Suicide of Older People in Rural China
Shanshan Wei
Institute for Population and Development Studies
Xi'an Jiaotong University (China)
Yanping Zhang
Institute for Population and Development Studies
Xi'an Jiaotong University (China)
Jesús J. Sánchez-Barricarte, Ph. D.
Carlos III University of Madrid (Spain)
1 Abstract
With the extension of life expectancy, the number and proportion of older population is increasing rapidly. And the suicide of older people in rural China has attracted widespread attention. Based on the literature on the suicide of older people in rural China, it is found that the annual average suicide rate is relatively high, and that the general trend has been increasing since the 1980s but that the tendency has declined after 2000. Besides, the suicide rate of rural older people increases with age and the incidence of suicide ideation also makes up a higher percentage.
The ways of suicide mainly include drinking pesticides, hanging and drowning. Suicide among older people is mainly attributed to the decline in offspring number in the context of family old age support, fierce social competition, loss of filial piety and suffering of illness. Furthermore, many issues are reflected by the suicide of rural older people such as the imbalance of intergenerational relations in rural areas, the destruction of the traditional family system caused by gender imbalance and challenges to the traditional family old age support. Therefore, to cope with the suicide of rural older people, it is necessary to alleviate rural poverty and to perfect the rural social security system.
Keywords: older people, suicide, ways of suicide, loss of filial piety, social security
2 1- INTRODUCTION
With the development of social economy, there has been a progressive increase in the proportion of older people in China every year and the rate of aging is gradually accelerating. As is indicated by the population census in 2010, there are more than 177 million people aged 60 and over, accounting for 13.26% of the total population. By the end of 2015, the population of old people aged 60 and over has reached 222 million with the proportion of 16.1%. The projection of the United Nations in 2015 has shown that the proportion of older people in China will continue to grow and reach 27.55% in 2050 (UN, 2015). Issues such as the health of older people and the social security have aroused extensive attention. However, few researches are carried out from the perspective of the suicide of rural older people. The suicide behavior has gradually entered the public eyeshot (Sun et al., 2013), especially the suicide of older people, since Chinese government published the data on suicide rate in 1989 (Li et al., 2009).
The suicide of older people is a relatively serious issue in rural China. Compared with that in urban areas, the suicide rate of rural older people is four times higher (Phillips et al., 2002b) and the average rural suicidal population from 1987 to 2010 is 5.5 times that of urban areas with the maximum of 11 times in 2001 and the minimum of 1.4 times in 2005 (Huang and Liu, 2013). The average suicide number per year is 303,047 in rural China and 28.72 of every 100,000 rural people die by suicide (Sun Yefang Fiscal Science Foundation, 2010), among which the rate of older people aged over 60 is the highest (Wang, 2011) and the suicide rate of older people over 65 years old is 5-7 times higher than the average suicide rate in rural areas (WHO, 2009).
There are many factors accounting for the suicide of older people in rural China. Early researches paid much attention to the mental and psychological illness of individuals and hold the view that older people committing suicide all exhibit symptoms such as mental disorder and depression, etc. to different extent (Xu et al., 2000; Phillips et al., 2004; Yang et al., 2005). With the introduction of Durkheim’s “On Suicide”, scholars show a stronger tendency to explain the causes of suicide among older people in the dimensions of the social structure and its changes and changes in family relations (Yang and Ou, 2013; Liu, 2014b). Besides, humanistic factors such as religion, culture and values also account for the suicide of older people (Chen, 2007; Wu, 2007;
Yang and Fan, 2009). Nevertheless, there are four factors that require special attention since 2000.
3 One is that the decline in offspring number in the context of family old age support; the second is the fierce social competition has weakened the function of family support for older people; the third is attributed to the loss of filial piety; the fourth is the physical and mental suffering of illness among older people.
Suicide poses a serious threat to people’s psychological and life safety. Every 100,000 deaths caused by suicide correspond to 800,000 attempted suicide and one suicide death exerts great influence on 6 people, with the lasting psychological harm to others for up to 10 years. At the same time, 2 people are seriously affected by one case of attempted suicide and the psychological harm will continue for half a year (Huang, 2011). The suicide of rural older people will not only make their children feel double penalized in terms of the reputation loss in public opinions and the anxiety and guilt of conscience (He and Guo, 2012), but also produce the imitation effect among the older people around. Consequently, suicide of older people in rural China has become a serious social and public health issue (Deng, 2014). Chinese professionals and organizations should pay more attention to the suicide crisis among the rural older people (Li et al., 2009).
On the basis of the literature review, especially the literature in Chinese, this paper aims to exhibit the trend and ways of suicide among rural older people and explore the causes of suicide, as well as the social changes in rural China reflected by suicide. The remaining of this paper consists of five sections. Section Two presents the suicide trend of rural older people.
Section Three specifies the main suicide methods of older people. Section Four analyzes four factors that cause the suicide of older people –the decline in offspring number in the context of family old age support, the fierce social competition, the loss of filial piety and the suffering of illness. Section Five deals with the social changes in rural areas reflected by suicide such as the imbalance of intergenerational relations in rural areas, the destruction of traditional family system caused by gender imbalance and challenges to families in supporting older people. The last section, the conclusion part makes a summary of the major findings. It is expected that the analyses below will help to understand the current suicide situation of older people in rural China and provide scientific bases for intervention measures against the suicidal behaviors of rural older people.
