Skip to main content
SpringerLink
Log in

How to make adjustments of underreporting of suicide by place, gender, and age in China?

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Underreporting of suicide is a worldwide problem. In particular, the national suicide rates published by the Chinese Ministry of Health (“MOH”) could be severely underreported. Validity of the assumption of evenly underreported of suicide by place (city/rural), gender, and age in China has been evaluated and some possible adjustments to the underreporting have been suggested.

Methods

Mortality rates from the MOH from 2002 to 2016 were extracted. Due to zero undetermined deaths, accidental deaths (weighted by causes of death) were used to evaluate underreported suicides. 53% of drownings, 11% of falls, 11% of poisonings, and 7% of other accidents were assumed as underreported suicides. Negative binomial regressions were used to calculate the rate ratios of the underreported suicides compared to suicides. Negative binomial regressions were also used to calculate the annual percentage changes of different mortality rates.

Results

Suicides of rural males could most likely be underreported (49%; 95% CI 39–61%), but suicides of rural females would least likely (30%; 95% CI 24–38%). Suicides of people aged 15–24 years and 75 years and above could more likely to be underreported than other ages. After adding the underreported suicides, declining trends of the national suicide rates had been eased.

Conclusions

People who lack social connection could have a high possibility of underreporting suicide. However, when rural females died of unnatural causes, their parents or even the whole village tended to quest for their intents, thus rural females had a lower possibility of underreporting suicide.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Organization WH (2019) Suicide. https://www.who.int/news-room/fact-sheets/detail/suicide. Accessed 12 Dec 2019

  2. Osman M, Parnell AC, Haley C (2017) “Suicide shall cease to be a crime”: suicide and undetermined death trends 1970–2000 before and after the decriminalization of suicide in Ireland 1993. Irish J Med Sci 186(1):201–205

    PubMed  Google Scholar 

  3. Auger N, Burrows S, Gamache P, Hamel D (2016) Suicide in Canada: impact of injuries with undetermined intent on regional rankings. Inj Prev 22:76–78

    PubMed  Google Scholar 

  4. Salmerón D, Cirera L, Ballesta M, Navarro-Mateu F (2013) Time trends and geographical variations in mortality due to suicide and causes of undetermined intent in Spain, 1991–2008. J Public Health 35(2):237–245

    Google Scholar 

  5. Chang S-S, Sterne JA, Lu T-H, Gunnell D (2010) ‘Hidden’suicides amongst deaths certified as undetermined intent, accident by pesticide poisoning and accident by suffocation in Taiwan. Soc Psychiatry Psychiatr Epidemiol 45(2):143–152

    PubMed  Google Scholar 

  6. Pritchard C, Hansen L (2015) Examining undetermined and accidental deaths as source of ‘under-reported-suicide’ by age and sex in twenty Western countries. Community Ment Health J 51(3):365–376

    PubMed  Google Scholar 

  7. Jonasson B, Jonasson U, Saldeen T (1999) Suicides may be overreported and accidents underreported among fatalities due to dextropropoxyphene. J Forensic Sci 44(2):334–338

    CAS  PubMed  Google Scholar 

  8. Bakst SS, Braun T, Zucker I, Amitai Z, Shohat T (2016) The accuracy of suicide statistics: are true suicide deaths misclassified? Soc Psychiatry Psychiatr Epidemiol 51(1):115–123

    PubMed  Google Scholar 

  9. Björkenstam C, Johansson L-A, Nordström P, Thiblin I, Fugelstad A, Hallqvist J, Ljung R (2014) Suicide or undetermined intent? A register-based study of signs of misclassification. Popul Health Metrics 12(1):11

    Google Scholar 

  10. Gill J, Stajic M (2000) Ketamine in non-hospital and hospital deaths in New York City. J Forensic Sci 45(3):655–658

    CAS  PubMed  Google Scholar 

  11. Hanzlick R (2006) Medical examiners, coroners, and public health: a review and update. Arch Pathol Lab Med 130(9):1274–1282

    PubMed  Google Scholar 

  12. Ohberg A, Lonnqvist J (1998) Suicides hidden among undetermined deaths. Acta Psychiatr Scand 98(3):214–218

    CAS  PubMed  Google Scholar 

  13. Värnik P, Sisask M, Värnik A, Arensman E, Van Audenhove C, van der Feltz-Cornelis CM, Hegerl U (2011) Validity of suicide statistics in Europe in relation to undetermined deaths: developing the 2–20 benchmark. Inj Prev 18:321–325

    PubMed  Google Scholar 

  14. Li F, Chan HC, Liu S, Jia H, Li H, Hu Y, Wang Z, Huang W (2015) Carbon monoxide poisoning as a cause of death in Wuhan, China: a retrospective six-year epidemiological study (2009–2014). Forensic Sci Int 253:112–118. https://doi.org/10.1016/j.forsciint.2015.06.007

