivity Instrument was adequate to measure impulsivity trait for suicide victims and living controls through proxy data in rural China.

Suicidal Intent Among Young Suicides in Rural China

To understand psychometric characteristics of Beck Suicide Intent Scale (SIS) and different characteristics of suicides between high and low intent in Chinese culture. Data of 386 suicides and 416 living controls aged 15–34 years were used to analyze psychometric characteristics of SIS with 6 items. SIS with 6 items had high reliability and validity. Different characteristics were found between suicides with high intent and low intent. Hopelessness, depression, impulsivity, and approach coping skill were common factors of suicide with high and low intent. Education years, marriage, social support, and mental disorders were specific factors of suicide with low intent. High intent suicides had different characteristics from low intent suicides. SIS with 6 items is suitable for use in young rural China.

AIDS/HIV Infection, Comorbid Psychiatric Illness, and Risk for Subsequent Suicide: A Nationwide Register Linkage Study

OBJECTIVE To explore socioeconomic and psychiatric characteristics of persons with acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection and to assess the effect of AIDS/HIV infection on risk for subsequent suicide in the context of psychiatric comorbidity and socioeconomic status. METHOD In this study based on the entire population of Denmark, we interlinked 5 national registers to retrieve personal data on AIDS/HIV infection and covariates for 9,900 men who died of suicide during 1986-2006 and 189,037 controls matched for sex and date of birth. Suicide risk associated with AIDS/HIV infection was assessed using a conditional logistic regression model. RESULTS People with AIDS/HIV infection, especially those who died of suicide, mostly lived as single people, had low income, and were dwellers of the Capital area of Denmark (Copenhagen and Frederiksberg). While presence of other physical illness was common in these patients, 38.6% of suicide and 29.0% of control patients developed psychiatric illness after being diagnosed with AIDS or HIV infection. Meanwhile, AIDS/HIV infection constituted a significant risk factor for subsequent suicide (adjusted incidence rate ratio [IRR] = 3.84; 95% confidence interval, 2.53-5.81); the risk was substantially higher for persons who were diagnosed for the first time recently, were treated as inpatients, had a recent hospital contact, or had multiple hospital contacts because of the illness. The increased suicide risk associated with AIDS/HIV infection was slightly stronger before the introduction in 1997 of highly active antiretroviral therapy (HAART) (adjusted IRR = 5.55; 95% CI, 3.07-10.06), but remained highly significant in the HAART era (adjusted IRR = 2.77; 95% CI, 1.55-4.94). Moreover, AIDS/HIV infection significantly interacted with psychiatric illness (P < .0001), and their comorbidity increased the risk of suicide substantially. CONCLUSIONS Suicide risk is increased in individuals with AIDS/HIV infection, particularly those with a recent diagnosis, more intensive and frequent hospital care, or comorbid psychiatric illness. The findings call for improvement of clinical capacities to address psychosocial and existential needs in the treatment of patients with AIDS/HIV infection.

Reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) among suicide attempters and comparison residents in rural China

BackgroundDepression is an important public health problem and is closely associated with suicidal behavior in the population. Although the Center for Epidemiologic Studies Depression Scale (CES-D) is widely used for assessment of depression, the psychometric characteristics of this scale have not been explored in studies of suicide attempters and local residents in rural areas.MethodsIn this study, reliability and validity of CES-D were assessed in 409 suicide attempters and 409 comparison residents from rural China and through internal consistency analysis and confirmatory factor analysis (CFA).ResultsCronbach’s alpha values of the CES-D were 0.940 and 0.895 in, respectively, suicide attempters and comparison residents. CES-D scores were significantly correlated with the scores of Trait Anxiety Inventory (TAI) and Beck Hopelessness Scale (BHS) in both the suicide attempters and the comparison residents. Confirmatory factor analyses indicated that 3-factor structure (positive affect, interpersonal problems, depressive mood and somatic symptoms combined) with 14 items (excluding items 9, 10, 13, 15, 17, and 19) had the best fit in these two populations.ConclusionsThe CES-D scale has satisfactory reliability and validity when used for assessing depression in suicide attempters and comparison residents in rural China.