4 2- SUICIDE TREND OF RURAL OLDER PEOPLE
The suicide rate of older people in rural China is comparatively high. Internationally, countries with the suicide rate of more than 30/1000,000 is regarded as countries of high suicide rates, while countries with low annual average suicide rate maintain the rate of less than
10/100,000 (Khan, 2005). The annual average suicide rate of older people in rural China is 82/
100,000 from 1995 to 1999 (Phillips et al., 2002a). Table 1 provides official statistics on suicide rates in China from 2002 to 2014, showing a relatively high suicide rate among the rural older people. At the same time, it shows that the suicide rate of old men is evidently higher than that of women, which can be accounted for the poorly social skills of the male elderly, as well as their loss of family status. Table 2 presents some survey data concerning the suicide of rural older people. Having analyzed the data of several decades in one or several villages, these surveys have found that the annual average suicide rate among the rural older people is higher than 30/100,000 and reaches a maximum of 861.30/100,000 in some villages in Guizhou province. Although the sample of the data is too small to represent the average level of suicide among older people, the occurrence of so many suicide cases in one or several rural areas also accounts for the seriousness of suicide among rural older people. Table 1 Suicide rate of older people by age group in rural China (per 100,000）
Age group
Year 60-64 65-69 70-74 75-79 80-84 85 及以上
overall male female overall male female overall male female overall male female overall male female overall male female
2002 32.25 39.94 23.92 42.91 54.48 31.67 61.83 77.66 47.62 90.44 107.23 77.86 95.22 132.65 72.73 113.12 137.11 101.58
2003 38.48 42.13 36.25 57.20 59.24 50.33 77.04 88.55 64.13 131.79 109.67 77.86 159.12 130.79 72.73 138.18 101.42 101.58
2004 26.09 30.07 21.61 30.24 33.47 26.86 44.88 53.12 37.10 59.68 53.33 64.86 89.53 123.32 66.86 107.62 94.48 114.32
2005 22.87 25.03 20.13 39.15 39.82 38.35 42.89 46.00 39.33 65.16 74.23 56.30 82.98 96.54 71.93 97.50 77.12 111.71
2006 20.89 24.24 17.20 26.35 29.67 22.91 36.11 45.01 27.82 48.02 58.04 40.08 65.82 87.89 51.59 74.03 83.46 69.61
2007 22.34 27.27 17.13 28.45 34.27 22.67 40.55 51.69 30.23 57.21 67.46 48.85 86.73 103.51 75.13 97.52 127.97 81.08
2008 18.52 17.96 19.14 20.51 27.32 13.60 26.93 31.46 22.76 41.18 47.19 36.40 51.87 68.40 41.28 62.48 106.10 42.47
2009 19.83 22.09 17.38 23.68 26.48 20.80 35.10 43.21 27.34 53.00 64.07 43.80 81.16 90.31 74.78 104.92 130.25 91.90
2010 17.67 18.57 16.73 27.02 29.19 24.81 44.25 51.44 37.31 68.78 88.71 52.30 108.13 151.03 79.49 191.74 256.81 159.70
2011 17.82 19.48 16.04 25.59 29.57 21.47 35.23 41.69 28.87 46.36 50.99 42.39 78.50 104.13 60.52 93.46 148.44 63.76
2012 15.49 16.71 14.18 19.79 21.64 17.83 26.58 29.90 23.20 43.47 47.50 39.79 53.08 64.93 43.79 71.17 92.21 58.72
2013 15.56 17.62 13.40 22.06 25.47 18.59 30.96 37.05 24.79 43.95 53.66 35.27 59.18 73.17 48.38 72.40 95.03 58.92
2014 15.16 16.80 13.44 21.44 25.31 17.52 30.99 35.46 26.50 42.02 49.16 35.53 55.83 67.51 46.62 70.29 93.54 56.19 Data sources: The Ministry of Health in China (2003-2012); National Health and Family Planning Commission in China (2013-2015).
5 Table 2 Annual average suicide rate of rural older people Survey Period length in years Number of Annual average Survey Total older suicide deaths suicide rate among starting ending number No. description population population among older older people (per year year of years people 100,000) A village in 1 1980 2007 28 3926 518 59 406.78 Anhui Province 3 villages in 2 1980 2009 30 6740 1166 31 88.62 Hubei Province 6 villages in 3 1980 2009 30 6991 1210 128 352.62 Hubei Province 8 villages in a 4 Province in 1980 2009 30 9365 1621 145 298.17 central China Villages in 5 Shandong 2011 2012 2 390800 44559 63 70.69 Province 4 villages in 6 1970 2009 40 8500 985 40 101.52 southern China 3 villages in 7 1980 2009 30 6613 553 25 150.69 Hubei Province 13 villages in 8 1980 2009 30 7159 611 102 556.46 Hubei Province 4 villages in 9 Henan 1980 2009 30 7636 808 23 94.88 Province 34 villages in 10 seven 1980 2009 30 28461 3488 329 314.41 provinces 4 villages in 11 1989 2009 21 4161 760 92 576.44 Hubei Province Villages in 12 Guizhou 2004 2008 5 23150 1579 68 861.30 Province Data sources: Survey 1 comes from Wu (2009); 2 and 3 come from Zhao and Zhong (2012); 4 comes from Yang and Ou (2013); 5 comes from Zhang (2013); 6 comes from Yang (2013); 7 and 8 come from Liu and Wang (2013); 9 comes from Liu (2013); 10 comes from Liu (2011); 11 comes from Xia and Xu (2015); 12 comes from Li (2013). Note: The annual average suicide rate is calculated by using the population data at the time of the survey and the cumulative suicide deaths over the years. The formula adopted is the cumulative suicide deaths/ (the current population*years). As the number of older people in history may be less than it is now, the data of the annual average suicide rate is actually underestimated.
Seen from the trend of the suicide rate of rural older people, Table 1 shows a downward trend in recent years, but some survey data present an increasing trend since the 1980s. As is shown in
Figure 1, the suicide rate of rural older people has increased from 100.34/100,000 in the 1980s to
610.67/100,000 in recent years, based on the data of suicide rates gathered from 34 villages in
Hubei, Hunan, Henan, Shanxi, Anhui, Fujian and Jiangxi Provinces (Liu, 2011). The data of suicide rates of 20 villages in Henan, Hebei and Hubei Provinces in 2007 exhibit an upward trend from 60.85/100,000 in the 1980s to 507.1/100,000 (Liu, 2013). During the period between the early years of the 1980s and 2009, the suicide rate in six villages in Jingshang County of Hubei
Province has increased from 198.35/100,000 to 528.93/100,000 (Xia and Xu, 2015). In the same 6 period, the suicide rate of older people has risen from 57.92/100,000 to 984.55/100,000 in a village of Anhui Ningguo, nearly 16 times than the previous rate (Wu, 2009). Besides, the suicide rate of older people in 8 villages in central China shows an accelerating trend from
148.06/100,000 to 499.69/100,000 (Yang and Ou, 2013).
Suicides per 100000 per year
Year
Figure 1 Trend of the annual average suicide rate of rural older people (every 100,000) Data sources: the data of 34 villages in 7 provinces in survey 1 come from Liu (2011); the data of 20 villages in 3 provinces in survey 2 come from Liu (2013); the data of 8 villages in central regions in survey 3 come from Yang and Ou (2013); the data of 6 villages in Jingshan County in survey 4 come from Xia and Xu (2015); the data of village A in Anhui Ningguo in survey 5 come from Wu (2009).
Table 3 provides the number of suicide deaths among rural older people over the years.
Owing to the unavailability of the data, estimated data are employed in this paper (Huang and Liu,
2013), which refer to the number of suicide deaths among older people over 55 years old. The number of suicide deaths among rural older people has increased from the 1980s to the beginning of 21st century, as a result of rapid changes in social and economic development and the increasingly fierce competition (Huang and Liu, 2013), simultaneously with the explanation of the aging of population structure. Since 2001, the government has begun to pay attention to the issue of suicide. Although there is an increase in the number of rural older people, the number of suicide deaths has presented a downward trend, quickly dropped from 78500 in 2001 to 32200 in 2008.
Moreover, the decrease in the number of suicide deaths is consistent with the downward trend of suicide rates among rural elderly in Table 1. For people aged over 55, the average age of suicide is about 70 years old.
7 Table 3 Number of suicide deaths and suicide rate among rural older people aged 55 and over Average age at Year Number of suicide deaths Suicide rate (1/100,000) suicide death ( thousand) (years old) 1987 63.1 54.8 68.3 1988 63.9 53.9 68.5 1989 64.9 53.7 68.5 1990 57.5 46.8 69.1 1991 75.3 58.6 69.1 1992 68.8 52.7 69.2 1993 75.1 54.7 69.2 1994 76.8 54.4 69.5 1995 70.7 50.1 69.8 1996 75.2 51.5 69.8 1997 79.8 52.9 69.8 1998 75.6 49.6 70.0 1999 76.0 48.9 70.2 2000 74.4 46.7 70.2 2001 78.5 47.6 70.5 2002 57.6 45.4 70.8 2003 65.5 46.8 70.2 2004 45.0 31.0 70.9 2005 45.1 41.1 71.1 2006 36.9 23.1 70.5 2007 43.8 22.4 70.8 2008 32.2 16.4 69.8 2009 39.6 19.5 71.7 2010 52.2 25.3 73.6 Data source: Huang and Liu (2013). Note: Huang and Liu (2013) estimated the number of suicide deaths for people aged 55 and over, as the retirement age is 55 for urban women and the age group of 55 and over includes the entire older population.
