In China, suicide in young women is a problem too

British Medical Journal, Sept 9, 2000 by Sing Lee

EDITOR--Mayor reports that the Men's Health Forum recommends that suicide in young British men needs multiagency solutions rather than efforts by psychiatrists or general practitioners alone.[1] This is true in China too, except that it is young women who should be the target of interventions.

China's national suicide rate has been estimated to be about 30/100 000 annually,[2] about three times the global average. Consequently, China accounts for more than four tenths of suicides reported worldwide, including more than half of suicides among women (although reliable data on suicide from Central and South America, Africa, the Middle East, and huge Asian countries such as India and Indonesia are still lacking). Among women, completed and attempted suicide is a greater source of lost working days than diabetes, heart disease, or cancer.

The rate is astonishingly high in young rural women aged 15-24, which casts doubt on the view of experts such as Baechler that "women endure misfortune better than do men. Their social roles require them to face unbearable problems less frequently.... As daughters, wives, and mistresses, and conforming to the dependency which nature and culture encourage, women have a greater tendency to reach their ends by the threat of trying to kill themselves.... Dangerous and aggressive behavior generally is not characteristic of women."[3]

Evidence suggests that high rates of suicide in young Chinese rural women have multiple causes: low social status, forced marriage, domestic abuse, birth control policy, harassment by the husband's family, frustration over rural life, easy availability of pesticides, and greatly limited access to medical resuscitation facilities.[4] Since most rural Chinese people do not have medical insurance and psychiatrists and even general practitioners are barely available in many rural areas, the prevention of suicide must rest, provided political will is available, on the intersectoral collaboration of multiple local agencies.

Sing Lee senior lecturer in psychiatry Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong singlee@cuhk.edu.hk

[1] Mayor S. Suicide in young men needs multiagency solutions [news extra] bmj.com/cgi/content/full/320/ 7242/1096/d

[2] Phillips M, Liu HQ, Zhang YP. Suicide and social change in China. Culture Med Psychiatry 1999;23:25-50.

[3] Baechler J. Suicides. Oxford:Blackwell, 1979:291.

[4] Lee S, Kleinman A. Suicide as resistance in Chinese society. In: Perry EJ, Selden M, eds. Chinese society: change, conflict and resistance. London: Routledge, 2000:221-40.