Seasonality of Chinese rural young suicide and its correlates

BACKGROUND There had been few studies on seasonality of Chinese suicide especially for Chinese rural youths. In this research, we wanted to find the seasonal pattern and the relationship between personal and behavioral characteristics and seasonal variation of suicide. METHOD We examined Chinese rural young adults aged 15 to 34 years who died by suicide using Psychological Autopsy method to gather information from the informants of suicide victims. Altogether 330 suicide victims were collected among which 144 were female and 186 were male. The χ(2) test was used for comparison, and the multiple logistic regressions and Odds Ratios were adopted to analyze the seasonal preferences of suicide victims. RESULT Seasonal summer peak of suicide emerged in total population and in each subgroup. Four logistic regression models were constructed: in spring, six variables were included in the regression model, which were Gender (OR = 1.627), Pesticide Used (OR = 1.622), Life Events (OR = 2.764), Suicide Intent (OR = 1.641), Marital Status (OR = 0.574) and Family Conflicts (OR = 0.590); in summer, only Marital Status (OR = 1.927) was accepted; in autumn, four variables including Marital Problems (OR = 1.924), Trait Anxiety (OR = 1.758), Gender (OR = 0.518) and Religion (OR = 0.534) were retained; in winter, Pesticide Used (OR = 0.486) and Suicide Intent (OR = 0.614) were retained. CONCLUSION Seasonal variations of personal and behavioral characteristics, combined with social activities, might also play very important roles in suicide seasonality.

Menarche, menstrual problems and suicidal behavior in Chinese adolescents

BACKGROUND Menarche is the first menstrual cycle. Menstrual problems, such as dysmenorrheal menorrhagia, oligomenorrhea, and irregular cycle are common in female adolescents. This research aims to examine the associations between age at menarche and menstrual problems and suicidal behavior among Chinese female adolescents. METHODS An epidemiological survey of 5831 female adolescents from eight high schools of three counties of Shandong province, China, was conducted. A self-administered paper-and-pencil questionnaire was used to collect information. Logistic regression analyses were used to examine the association between menstruation and suicidality. RESULTS The mean age of the sample was 15.02 (SD=1.44) years. Of the sample, 5,231 (90.0%) had experienced their first menstrual cycle, and 23.2%, 10.4%, and 4.5% of the sample reported having had suicidal ideation, plan and attempt, respectively. In multivariate models, menarche at ≤11 years was associated with increased risk of suicidal ideation (OR=1.41, 95%CI: 1.10-1.81) and menarche at 12 years was associated with suicide plan (OR=1.23, 95%CI: 1.00-1.51). Irregular menstrual cycle was significantly associated with increased risk of suicidal ideation (OR=1.40, 95%CI: 1.05-1.86) and menstrual period less than or equal to 4 days was significantly associated with increased risk of suicide plan (OR=1.32, 95%CI: 1.06-1.66). LIMITATIONS This cross-sectional study cannot establish the causal directions between menstrual problems and suicidality in adolescents. CONCLUSIONS Our study suggests that earlier menarche, irregular menstrual cycle and short menstrual period are associated with suicidal behavior in female adolescents. Further research is warranted to examine the causal relationship between menstrual problems and suicidal behavior in adolescents.

Suicides and medically serious attempters are of the same population in Chinese rural young adults

BACKGROUND Suicide rates in China are among the highest in the world, although there has been a decreasing trend in the past few years. One practical approach to study the characteristics and risk factors of suicide is to interview the suicide attempters. It was to compare completed suicides with serious attempters that may shed lights on suicide prevention strategies. METHOD This is a combination of two case control studies for suicide completers and suicide attempters respectively. After a sample of suicides (n=392) and community living controls (n=416) were obtained and studied in rural China, we collected in the same rural areas data of suicide attempt and studied 507 medically serious attempters and 503 community counterparts. RESULTS Characteristics and previously observed risk factors were compared between the suicides and the attempters, and we found that the demographic characteristics and risk factors for the suicides were also for the medically serious attempters but at some lesser degrees for the attempters than for the suicides. It was especially true of suicide intent, deficient coping, negative life events, and impulsivity. While most of the demographic characteristics were not significantly different between the suicides and the attempters, most of the clinical variables could distinguish the two groups. CONCLUSIONS The suicide victims and the serious attempters could be of the same group of people who were at the edge of fatal self-injury, and the same clinical risk factors but of different degrees have divided them into the life and death groups.