Table 1 shows that the suicide rate of rural older people increases with age. In 2002, the suicide rate of older people aged 60-64 is 32.25/100,000 in rural China and increases to
113.12/100,000 for those aged 85 and over, while the rate is 15.16/100,000 and increases to
70.29/100,000 in 2014. It has been confirmed by some surveys that the older the rural population is, the higher the suicide rate is. According to the survey carried out in Hunan, Henan and Hebei
Provinces, it has been found that the suicide rate in southern rural areas reaches 101.63/100,000 and 221.24/100,000 respectively among older people at the age of 60-69 and 70 and over; the suicide rate of older people is relatively low in northern rural areas with 79.37/100,000 for older people aged 60-69 and 120.61/100,000 for those aged 70 and over; in central regions, the suicide among older people is the most serious issue with the corresponding proportion of 238.10/100,000 and 1186.99/100,000, where the annual average suicide rate among rural elderly aged 70 and over is much higher than that among the elderly aged 60-69 (Liu, 2013). The data above indicate that 8 the suicide rate is related not only to the worse physical condition with the increasing age but also to the more vulnerable psychological state growing with age.
The rate of suicide ideation is also at a high level. Suicide ideation refers to the clear intention to hurt oneself, but there is no elaborate plan and preparation committing suicide or actual behavior hurting oneself (Xiao et al., 2005). It is an essential phase of suicidal behavior and is closely related to suicide (Dong et al., 2014). The data in Table 4, concerning the rate of suicide ideation among older people in rural areas of some provinces, show that the incidence of suicide ideation is more than 10%, much higher than 0.67% of urban elderly (Luo et al., 2015). The rate of suicide ideation is also high among older people in rural China compared with that in countries such as France (8.4%) (Vasiliadis et al., 2013), Nigeria (4.0%) (Ojagbemi et al., 2013), Australia
(4.8%) (Almeida et al., 2012), Japan (10.0%) (Noguchi et al., 2014) and Canada (11.9%) (Lemstra et al., 2009). The high rate of suicide ideation indicates that there are more rural older people with suicide tendencies and they are likely to vent their anger, caused by difficulties, to suicide. Table 4 Rate of suicide ideation among older people in rural China Number of Rate of Survey Total rural older people Observed Survey suicide Scale No. population with suicide point ideation(%) ideation 160 cities and Self-designed 1-year 1 counties in 20 9954 165 1.66 questionnaire prevalence provinces in China 3 villages in Scale of Beck suicide 1-year 2 Yuanjiang, Hunan 912 181 19.90 ideation prevalence Province 2 villages in Simplified scale of 1-year 3 Liuyang, Hunan 839 47 5.60 UCLA loneliness prevalence Province Dangtu County in Scale of Beck suicide 4 Ma’anshan, Anhui 695 164 23.60 - ideation Province 3 villages in Self-designed 1-year 5 Macheng, Hubei 2025 144 7.10 questionnaire prevalence Province 3 villages in Self-designed 1-year 6 Hengyang, Hunan 1040 224 21.50 questionnaire prevalence Province 4 villages in Self-designed Lifetime 7 Lengshuijiang, 670 87 13.00 questionnaire prevalence Hunan Province 2 districts in Self-rating scale of 8 Chenzhou, Hunan 988 257 26.01 - suicide ideation Province 14 villages in 5 cities Model with random Pooled 9 from 3 provinces in - - 14.70 effect (D-L model) prevalence China 24 villages in Self-designed 1-year 10 Mianyang, Sichuan 87 9 10.30 questionnaire prevalence Province Data sources: Survey 1 comes from Luo et al. (2015); 2 comes from Qing (2007); 3 comes from He et al. (2014); 4 comes from Cheng et al. (2013); 5 comes from Li et al. (2011); 6 comes from Tao et al. (2011); 7 comes from Li (2015); 8 comes from Hu (2016); 9 comes from Dong et al. (2014); 10 comes from Chiu et al. (2012).
9 3- WAYS OF SUICIDE AMONG RURAL OLDER PEOPLE
The main methods of suicide in China are drinking pesticides and rat poison (30% -67%), followed by hanging (8% - 44%), drowning (3% -14%) and jumping from high-rise buildings (3%
-7%) (Ji et al., 2001). During the survey in a village of Hubei Province, the surveyor was told by an old man that only “three sons” were the most reliable for the elderly in this village, namely,
“son of pesticide” (drinking pesticide), “son of rope” (hanging) and “son of water” (drowning)
(Xuan, 2014). Table 5 Proportion of rural older people in different ways of suicide (%) Survey Total Survey Pesticides Hanging Drowning Others No. number 25 villages in 3 counties of Shandong 1 112 50.0 39.3 1.8 8.9 Province, 2008-2009 Clinical reception in Henan 150 2 97 48.5 8.2 4.1 39.2 Hospital, 2000-2005 3 8 villages in Changsha, 1996-2000 134 68.0 20.9 9.7 1.4 4 20 villages in 4 provinces, 1980-2009 150 70.0 22.0 6.0 2.0 a town in Ningguo, Anhui Province, 5 29 51.7 17.2 31.1 0.0 2001-2005 Clinical reception in People’s Hospital 6 in Anhua County, Hunan Province, 65 92.3 0.0 0.0 7.7 2007-2010 Psychological rehabilitation hospital in 7 30 70.0 30.0 0.0 0.0 Yantai, Shandong Province, 1990-1996 3 villages in Hengyang, Hunan 8 57 71.9 3.5 7.0 17.6 Province, 2008-2009 a town in Yuqing County, Guizhou 9 68 52.9 22.1 25.0 0.0 Porvince, 2004-2008 Data sources: Survey 1 comes from Wang (2011); 2 comes from Guo and Guo (2007); 3 comes from Lv et al. (2003); 4 comes from Liu (2013); 5 comes from Wu et al. (2009); 6 comes from Li and Xiao (2011); 7 comes from Ju and Sun (2000); 8 comes from Li et al. (2011); 9 comes from Li (2013).
Drinking pesticide is the most common way of suicide among rural older people. As is shown in Table 5, the number of suicide by drinking pesticides has accounted for more than 50% of all suicide deaths, so “drinking pesticides” has become synonymous with rural suicide (Li, 2008). Of the 266 suicide data in a rural county of Shandong province, only less than 10 people take a non-drug approach to suicide (Li and Zhang, 2015). Pesticides are widely used and stored in rural areas of China, which provides convenience for the elderly who want to commit suicide. The high lethality of pesticides and the backward medical level lead to a lot of impulsive suicide deaths and the high rate of suicide caused by venting dissatisfaction to pesticides, having increased the suicide rate among rural older people.
