Suicide by rural Chinese, especially Chinese rural young women, is an urgent focus in suicide research, because of the high suicide rates and the large population in China. Previous research on suicide has focused on individual and epidemiologically defined risk factors, but a fundamental understanding of the suicide process remains elusive. Society and culture play an enormous role in dictating how people respond to and view mental health and suicide. Yet no studies to date have systematically examined the role of cultural factors (e.g. the value systems) that may play in determining risk for suicide. This proposed project is designed to study a cultural model of suicide in China. Confucian values, which are considered to be the cultural foundation of most Asian societies including China, are supposed to explain the high suicide risks for young women and the comparatively lower risks for young men. The deep-rooted Confucian sexism coupled with the communist egalitarianism advocated in China creates frustration or strain in the daily life of some rural young women. The strain resulting from the traditional reality and modern aspiration, interacting with other risk factors, is hypothesized to increase suicide risks for Chinese rural young women. We will use the psychological autopsy (PA) method, previously validated in China with our NIMH R03 grant, in a case-control design to investigate the cultural and other factors of rural young suicides. The subjects will be 200 rural women and 200 rural men aged 15- 34 who have died of suicide, randomly sampled from rural counties selected in Liaoning and Hunan provinces of China. The community living controls are a representative sample of men and women aged 15-34 years from the same counties as the cases. The study has the following three major aims: 1. To examine the impact of cultural factors related to Confucian values and communist ideology on completed suicide in rural China and the role of gender in the relationship. 2. To evaluate the direct effect of risk factors from four domains (personal factors, social structure, negative life events, and psychological/psychiatric factors) on suicide in rural China. 3. To test the moderating or intervening effects of the risk factors on the relationship between strain and completed suicide in rural China. Findings may be generalizable to other Chinese and Asian populations in the United States and elsewhere in the world. The specific theory to be tested in the project (i.e., suicide as a result of psychological strain due to competing values) can be generalized to most other populations in the world.
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