经济增长与自杀率变化

al r 2 . S e an Yor ontr , Sha nive ed f 18 European Psychiatry 25 (2010) Objectives: It is to estimate the trend of suicide rate changes during the past three decades in China and try to identify its social and economic correlates. Methods: Official data of suicide rates and economic indexes during 1982–2005 from Shandong Province of China were analyzed. The suicide data were categorized for the rural / urban location and gender, and the economic indexes include GDP, GDP per capita, rural income, and urban income, all adjusted for inflation. Results: We found a significant increase of economic development and decrease of suicide rates over the past decades under study. The suicide rate decrease is correlated with the tremendous growth of economy. Conclusion: The unusual decrease of Chinese suicide rates in the past decades is accounted for within the Chinese cultural contexts and maybe by the Strain Theory of Suicide. # 2009 Elsevier Masson SAS. All rights reserved. Keywords: Suicide rate; Economic growth; China; Culture; Strain Theory of suicide 1. Introduction Durkheimianism postulates that economic growth epito- mized by urbanization, industrialization, and modernization usually leads to higher level of social anomie and lower level of social integration, and subsequently increases suicide rates in society [3]. A strong positive correlation was reported between suicide rates and industrialization for 71 nations in the world [14]. Studies for Finland [15], Ireland [6], and the United States [7] have also found support to the sociological model of suicide. However, some other findings posed challenges to the Durkheimian theories. For example, a negative correlation was found between female labor force participation and suicide rates for both American males and females [1], and changes in the suicide rates were unrelated to the level of the social variables from a meta-analysis of European suicide data [9]. Further among recent studies, it has been found that the suicide rates in poor and rural areas have increased disproportionately compared to well-developed urban areas in Great Britain [4], and that suicide rates, higher in urban than in rural areas, have changed over past decades and the ratio of rural to urban suicide rates has continuously increased in both genders over the past 35 years in Austria [5]. It is noted that previous studies have typically found mixed results, with approximately one-third having positive associations between economic growth and suicide rates, one-third no associations, and one-third negative associations [16]. The components of modernization in terms of urbanization, industrialization, and secularization may have leveled off or have been replaced by new sources of integration/ regulation over the past 100 years in the West since Durkheim’s 1897 classic. It is also noted that the overwhelming majority of prior findings were largely based on the data from well-developed Western societies, and data in this respect from currently developing Asian countries including China are scarce. With one of the fastest growing economies in the world, China has * Corresponding author. Tel.: +86 531 88382141. E-mail address: jiachongqi@sdu.edu.cn (C. Jia). 0924-9338/$ – see front matter # 2009 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.eurpsy.2009.07.013 Origin Economic growth and suicide from 198 J. Zhang a,b, J. Ma c, C. Jia d,*, J aCentral University of Financ b State University of New c Shandong Center for Disease C dDepartment of Epidemiology and Health Statistics e School of Public Health, Queensland U Received 20 April 2009; received in revis Available online Abstract article ate changes: A case in China to 2005 un e, X. Guo c, A. Xu c, W. Li c d Economics, Beijing, China k College, Buffalo, USA ol and Prevention, Jinan, China ndong University, Jinan 250012, Shandong, China rsity of Technology, Brisbane, Australia orm 28 July 2009; accepted 30 July 2009 November 2009 159–163 syc experienced tremendous socioeconomic changes in the past three decades and can offer some optimal data to reexamine Durkheim’s theorem on suicide rates and economic develop- ment. Since China opened its door to the West in early 1980s, the economic reform has brought about significant social and value changes to the nation, although the political structure of the state remains basically intact. The national Gross Domestic Product (GDP) per capita has jumped from 463 Yuan in 1980 to 14040 Yuan in 2005, and the foreign trade values improved 205 times in 2005 to those in 1980 [10]. In line with Durkheimianism, socioeconomic developments should shed light on a change in suicide rates. As above noted, some earlier studies have supported Durkheim’s assumption that economic development is correlated with high suicide rates, but the majority