Hanging comes in second among rural older people. The vast majority of older people with 10 weak legs commit suicide by means of hanging themselves and their suicide ideation often achieves a middle or high level (Wang, 2011). Besides, owing to the difficulty in action, some older people hang themselves on the window. With high lethality and enormous rescue difficulty of hanging, the large proportion indicates their determination to die and the lack of care for them.
Apart from drinking pesticides and hanging themselves, drowning is also a common way of committing suicide among rural older people. The way of drowning is mainly related to the local geographical conditions. In some rural areas, drowning makes up a large proportion because of the lakes and ponds (Liu, 2013). In a village of Guizhou Province, there is a reservoir specially used to develop the aquaculture in fishery production and owing to the convenience, the elderly in this village commit suicide by drowning themselves in the lake in April or May, the flood season of the year (Zou, 2011). The fact that older people choose to drown themselves reflects the strong intention to commit suicide.
In addition to the ways above, older people also adopt other indirect methods to commit suicide such as by refusing to eat or drink, taking medicine and hurting themselves, etc. (Zhai,
2001). Other ways to commit suicide are also employed such as swallowing sleeping pills, devouring the match head, being suffocated by soil and being deliberately run over by trucks (Liu,
2012；Xia and Xu, 2015). If they want to commit suicide, the suicide ideation will be very strong
(Gao, 2010；Wang, 2012), and a variety of methods will be adopted to achieve their goals (Yang et al., 2005).
4- DIRECT CAUSES OF SUICIDE AMONG RURAL OLDER
PEOPLE
Family support for the elderly is the main model of old-age care in rural areas, owing to the incomplete social security system in China. According to the census in 2010, of the rural population aged 65 and over, 59% of the elderly make a living by what they get from other family members, 28% rely on their own labor income and only 5% live on retirement pension (Jiang et al.,
2016). Against the background of rapid social and economic transformation, rural areas are affected by the decline in household size and the large-scale population flow between cities and towns (rural population move to cities to seek jobs) and there has been a great impact on the traditional family old age support model for the aged.
11 There are many reasons for suicide among rural older people, such as the family economic poverty and the decline of their family status, etc. Quite often, the suicide among older people is not simply caused by one inducing factor, maybe two or more. At present, special attention is required to be paid to the following causes -the decline in offspring number in the context of family old age support, the weakened function of traditional family support for older people caused by fierce social competition, the loss of filial piety and the suffering of illness.
The decline in offspring number in the context of family old age support
Traditionally Chinese older people depend on male adult children for old age support. The number of children, especially sons, is a very important determinant for older people’s life. Based on the family old age support system, it is easy to understand the confusimism ideology of “more sons, more blessings”. However, since early 1970s, China launched the birth control policy initiated by “Wan-Xi-Shao” (late childbearing, longer birth interval, and fewer children), and followed by a strict one-child policy, which resctrcted the number of children a couple could have
(Jiang and Liu, 2017). Due to China’s birth control policy, and ideational transformation with socioeconomic development, the fertility level and numbe of offspring has declined markedly during the past years, especially for those women who were at the prime childbearing age in the
1970s and 1980s declined markedly. Now those women have entered the old age stage, and their birth number showed a dramatic decline trend with the decrease in age, as shown in Table 6. The decline of offspring number has weakened the capacity of supporting the older people, which could be accomplished by a large family. Table 6 Number of children ever born alive, and surviving by age Age Number of children ever born alive Number of surviving children 55 2.08 2.05 56 2.13 2.10 57 2.22 2.18 58 2.30 2.26 59 2.38 2.34 60 2.48 2.43 61 2.60 2.54 62 2.70 2.64 63 2.78 2.71 64 2.81 2.74 Data source: PCO (2012)
12 The weakened function of traditional family old age support caused by fierce social competition
With the rapid transformation of social and economic development in China, the increasingly fierce social competition and added pressure have aroused the collective anxiety among the middle-aged people in rural areas. The older people mainly rely on their family members for support because of the imperfect social security system in rural China (Jiang et al., 2016). For their adult children, older people is not only a servant which can be employed but also a burden which can be removed. If the elderly is no longer able to earn money, he will be a despised drag on their children. It is believed among many middle-aged people that “Damn the older people for their uselessness. If they don’t die, do the young go to die?” (Yang and Fan, 2009). Young people often say: “Older people have difficulty in moving freely and need much care, so delays often occur. Actually, their children indeed want them to die.” (Chen, 2009).
In a village of Jingshan county, Hubei Province, a son, in order to migrate to urban areas for employment, put a bottle of pesticide at his mother’s bedside, who was seriously ill, and said:
“You’d better drink it, otherwise I could not go out to work if you were still alive.”. Consequently, his mother really committed suicide by drinking the pesticide (Chen, 2009). Likewise, in the same village, an old man, at the age of over 70, was ill and called up his three sons who worked outside and after their return, they said: “There are only seven days off. We must go back to work as soon as the leave ends. You have no choice but to die, otherwise nobody will take care of you”, and later, the old man died within the specified time and his sons returned to work after arranging the funeral (Liu and Yang, 2014). Another case is as such: in 2009, an old man called Dong Jiang, in Ji
Village of Hebei Province, could not afford his son’s wedding expenses. His son feared that his wedding would be destroyed, so he quarreled with his father and scolded him for his incompetence. Dong Jiang blamed himself for his drag on his son and he committed suicide by drinking pesticide in a pet (Liu, 2014a).
Such cases are not rare. The competitive pressure of the offspring has accelerated the transformation of the intergenerational relationship from love and piety between father and son to exploitation, which has weakened the function of the traditional family support for the elderly.
13 Based on the trend of intensified social competition, more pressure has been placed on the middle-aged man, as a result of comparison among peers in the same village. Consequently, the intolerable pressure will be transferred to the more vulnerable elderly.
The loss of filial piety
The loss of traditional filial piety is another major cause which accounts for the serious suicide issue among rural older people. China is a country that advocates the culture of filial piety, where parents should bring up their children and adult children should provide support for the aged parents and attend upon their funerals. However, with the development of social economy, there is a sharp rise of “opportunity cost” in family support for the aged caused by the excessive pursuit of economic interests, concern for children and more energy invested in children, which leads to the dilemma concerning the maintenance of filial piety (Gao, 2010). Besides, there is a huge conflict between the ethic-based concept of the elderly and the rights-based behavior of children (Yang, 2013). The traditional filial piety gradually loses its binding force on unfilial behaviors, and the moral hazard is greatly reduced that children do not show filial obedience to their parents, thus giving rise to the common occurrence of non-filial behaviors (Zheng, 2010).
The filial piety in rural areas has gradually lost its status and the function of family support has been greatly weakened. Older people with no economic income have no choice but to rely on their children after losing the labor capacity. However, whether the elderly can receive the due care depends on the attitudes of their children. If their children refuse to support them, some of the elderly will find relief from committing suicide. An old man surnamed Qian, living in Yabian
Village in Tongwei, Gansu Province in the northwest of China, went to a hunger strike to end his life. Having lost the labor capacity, Qian relied on his son entirely for support. During his illness,
Qian did not receive any medical care and his son showed no filial obedience to him, which made him lose the confidence to keep alive. Some old men in the village, who had visited Qian, said:
“When I visited him, Lao Qian said that he had not eaten anything for 10 days and must die.