    Article  CAS  PubMed  Google Scholar 

  15. Värnik P, Sisask M, Värnik A, Laido Z, Meise U, Ibelshäuser A, Van Audenhove C, Reynders A, Kocalevent R-D, Kopp M (2010) Suicide registration in eight European countries: a qualitative analysis of procedures and practices. Forensic Sci Int 202(1):86–92

    PubMed  Google Scholar 

  16. Poreddi V, Thimmaiah R, Ramu R, Selvi S, Gandhi S, Ramachandra S, Math S (2016) Gender differences related to attitudes toward suicide and suicidal behavior. Community Ment Health J 52(2):228–232. https://doi.org/10.1007/s10597-015-9913-1

    Article  PubMed  Google Scholar 

  17. Mishara BL, Weisstub DN (2016) The legal status of suicide: a global review. Int J Law Psychiatry 44:54–74

    PubMed  Google Scholar 

  18. Li F, Lu X, Yip PS (2019) A study of the characteristics of suicide notes in China. Crisis. https://doi.org/10.1027/0227-5910/a000601

    Article  PubMed  Google Scholar 

  19. Chan HC, Li F, Liu S, Lu X, Jia H (2017) Sexual homicides in China: exploring the offender, victim, and offense characteristics. Int J Offender Ther Comp Criminol. https://doi.org/10.1177/0306624X17746293

    Article  PubMed  Google Scholar 

  20. Maniam T (1995) Suicide and undetermined violent deaths in Malaysia, 1966–1990: evidence for the misclassification of suicide statistics. Asia Pac J Public Health 8(3):181–185

    CAS  PubMed  Google Scholar 

  21. Pritchard C, Amanullah S (2007) An analysis of suicide and undetermined deaths in 17 predominantly Islamic countries contrasted with the UK. Psychol Med 37(3):421–430

    PubMed  Google Scholar 

  22. Ministry of Health (2017) Annual statistics. https://www.nhc.gov.cn/wjw/tjnj/list.shtml. Accessed 10 Oct 2018

  23. Yang G, Hu J, Rao KQ, Ma J, Rao C, Lopez AD (2005) Mortality registration and surveillance in China: history, current situation and challenges. Popul Health Metrics 3:1–9. https://doi.org/10.1186/1478-7954-3-3

    Article  Google Scholar 

  24. Phillips MR, Li X, Zhang Y (2002) Suicide rates in China, 1995–99. Lancet 359(9309):835–840. https://doi.org/10.1016/S0140-6736(02)07954-0

    Article  PubMed  Google Scholar 

  25. Wang CW, Chan CLW, Yip PSF (2013) Suicide rates in China from 2002 to 2011: an update. Soc Psychiatry Psychiatr Epidemiol. https://doi.org/10.1007/s00127-013-0789-5

    Article  PubMed  Google Scholar 

  26. Chen Y, Yousuf S, Yip P, Wu K (2012) Suicide in Asia: opportunities and challenges. Epidemiol Rev 34(1):129–144

    CAS  PubMed  Google Scholar 

  27. Wang S, Li Y, Chi GB, Xiao S, Ozanne-Smith J, Stevenson M, Phillips M (2008) Health System Reform in China 4 Injury-related fatalities in China: an under-recognised public-health problem. Lancet 372(9651):1765–1773. https://doi.org/10.1016/S0140-6736(08)61367-7

    Article  CAS  PubMed  Google Scholar 

  28. National Bureau of Statistics of China (2010) The Sixth National Census. https://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm. Accessed 04 Apr 2017

  29. He M, Fang Y-X, Lin J-Y, Ma K-J, Li B-X (2015) Unnatural deaths in Shanghai from 2000 to 2009: a retrospective study of forensic autopsy cases at the Shanghai Public Security Bureau. PLoS ONE 10(6):e0131309

    PubMed  PubMed Central  Google Scholar 

  30. He M, Li W-C, Sun D-M, Ma K-J, Zhao Z-Q, Li B-X, Li L (2014) Epitome of China’s unnatural deaths: a historically retrospective study of forensic autopsy cases in Shanghai Public Security Bureau from 1990 to 1999. Am J Forensic Med Pathol 35(3):218–221. https://doi.org/10.1097/PAF.0000000000000115

    Article  PubMed  Google Scholar 

  31. Li F, Lu X, Ou Y, Yip PS (2019) The influence of undetermined deaths on suicides in Shanghai. China Soc Psychiatry Psychiatr Epidemiol 54(1):111–119

