|Year : 2016 | Volume
| Issue : 3 | Page : 131-135
Suicide Deaths in China: An Analysis of Forensic Cases
Dong Zhao1, Longlong Wang2, Kun Wang3, Zhimin Wang2, Eradil Orazhkan2
1 Collaborative Innovation Center of Judicial Civilization; Key Laboratory of Evidence Science (China University of Political Science and Law), Ministry of Education, Beijing 100088, China
2 Public Security Bureau of Karamay, Xinjiang 834000, China
3 Public Security Bureau of TuHa, Xinjiang 83400, China
|Date of Web Publication||30-Sep-2016|
Public Security Bureau of TuHa, Xinjiang Turpan 83400
Source of Support: None, Conflict of Interest: None
Suicide cases are often encountered during death investigations in forensic medicine. In this study, through a comparative analysis of our own data of 98 suicide cases and previous reports from various forensic institutions in China, we analyzed the risk factors of Chinese suicides and explored the implications thereof from a forensic point of view. Moreover, the age and sex differences, means, causes, and other concerns regarding suicide are discussed along with a review of the literature.
Keywords: Death investigation, forensic medicine, suicide
|How to cite this article:|
Zhao D, Wang L, Wang K, Wang Z, Orazhkan E. Suicide Deaths in China: An Analysis of Forensic Cases. J Forensic Sci Med 2016;2:131-5
| Suicide Overview|| |
In 2014, the World Health Organization (WHO) released its first ever publication on suicide, "Preventing suicide: A global imperative, 2014," and all WHO member countries are now aiming to reduce the suicide rate of each country to 10% by 2020, which is also the aim of the WHO (2013) Comprehensive Mental Health Action Plan 2013-2020. Every 40 s, a person dies because of suicide somewhere in the world, and over 800,000 people commit suicide every year. Globally, suicide is the second leading cause of death in 15-29-year-olds. In the WHO South-East Asia region, the estimated suicide rate is the highest as compared to other WHO regions. China accounts for more than 30% of the world's suicide cases and displays a unique pattern of suicide rates, according to the WHO (2014) Global Health Estimates 2013: Deaths by Cause, Age and Sex, Estimates for 2000-2012. ,,
Since the 1980s, China has undergone a period of rapid economic and social development. As a result, the suicide rate declined from 23.3/100,000 in 1995-1999 to 9.8/100,000 in 2009-2011, and 5.3/100,000 in 2002-2011. Moreover, the suicide rate of young females (15-34 years) declined by 90%, from 35.2/100,000 in 1995-1999 to 3/100,000 in 2011. ,, In this study, we analyzed 98 suicide cases from our own casework along with data obtained from the previous reports published in Chinese journals. ,,,,
| Materials, Methods and Results|| |
Case origins and sex differences
A total of 98 suicide cases (60 males, 61.2%; 38 females, 38.8%) occurring in the recent five years were collected for analysis from the authors' forensic medicine practice in Karamay City, China. The population of this area was about 1.3 million in 2004, and the suicide rate was 3.85/100,000 in 2012 based on unpublished data from local statistics office. All cases including the crime scene investigation, autopsy, and other related inspections, had been handled by local public security organizations. When necessary, the causes of death were determined through examinations of pathology, histology, and drug toxicology, combined with the case history and other information. For comparisons of the case origin and sex differences, data derived from references #4 to 8 are listed together with the present 98 cases in [Table 1].
For the present 98 suicide cases, the case distributions according to age groups were as follows: 5-14 years, 1.0%; 15-24 years, 12.2%; 25-34 years, 19.4%; 35-44 years, 16.3%; 45-54 years, 16.3%; 55-64 years, 14.3%; 65-74 years, 12.2%; and >74 years, 8.2%. For comparison of the age distributions, data derived from references #4 to 8 are listed together with the present 98 cases in [Table 2].
For the present 98 cases, hanging was the leading means of suicide (42.9%), followed by ingestion of toxic substances (22.4%), jumping (17.3%), drowning (9.2%), and others. The same order was found when separately analyzing the 60 female and 38 male cases. For comparison of the means of suicide, data derived from references #4 to 8 are listed together with the present 98 cases in [Table 3].
For the present 98 cases, physical disease was the leading suicide cause (33.7%), followed by family problems (26.5%), problems related to romantic relationships (16.3%), mental disease (16.3%), work pressure (3.1%), drug abuse (2.0%), and debt (2.0%). Male cases showed a similar order to that of the total cases whereas female cases showed a unique order of suicide causes, with the first and second leading causes being problems related to family members and lovers, respectively.
Conflicts between husband and wife accounted for 84.6% (22 cases) of the total 26 cases of bad family relations, with conflicts with other family members accounting for the remaining 15.4% (4 cases). For the 16 cases of lover-related suicides, men and women accounted for 6 and 10 cases, respectively. There were 13 cases aged between 21 and 30 years, accounting for 81.3% of all lover-related suicides.
For comparison of the causes of suicide, data derived from references #4 to 8 are listed together with the present 98 cases in [Table 4], with unavailable data from reference #6.