Having said that, Qian burst into tears. Miserably, maybe Lao Qian couldn’t close his eyes at the hour of death.” (Yan, 2015).
When interviewed the question that whether adult children would send their sick parents to doctors, the secretary in one village, located in Hubei Province, answered that adult children
14 would not spend money for their parents unless the elderly could earn the money back (Chen,
2009). Under the circumstances of family economic poverty, non-filial behaviors are no longer rare that adult children spend money for the elderly on medical care by measuring the economic value of their parents. The loss of filial piety is a heavy blow to the older people who are deeply influenced by traditional ideas and have great expectations for their children.
The suffering of illness
According to China’s population census in 2010, the percentages of rural older people aged
65 and over in terms of our health status, i.e., healthy, basically healthy, unhealthy but able to take care of oneself, and not able to take care of oneself, are 32%, 42%, 22% and 4% respectively. For rural older people aged 80 and over, the percentages of the four groups are 16%, 39%, 34% and
11% respectively (PCO, 2012). Survey data indicate that health status of the elderly is even worse than that seems to indicate. In a self-rated health survey, 31.8% of elderly people stated that they were in bad or worse health, 38.1% had physical disabilities (having difficulty in completing basic daily activities), 23.8% needed help in basic daily activities, and 33.4% suffered physical pain
(CHARLS Research Team, 2013). China’s elderly people have major difficulties with the
Instrumental Activity of Daily Living (IADL) or Activities of Daily Living (ADL) (For IADL disability and ADL disability, the life expectancy of people aged 65 is 16.3 years, including 8.7 years of healthy status, 4.8 years with only difficulty in IADL, and 2.8 years with difficulty in
ADL（Jiang et al., 2016). Traditionally the spouse is the main caregiver for older people. However, the widowhood rate is rather high. According to China’s population census in 2010, 24.50 million rural older people are widowed, accounting for 37%; 7.67 million older men are widowed, accounting for 24%; 18.63 million elderly women are widowed (49%) (PCO, 2012).
When suffering from illness, older people not only endure the pain of the body but also are tortured by the concept “A person must work, otherwise he is not a person”, which undoubtedly increases their suicide probability. In a village of Hubei Province, among the older people who commit suicide, over 70% spend their lives in pain and disability or semi-disability, with the proportions of 31% and 40% respectively (Liu and Wang, 2014). Cases of suicide, where older people want to get rid of the pain caused by physical and mental illness, account for 34% of all suicide deaths (Liu, 2013). It is generally believed by most older people that it is natural to end
15 their lives without regret as a result of serious illness. A village secretary in Hubei Province even argues that drinking pesticides owing to the intolerable agony cannot be counted as suicide (Chen,
2009). In their view, no such thing is more normal than the death caused by illness. Suicide is just a way to end their pain, which shows no difference from the death from illness.
There are many cases where older people who are suffering from illness commit suicide for the purpose not dragging their children. In order not to be a burden to their children, the elderly is likely to commit suicide, especially when they are informed of the incurable illness. Besides, they are also affected by the dilemma of expensive medical bills and difficult access to quality medical services, as well as the concept of “ignoring ailment and enduring serious illness until die”. An old man surnamed Wang, in Fang Village of Jingshan, Hubei Province, suffered from skin cancer and he had to spend thousands of yuan every year on his disease; he felt that he had placed so much burden to his children since they had to pay for the education of their children although they were filial to him and willing to pay for his disease, so he drank pesticides secretly to avoid causing more trouble for his children (Chen, 2009). In 2002, a 68-year-old man surnamed Li in a village of
Anhui Province was paralyzed on one side of his body owing to a cerebral hemorrhage, and caused by the incurable disease, he learned that he could not do anything for his family but drag them, then he committed suicide by drinking pesticides (Wu, 2009).
Therefore, in addition to killing the pain brought by the disease itself, factors such as lack of money and considerable family pressure also lead to suicide among the elderly in order to remove the burden on their children.
5- SOCIAL CHANGES IN RURAL AREAS REFLECTED BY
SUICIDE
The imbalance of intergenerational relations
The suicide among older people highlights the issue concerning the imbalance of intergenerational relations. The traditional intergenerational relations are demonstrated in terms of rearing children and supporting the elderly between two generations of parents and children, that is, parents raise their children until they have grown up and adult children provide support for
16 their elder parents, presenting a “feedback” mode (Fei, 1983). With the development of social economy and the transformation of family function, the intergenerational model has changed a lot, whose balance has been broken (Wang, 2003). After children having grown up, exchange relationship has developed between the two generations (Wang, 2008). This kind of exchange relationship is reflected as such: when the elderly possesses the ability to create wealth for their children, they can get appropriate support and care from their children. However, once they lose such ability, the shift in power would lead to the decline of their authority and family status (Yan,
2005). The more risk of being abandoned by their children, the farther the intergenerational relationship would be and more difficult it would be for the elderly to gain intergenerational support (Lin, 2014). The possibility of suicide will increase because of the lack of material basis and emotional frustration.
Parents have fulfilled the obligation of raising their children but adult children do not take the responsibility for supporting the elderly, which gives a heavy blow to older people who have great expectations for their children. In some rural areas, children are not kind to their parents and parents show great fear of their children; there are also many cases of extreme abuse of the elderly
(He, 2008). In rural areas of Northern Anhui, some adult sons live in large and spacious buildings, while their parents spend winters in a plastic shed and even some elderly parents live in an abandoned pigsty (Chen, 2007). The excessive imbalance of intergenerational relations results in the seriousness of suicide among rural older people.
The destruction of traditional family system caused by gender imbalance
In recent years, the imbalanced gender ratio has brought about an increase in women’s negotiation ability in marriage and the ability of controlling family. Because of the difficulty in getting married, a man tries his best to meet the requirements proposed by the woman (Jiang et al.,
2015). In addition, the phenomenon gradually occurs that at the time of marriage it is clearly stated in the agreement that the new couple will not support the elderly in the future. An interviewee in a village of Shangdong Province has said: “The wives in our village will not care for their parents-in-law, which has already been negotiated before getting married. Not only will they not provide any family support for the elderly but also they won’t allow their parents-in-law
17 to live in the new house with them. How poor these people are when they get old! There is no point in spending life as such.” (Li, 2012). Parents spend all their savings and even are burdened with high debt for the marriage of their sons. However, the married son does not support his elderly parents, so they have no choice but to continue farming on their land, the only remaining property, to make a living. The analysis above accounts for the phenomenon in a village of the
North China Plain that old people aged 80 and over have to work to feed themselves after their son getting married (Tao, 2013).