    PubMed  Google Scholar 

  32. Yang Z (2016) Review on "Natural Person". Chapter 2 of general principles of civil code. Jurist 5:20–33

    Google Scholar 

  33. Rockett IR, Caine ED, Connery HS, Nolte KB, Nestadt PS, Nelson LS, Jia H (2019) Unrecognised self-injury mortality (SIM) trends among racial/ethnic minorities and women in the USA. Inj Prev. https://doi.org/10.1136/injuryprev-2019-043371

    Article  PubMed  Google Scholar 

  34. Li F, Lu X (2019) Infant deaths in Pudong, Shanghai, China: a retrospective study of the police data and comparison with the centre for disease control data. J Forensic Leg Med 62:7–13

    PubMed  Google Scholar 

  35. Li F, Liu J, Yip PS, Lu X, Liu S (2019) Mortalities of methamphetamine, opioid, and ketamine abusers in Shanghai and Wuhan, China. Forensic Sci Int 306:110093

    PubMed  Google Scholar 

  36. Li F, Liu S, Lu X, Ou Y, Yip PSF (2018) Application of the injury scales in homicides. Forensic Sci Int 292:83–89. https://doi.org/10.1016/j.forsciint.2018.09.010

    Article  PubMed  Google Scholar 

  37. Ye P, Er Y, Jin Y, Duan L (2018) The analysis of the trend of mortality rate of falls in China from 1990 to 2015. Zhonghua yu fang yi xue za zhi [Chin J Prev Med] 52(5):498–510

    CAS  Google Scholar 

  38. Li F, Zeng J, Huang J, Zhang J, Chen Y, Yan H, Huang W, Lu X, Yip PS (2019) Work-related and non-work-related accident fatal falls in Shanghai and Wuhan, China. Saf Sci 117:43–48

    Google Scholar 

  39. Zhong BL, Chan SSM, Liu TB, Chiu HFK (2018) Nonfatal suicidal behaviors of Chinese rural-to-urban migrant workers: attitude toward suicide matters. Suicide Life Threat Behav. https://doi.org/10.1111/sltb.12519

    Article  PubMed  Google Scholar 

  40. Liu Y, Wang X (2015) "Darenmin": intervention of rural females' sucides. Ideol Front 41(2):43–48

    Google Scholar 

  41. Qiao Y, Xiang W, Xu L (2016) Analysis of disease characteristics and treatment status of 118 abandoned infants (children) from 2005 to 2014. China Med 11(4):591–594

    Google Scholar 

  42. Liu S, Wu X, Lopez AD, Wang L, Cai Y, Page A, Yin P, Liu Y, Li Y, Liu J (2016) An integrated national mortality surveillance system for death registration and mortality surveillance, China. Bull World Health Organ 94(1):46

    PubMed  Google Scholar 

  43. Chen Y, Li X, Yang C, Hao L, Sun Q, Yan B (2016) Analysis on epidemiological characteristics and trend of injury caused death among working-age population in Pudong New Area of Shanghai, 2002–2013. Chin J Health Educ 32(1):64–68

    CAS  Google Scholar 

  44. Zhou X, Wang J, Li X, Yang C, Yang L (2015) Injury mortality in Pudong, Shanghai, 2002–2010. Chin J Prev Control Chron Dis 23(3):235–237

    Google Scholar 

  45. Rockett IR, Caine ED (2020) Reconciling suicides with “accidental” drug-intoxication deaths: a behaviorally based definition of self-injury mortality. American Public Health Association, Washington

    Google Scholar 

  46. Mohammed M, Kharoshah MA (2014) Autopsy in Islam and current practice in Arab Muslim countries. J Forensic Leg Med 23:80–83. https://doi.org/10.1016/j.jflm.2014.02.005

    Article  PubMed  Google Scholar 

  47. Sha F, Chang Q, Law YW, Hong Q, Yip PS (2018) Suicide rates in China, 2004–2014: comparing data from two sample-based mortality surveillance systems. BMC Public Health 18(1):239

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Social Work and Social Administration Department, The University of Hong Kong, Pokfulam, Hong Kong SAR, China

    Feng Li & Paul S. F. Yip

  2. Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China

    Paul S. F. Yip

Authors
  1. Feng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul S. F. Yip
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design: FL. Editing and supervision: PSFY. Drafting of the manuscript: all authors.

Corresponding author

Correspondence to Paul S. F. Yip.

Ethics declarations

Conflict of interest

We declare that no conflict of interest exists.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, F., Yip, P.S.F. How to make adjustments of underreporting of suicide by place, gender, and age in China?. Soc Psychiatry Psychiatr Epidemiol 55, 1133–1143 (2020). https://doi.org/10.1007/s00127-020-01856-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-020-01856-2

Keywords

Search

Navigation