Suicide place, time, and other factors
The present 98 cases included 58 (59.2%) indoor and 40 (40.8%) outdoor suicide cases. Fifty-seven (58.2%) suicide cases occurred during the day, and 41 (41.8%) cases occurred at night. For comparison of the year of suicide, data derived from references #4 to 8 are listed together with the present 98 cases in [Table 5], with unavailable data from references #4 to 5.
| Discussion|| |
Generally, according to the WHO statistics, more men commit suicide than women, and, in developed countries, men are 3-fold as likely to die by suicide compared to women. Low- and middle-income countries in the Western Pacific Region are the only region in the world where the proportion of all deaths due to suicide is greater in females than in males and where the rank of suicide as a cause of death is higher in females than in males. The WHO statistics (2011) showed that the average suicide rate was 9.48/100,000 globally, with the suicide rate of females being higher than that of males in China. ,, On the other hand, the present 98 cases showed a higher suicide rate in males than in females [Table 1], similar to that in the three previous reports. ,, Conversely, the female suicide rate was higher in references #4 (aged <35 years) and #5 (relatively old data from 1983 to 1993). This indicates that the suicide rate may be changing spatiotemporally in China, with male suicide cases tending to increase in recent years. ,,,,, Moreover, for young cases, female suicides tend to be more common than male suicides , while in cases aged >40 years, male cases are more common than female cases. ,
In the present 98 cases, most suicides involved individuals aged 25-34 years (19.4%). Based on this and previous reports, cases aged between 20 and 55 years generally account for more than half of all suicide cases. This age group represents a key period of many people's lives and is associated with great levels of stress from society and family as well as various difficulties and challenges from studies and work. , If such great stress is coupled with other risk factors such as concomitant disease or marriage problems, depression commonly ensues, and suicide represents the last option for the individuals to escape this depressive reality.
In 1978, the reform and open policy were initiated in China, and, since then, China has achieved a continuing and fast development, especially in terms of economic growth. As a result of this economic development, the subsequent rural to urban drift and rising urban living standards have resulted in a reduced incidence of suicide in China because these changes liberated many young women from parental pressures, bad marriages, and other stresses associated with poor, rural life. , Instead, an emerging threat right now comes from the resurgence of high rates of suicide among the elderly, who account for a fast-growing portion of the Chinese population. 
Pesticide ingestion, hanging, and firearms are among the most common methods of suicide globally, according to the WHO statistics. ,, In the present 98 cases, hanging, ingestion of toxic substances, jumping, and drowning were the four leading means of suicide in order for both male and female cases. Regarding the previous Chinese reports analyzed herein, hanging/strangulation was either the first or the second leading means of suicide while ingestion of toxic substances was particularly prevalent in female suicide cases and was always among the three leading suicide means. Jumping was the leading means followed by hanging/strangulation in Guangdong  and Beijing,  which are highly developed regions, where pesticides may not be easily accessible while high buildings can be found everywhere. Hanging is generally the easiest way to commit suicide, except in special cases where this means, is exceeded by ingestion of toxic substances (agriculture-dominant areas) or jumping (high-building areas). Sharp instrument injury and drowning are also frequently adopted means but are less commonly used compared to hanging and ingestion of toxic substances.
Based on WHO statistics, suicide by gunshot is the leading means of suicide in Western countries whereas pesticide ingestion is among the most common methods of suicide globally, particularly in rural agricultural areas in the Southeast Asia region. Because firearms are strictly prohibited in China, 58% of Chinese suicides instead occur through pesticide ingestion.
As a protective measure against suicide, a systemic national suicide prevention strategy is expected in China. Currently, effective ways to protect against suicide by means of hanging and sharp instrument injuries are relatively hard to achieve; however, in practice, it would be helpful to limit access to pesticides and set up some form of protective structure on high buildings as a means to protect people from falling and jumping.
In the present 98 cases, disease, unhappy family relations, and bad love lives/marriages were the main causes of suicide; however, the leading causes varied substantially among the analyzed Chinese reports, which may be because of the difficulty to completely avoid subjectivity when determining the causes during suicide inspection, as well as the lack of a standard classification for analyzing suicide causes. Nevertheless, physical and mental diseases, bad relationships with lovers and family members, and other social pressures can all significantly affect the occurrence of suicide. ,
Suicide place, time, and other factors
Compared to outdoor suicide, slightly more indoor deaths were found in the present 98 cases, which is in agreement with references #8 (71.83% of 213 cases were indoor suicides) and #6 (>60% of 208 cases were indoor suicides). Further, reference #8 showed that most suicide cases (43.2%) occurred between January and April, which is in agreement with the conclusion of a comprehensive analysis,  suggesting that suicides tend to occur more frequently in spring. Reference #8 also showed other characteristics as follows: (1) Most cases (63%) occurred before noon; (2) cases with an education level higher than senior middle school showed a significantly lower suicide rate (4.70%) compared to those with lower education; (3) for divorced and widowed persons, suicide occurred in 9 males, as compared to in no females, suggesting that more attention and care are needed for aged males in regard to suicide protection.
| Conclusion|| |
A comprehensive surveillance system of suicides in China, a rapidly developing country, is very much needed. Based on the present study and a review of the relevant literature, the risk factors of Chinese suicide deaths were analyzed, and the implications thereof were explored from a forensic point of view. Compared with the released statistics from the WHO, suicide cases collected during forensic death investigations revealed diverse details and meaningful characteristics of Chinese suicides, indicating the existence of regional common traits, as well as differences, in the characteristics of suicide cases, and highlighting the need for future suicide protective measures.
Financial support and sponsorship
Support was provided from the Beijing Natural Science Foundation (7163221) and the Program for Young Innovative Research Team from China University of Political Science and Law (2014CXTD04).
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]