On account of the increasing in women’s negotiation ability in marriage and controlling ability in family, which is the result of gender imbalance, older people do not receive the due care and not be treated dutifully. According to the law, the son and daughter-in-law should provide family support for their older parents but the daughter-in-law becomes a main catalyst of the phenomenon that the elderly cannot get proper care. On the basis of the investigation of 4 villages in the southern provinces, it has been found that more than half of older people commit suicide as a result of the intergenerational conflict and the rate of suicide caused by the conflict between older parents and their daughters-in-law is higher than that between the elderly and their sons
(Yang and Ou, 2013). The villagers in Jingshan County of Hubei Province have said that there is no son and daughter-in-law who do not heap abuse on their parents. A wife expresses her attitude towards abusing parents-in-law as such: “You deserve the abuse for the wrong things you have done.” In the year of 2005, a villager surnamed Wang aged 69, committed suicide after a quarrel with his daughter-in-law and the reason of suicide lied in the previous numerous abuse rather than the quarrel itself (Chen, 2009). In 2007, an old woman aged over 70, in a village of Jiangxi
Province, committed suicide by drinking pesticides. She had two sons but lived with the younger, and she was in good health and sold tofu every day. One day, her daughter-in-law quarreled with her, hurled abuse at her and hit her later, so Liu drank pesticides in a pet (Wang, 2012).
The conflict between mothers-in-law and daughters-in-law occupies a prominent place among the conflicts within the family. On the one hand, with the improve of negotiation and controlling capacity of women, daughters-in-law are no longer willing to live with their parents-in-law and most have done this, which increases the risk of family support for the elderly.
On the other hand, rural older people are deeply influenced by the traditional patriarchal concept and have high expectations and life requirements for their daughters-in-law. Once these 18 requirements are not met, the elderly will feel the threat of not being respected. The differences of ideas and ways of thinking between mothers-in-law and daughters-in-law will inevitably lead to numerous family conflicts (Huang and Liu, 2013), and the intensified conflict is likely to bring about suicide tragedy. Adding one person indicates adding a caregiver for the elderly. However, with one more person at the same time, older people are not well cared by their daughters-in-law but abused and maltreated. Together with the lack of legal constraints and supervision of public opinions, conflicts become more intensified, which leads to more suicide deaths.
The challenges to family old age support
Although the rural society is under the impact of the transformation of economic and social development, family support for the elderly still occupies a leading role in rural areas. Parents have a strong emotional sustenance towards their children, so children should love and respect their parents in turn (Xing, 2009), which is also the expectation of parents (Chen, 2009).
Nevertheless, some of adult children perceive their older parents as the burden of their pursuit of happiness and they are not willing to spend more money or time taking care of them (Zhang,
2015). Therefore, in terms of family support for older people, rural families are experiencing difficulties in family economic poverty, unwillingness or lack of time and energy to support the elderly, weak awareness of traditional culture concerning family support and decline of the family status of the elderly.
There are many challenges in family support for older people and the system of social pension has not been established. Problems still exist in rural endowment in China such as a serious shortage of pension agencies, shortage of funds and lack of pension equipments, etc., which makes social pension incompetent to play its role in promoting the rural pension undertakings. Older people in rural areas can only rely on their families or themselves. After the loss of self-care ability, simply relying on adult children does not offer a guarantee of security for his later years. Without other choices, older people have to end their lives by committing suicide.
6- CONCLUSIONS AND DISCUSSIONS
With the acceleration of aging, the number of older people has been growing rapidly and issues related to the elderly have become increasingly prominent. Besides, the suicide among 19 older people has attracted more and more attention of the public. The suicide rate is relatively high among rural elderly, with a rising trend since the 1980s and a downward trend in recent years, and it grows with age. In addition, the rate of suicide ideation is also at a high level.
In terms of ways of suicide, the main ways to suicide include drinking pesticides, hanging and drowning, all with high lethality, owing to the determination of older people to death.
Although the suicide issue among older people can be solved and the rate can be lowered to some extent from the perspective of ways of suicide, there is still a need to explore the fundamental cause of suicide among the elderly in order to solve the problem of suicide in a radical way.
The high suicide rate among older people in rural China is mainly attributed to the following factors. One is the decline of offspring number in the context of family old age support, which cut the capacity of family old age support which could be accomplished by more siblings. The second is that the fierce social competition has weakened the function of family support for the elderly.
Adult children are burdened with the increasingly fierce social competition as a result of the rapid transformation of social economy. Besides, the family status of rural older people is decreasing with the decline of economic status and the social pension system has not been established in rural
China, which lead to the weak economic foundation of the elderly in rural areas and thus they cannot live by themselves. The third factor is the loss of the traditional filial piety in China. The ideas have gradually faded away such as respect and support for older people. Although there are relevant legal provisions used to impose constraints on adult children to support their older parents, these provisions are issued late and are not carried out strictly in actual circumstances. The reasons above all contribute to the situation where older people receive less care from their children and have to make a living on their own with considerable pressure. The last is the physical condition of older people who have showed high prevalence of disease. On the one hand, they cannot withstand the impact of their failure to work while suffering from illness. On the other hand, in view of the burden of families, they are likely to commit suicide under double pressure. From the analyses above, the fundamental cause of suicide among rural elderly lies in poverty in rural areas.
They do not have any material basis for pension and enough money to afford the expensive medical expenses. Therefore, they have no choice but to commit suicide when they can no longer bear the pain caused by illness. Moreover, adult children also lack the material capital to support the elderly and have to participate in the fierce social competition to gain more. Under great 20 pressure, many adult children have gradually lost the sense of filial piety.
The suicide issue among rural older people also reflects the current transformation of social economy in rural China, represented by the imbalance of intergenerational relations, the destruction of traditional family system caused by gender imbalance and challenges to traditional families in supporting older people. During the process of family changes in intergenerational relations, the relationship between old parents and adult children has gradually changed from support to exchange relations. The fact that exchange relations are not established results in the imbalance of intergenerational relations and the loss of dependency of older parents. With the improving abilities of rural women in marriage and family, as a result of the imbalanced gender, they, as daughters-in-law, are likely to regard older parents as burden and refuse to provide any family support for them. In the rural society where family support is the main form for the elderly, the possibility of suicide would increase when family support faces challenges, social pension system is not perfect and the elderly have nothing to rely on.
China is actively establishing the social security system and the rural cooperative medical system in rural areas and it has produced a positive effect. However, with the acceleration of aging population and the migration of rural young labors finding jobs in cities, the issue concerning providing family support for rural older people has become a serious social problem and the suicide among the rural elderly is extremely severe, as a result of the great changes of social economy in rural areas and the strong impact on traditional family support for the elderly. At present, to alleviate the suicide among rural older people, it is an effective way to develop rural economy, reduce poverty and provide assistance so that rural adult children could afford the expenses of the elderly with sufficient physical capital and so could the elderly feed themselves, on the one hand; on the other hand, Chinese government should strengthen the establishment and perfection of the rural pension security system in order to achieve the joint development of the society and family support.
21 REFERENCES Almeida, O. P., B. Draper, J. Snowdon, N. T. Lautenschlager, J. Pirkis, G. Byrne, M. Sim, N. Stocks, L. Flicker, and J. J. Pfaff. 2012. Factors associated with suicidal thoughts in a large community study of older adults. The British Journal of Psychiatry 201(6): 466-472. CHARLS Research Team. 2013. Challenges of population aging in China: evidence from the national baseline survey of the China Health and Retirement Longitudinal Study (CHARLS). Chen, B. 2007. The change of farmers' values and its impact on family relationship. China Agricultural University Journal of Social Sciences Edition 24 (01): 106-113. Chen, B. 2009. Change of inter-generational relations and the elderly suicide: an empirical study in Jingshan county, Hubei province. Sociological Studies 24(04): 157-176+245. Cheng, L., H. Chen, and M. Zheng. 2013. Association of suicidal ideation and family factors among rural elderly. Chinese Journal of Public Health 29(02): 157-159. Chiu, H. F. K., J. Dai, Y. T. Xiang, S. S. M. Chan, T. Leung, X. Yu, Z. J. Hou, G. S. Ungvari, and E. D. Caine, 2012. Suicidal thoughts and behaviors in older adults in rural China: a preliminary study. International journal of geriatric psychiatry 27(11): 1124-1130. Deng, W. 2014. The model of social work intervention on rural elderly suicide risk——take resilience view for example. China Agricultural University Journal of Social Sciences Edition 31(01): 33-40. Dong, Y., F. Huang, G. Hu, Y. Liu, R. Zheng, Q. Zhang, and X. Mao. 2014. The prevalence of suicidal ideation among the elderly in China: a meta-analysis of 11 cross-sectional studies. Comprehensive psychiatry 55(5): 1100-1105. Fei, X. 1983. Old age support in the transitional familial relations. Journal of Peking University (Philosophy and Social Sciences) 20(03): 7-16. Gao, X. 2010. The suicide of the rural older peopleelderly. Legal System and Society 19(08): 190. Guo, X. and L. Guo. 2007. The analyses on the causes of suicide among 97 rural older people. Practical Journal of Medicine & Pharmacy 24(07): 849-850. He, J., Y. Tian, M. Hu, S. Xiao, and L. Zhou. 2014. Association between loneliness and suicidal ideation among rural elderly. Chinese Mental Health Journal 28(08): 618-622. He, X. 2008. Change of generation relationship in rural households and its influence. Jianghai Academic Journal 51(04): 108-113+239. He, X. and J. Guo. 2012. Category and logic of suicide in rural China. Journal of Huazhong University of Science and Technology (Social Science Edition) 26(04): 108-116. Hu, C. 2016. Risk Factors for Suicide Ideation among Elderly People Living Alone in the Rural Area of Anhui Province. Master's degree thesis of Medical University Of Anhui. Huang, R. 2011. Sex difference between the suicide population in China during 1987 and 2007. Northwest Population Journal 32(01): 59-63. Huang, R. and M. Liu. 2013. Analysis on the elderly suicide in China from 1987 to 2010. Population and Development 19(04): 95-100+81. Ji, J., A. Kleinman, and A. E. Becker. 2001. Suicide in contemporary China: a review of China's distinctive suicide demographics in their sociocultural context. Harvard Review of Psychiatry 9(1): 1-12. Jiang, Q., Y. Zhang, and J. J. Sánchez-Barricarte. 2015. Marriage expenses in rural China. China Review 15(1): 207-236.
22 Jiang, Q., S. Yang, and J. J. Sánchez-Barricarte. 2016. Can China afford rapid ageing? Springer Plus 5(1):1-8. DOI: 10.1186/s40064-016-2778-0. http://www.springerplus.com/content/5/1/1107. Jiang, Q. and Y. Liu. 2017. Low fertility and concurrent birth control policy in China. The History
of the Family. http://dx.doi.org/10.1080/1081602X.2016.1213179 Ju, H. and S. Sun. 2000. The analyses of the suicide among the old living in rural areas. China Journal of Health Psychology 08(04): 441-442. Khan, M. M. 2005. Suicide prevention and developing countries. Journal of the Royal Society of Medicine 98(10): 459-463. Lemstra, M., C. Neudorf, J. Mackenbach, T. Kershaw, U. Nannapaneni, and C. Scott. 2009. Suicidal ideation: the role of economic and aboriginal cultural status after multivariate adjustment. The Canadian Journal of Psychiatry 54(9): 589-595. Li, C. 2015. Study on suicideal ideation among the elderly living in rural areas and the influencing factors. Journal of Nursing Science 30(19): 11-13. Li, J. 2008. The spatial and temporal analysis of suicide. Guizhou Social Sciences 29(12): 32-37. Li, J. 2013. Study on Suicide. Beijing: Social Sciences Documentation Publishing House, pp. 327-332. Li, J. and Y. Xiao. 2011. Analysis on the causes of suicide among rural older people. Nurse Today 04(03): 145-146. Li, S. and L. Zhang. 2015. Characteristics, types and determinants of suicidal behavior in northern rural China—based on a field investigation in an agricultural county. Shandong Social Sciences 29(11): 85-91. Li, X., Z. Xiao, and S. Xiao. 2009. Suicide among the elderly in mainland China. Psychogeriatrics 9(2): 62-66. Li, Z. Q. 2012. Rural Groom Family’s Marriage Payment: Peasants’ Marital Strategy under the Background of Sex Ratio Imbalance. Shanghai: PhD Dissertation at Shanghai University. Li, Z., S. Xiao, and Y. Xiao. 2011. Suicidal behavior among elderly in a rural community of Human Province. Chinese Mental Health Journal 25(12): 949-954. Lin, Z. 2014. Balance or Unbalance: Family Intergenerational Relations and Old Age Support in Rural China. Master's degree thesis of Tsinghua University. Liu, R. and H. Yang. 2014. Lost in value and suicide of elderly: based on investigation in village J of Jingshan county, Hubei. Journal of Hunan Agricultural University(Social Sciences) 15(06): 46-53. Liu, Y. 2011. The suicide issue in the countryside(1980-2009):discussion with professor Jing Jun. Youth Studies 34(06): 72-82+93-94. Liu, Y. 2012. The Research of Chinese Peasant's Suicide(1980-2009):A Perspective of Social Mutual-construction Theory. Doctoral Dissertation of Huazhong University of Science and Technology. Liu, Y. 2013. The Suicides of the rural elderly and the crisis intervention in China :1980－2009. South China Population 28(02): 57-64+56. Liu, Y. 2014a. Living a fortune life for hope and value:a local Chinese concept to understand peasant’s suicide in Ji Village. Sociological Review of China 02(05): 68-86. Liu, Y. 2014b. Peasant’s Suicide in Rural China. Beijing:Social Sciences Documentation
23 Publishing House. Liu, Y. and X. Wang. 2013. Suicides of the aged in rural villages of China in the cultural perspective and their regional differences. Journal of Yunnan Normal University(Humanities and Social Sciences) 45(04): 125-134. Liu, Y. and X. Wang. 2014. Survey and analysis on risk management of the elderly in rural areas——a field survey of 11 villages in 8 provinces in China. Scientific Research on Aging 02(01): 20-28. Luo, M., J. Li, and Y. He. 2015. Research on suicide ideation of elderly people. Scientific Research on Aging 03(07): 41-57. Lv, L., S. Xiao, H. Xu, and J. Chen. 2003. Behavior characterstics study on completed suicide among elderly in rural sample of Changsha, Hunan, China. Chinese Journal of Behavioral Medicine and Brain Science 12(04): 422 －424. National Health and Family Planning Commission in China. 2013. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 315. National Health and Family Planning Commission in China. 2014. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 305. National Health and Family Planning Commission in China. 2015. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 305. Noguchi, M., T. Iwase, E. Suzuki, Y. Kishimoto, and S. Takao. 2014. Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community?. Social psychiatry and psychiatric epidemiology 49(4): 619-627. Ojagbemi, A., B. Oladeji, T. Abiona, and O. Gureje. 2013. Suicidal behaviour in old age-results from the Ibadan Study of Ageing. BMC psychiatry 13(1): 1. Phillips, M. R., X. Li, and Y. Zhang. 2002a. Suicide rates in China, 1995-1999. The Lancet 359(9309): 835-840. Phillips, M. R., G. Yang, Y. Zhang, L. Wang, H. Ji, and M. Zhou. 2002b. Risk factors for suicide in China: a national case-control psychological autopsy study. The Lancet 360(9347): 1728-1736. Phillips, M. R., G. Yang, S. Li, and Y. Li. 2004. Suicide and the unique prevalence pattern of schizophrenia in mainland China: a retrospective observational study. The Lancet 364(9439): 1062-1068. Population Census Office under the State Council (PCO). 2012. Tabulation on the 2010 population census of the People’s Republic of China. China Statistics Press, Beijing. Qing, W. 2007. Suicide Ideation and Its Risk Factors among the Elderly in Yuanjiang city. Hunan. Master's degree thesis of Central South University. Sun, J., X. Guo, J. Zhang, C. Jia, and A. Xu. 2013. Suicide rates in Shandong, China, 1991-2010: Rapid decrease in rural rates and steady increase in male-female ratio. Journal of affective disorders 146(3): 361-368. Sun Yefang Fiscal Science Foundation. 2010. Surveys of suicide among rural older people in China.Retrieved from http://www.snzg.cn/article/2010/0312/article_17666.html on 2016-11-16. Tao, R., Z. Zeng, G. Zhong, W. Cha, and W. Liang, 2011. Case-control study of suicide ideation among the elderly in some village in Hunan. Journal of Hunan Normal University(Medical
24 Sciences) 08(01): 82-85. Tao, Z. X. 2013. Split and Succession: A Study on the Sustaining Mechanism of Rural Families. Hubei: PhD Dissertation at Huazhong University of Science and Technology. The Ministry of Health in China. 2003. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 245. The Ministry of Health in China. 2004. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 267. The Ministry of Health in China. 2005. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 301. The Ministry of Health in China. 2006. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 303. The Ministry of Health in China. 2007. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 299. The Ministry of Health in China. 2008. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 299. The Ministry of Health in China. 2009. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 311. The Ministry of Health in China. 2010. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 319. The Ministry of Health in China. 2011. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 333. The Ministry of Health in China. 2012. Chinese Statistical Yearbook of Health and Family Planning. Pecking Union Medical College Press, Beijing, pp. 289. United Nations. 2015. Department of Economic and Social Affairs, Populations Division (2015). World Population Prospects: The (2015). Vasiliadis, H. M., S. Gagné, N. Jozwiak, and M. Préville. 2013. Gender differences in health service use for mental health reasons in community dwelling older adults with suicidal ideation. International Psychogeriatrics 25(03): 374-381. Wang, F. 2012. Research on Suicide Phenomenon in Rural China-A Field Study of LQ city in Shandong Province. Master's degree thesis of Shandong University. Wang, X. 2011. Risk Factors for Suicide among Rural Elderly People of Shandong Province:Based on a Paired Case-control Psychological Autopsy Study. Master's degree thesis of Shandong University . Wang, Y. 2003. A Study on the changing family structure in rural north China: cases in southern Hebei Province. Social Sciences in China 24(04): 93-108+206. Wang, Y. 2008. Theoretical analysis of the inter-generational familial relations in China. Population Research 32(04): 13-21. Wang, Y. 2012. Resistance and liberation: a comparative study on farmers' suicides in Jiangxi and Hubei. Journal of Huazhong University of Science and Technology(Social Science Edition) 26(04): 117-124. World Health Organization. 2009. Women and suicide in rural China. Bulletin of the WHO 87(12): 885-964. Wu, F. 2007. On“Living a Life of Fortune”. Sociological Studies 22(06): 66-85+243. Wu, L. 2009. Loss and Suicide-Study on the Phenonmena and Reasons of the Suicide of the
25 Elderly in a Villiage in the South of Anhui Province. Master's degree thesis of Nanjing Agricultural University. Wu, L., W. Lu, and G. Zhu. 2009. Analysis on the suicide of rural older people—a case study of Y village, Ningguo City, Anhui Province. Rural Economy and Science-Technology 20(04): 7-8+11. Xia, Y. and D. Xu. 2015. The risk of suicide and the elderly suicide in Jingshan, Hubei Province： an analysis of risk sociology. South China Population 30(02): 70-80. Xiao, S., L. Zhou, and H. Xu. 2005. Crisis intervention and suicide prevention: Concept and classification of suicidal behavior. Journal of Clinical Psychiatry 15(05): 298-299. Xing, C. 2009. Living: a framework for the analysis of suicide in China. China Book Review 23(11): 86-91. Xu, H., S. Xiao, J. Chen, and L. Liu. 2000. Epidemiological Study on Committed Suicide among the Elderly in Some Urban and Rural Areas of Hunan Province. Chinese Mental Health Journal 14(02): 121-124. Xuan, J. 2014. Tranquility and misery of the suicide among rural older people. The Health 35(12): 73-75. Yan, H. 2015. China in Ya Bian. Beijing: Peking University Press, pp. 32-33. Yan, Y. 2005. Private Life under Socialism: Love, Intimacy, and Intimate Relationship in a Chinese Villiage, 1949-1999. Shanghai: Shanghai Bookstore Publishing House, pp. 102-103． Yang, G. H., M. R. Phililips, M. G. Zhou, L. J. Wang, Y. Zhang, and D. Xu. 2005. Understanding the unique characteristics of suicide in China: national psychological autopsy study. Biomedical and Environmental Sciences 18(6): 379. Yang, H. 2013. A framework for understanding the suicide boom in southern China. Open Times 32(06): 47-66. Yang, H., and F. Fan. 2009. Suicide among older people in Jingshan county, Hubei. Open Times 28 (05): 104-125. Yang, H. and Y. Ou. 2013. Stratum differentiation, inter-generational exploitation and the suicide of rural older people----An analysis on the suicide of older people in central rural China. Management World 29(05): 47-63+75 Zhai, S. 2001. Causes and preventive measures of suicide among older people. Practical Geriatrics 15(01): 12-16. Zhang, F. 2015. Social transitions and the change in the suicide rate in rural China. Jingyue Journal 30(04): 113-117. Zhang, L. 2013. Research on Cultural Anomie’s Impact on Suicides in Rural China-A Field Study of Z County in Shandong Province. Master's degree thesis of Shandong University. Zhao, X. and Q. Zhong. 2012. Quality of rights: a perspective to interpret the suicide problem of farmers. Youth Studies 35(01):83-93+96. Zheng, W. 2010. Social factors causing the rural elderly depression and suicide and its related countermeasures. Journal of Hunan Agricultural University (Social Sciences) 11(06):43-48. Zou, X. 2011. The suicide phenomenon of rural older people from the perspective of funeral reform -- A case study of a town. Legal System and Society 20(25): 227-228.
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