of the studies were western-based. As Chinese suicide research did not start until after the economic reform about 30 years ago, very few documented studies have addressed the changes in Chinese suicide rates in the past 30 or so years. Even though, the limited number of publications on suicide rate changes has recorded a decreasing trend of Chinese suicide rates over the past three decades. In comparison with the Danish suicide data, Qin and Mortensen examined the Chinese male and female suicide rates between 1987 and 1994, and found that the suicide rates were decreasing in both rural and urban areas of China [12]. In a national survey of Chinese mortality rate changes, Yang et al. found a decrease of suicide rates for both rural and urban Chinese during the period between 1991 and 2000 [20]. In another study with national data, Yip et al. examined the trend of Chinese suicide rates with gender, age, and regional (rural or urban) from 1991 to 2000, and reported significant declines of suicide rates for both men and women, both old and young, and both rural and urban populations in China [19]. Yang et al. studied the suicide data of urban residents in Liaoning Province in 1992–2003 and found the overall suicide rates dropped by 36% over the 12 years, while the decrease level is larger for the female rates (48%) than for the male rates (22%) [18]. All the four trend studies with Chinese suicide rate data are in line with some of the non-China based studies as reviewed above, indicating a negative correlation between economic growth and suicide rates, a finding against Durkheimian classic theorem. The limited number of studies on the Chinese suicide rate trends is further limited by their short-term data, mainly due to the short history of Chinese suicidology that began only about 20 years ago. It is important to further explore the issuewith any available data, in order to get closer to the reality in terms of how the economic growth and suicide rates are interacted. It is the purpose of the current study to analyze alternative data and offer explanations to the findings. 2. Methods 2.1. Data collection Data for this study were from the mortality and economy J. Zhang et al. / European P160 statistics in Shandong Province. The mortality data focused on suicide were official from Shandong Provincial Center for Disease Control and Prevention (CDC), and the economy data were acquired from the Statistics Bureau of Shandong Provincial Government [17]. Shandong, with a population of 92.39 million, the second largest province in China, is located in the middle of the east coast of the country. About 45% of Shandong population are rural and 55% urban [10]. Shandong is a typical Chinese province in terms of population structure as well as social and cultural life. Because of the comparatively short history of economic reform in China, the mortality statistics at both national and provincial levels were not available until 1982. Therefore, the ultimate data in Shandong Provincewe can have for study range from 1982 and 2005. For the suicide mortality data from 1982 to 2005, we have the rates for the total population in the province and the rates for rural and urban residents grouped into males and females. Official data of economic indexes during 1982–2005 from Shandong Province included GDP, GDP per capita, rural income, and urban income, all adjusted for inflation. All the economic indexes are presented by RMB, the Chinese currency. At the time of writing, the exchange rate is about US$1 = 7.00RMB. 2.2. Statistical analyses For the 24 years from 1982 to 2005, the suicide rates, the Gross Domestic Product Per Capita (GDPPC), and the average incomes of urban and rural residents in Shandong Province are presented in Table 1. To decrease the variation, all the variables in the analyses were transformed by the natural logarithm. The trend of the suicide rate over time was assessed by Prais–Winsten regression method in which the errors are assumed to follow a first-order autoregressive process. The relation of GDP or adjusted average income per person to the suicide rate was analyzed by using regression model with ARMA Errors. The process for this analysis was as follows. Firstly, the regression analysis was fitted with no model for the noise process. Then the Augmented Dickey–Fuller unit- root test was used to verify the stationarity of the residual series from the regression model. If it is stationary, autocorrelation function and partial autocorrelation function were used to identify the order(s) of the autoregression and moving average based on the stationary regression residual series. Finally, if there is no serial autocorrelation of the residual series, ARMA (0,0) model for the noise process was fitted, otherwise, the ARMA (p,q) model for the noise process was fitted, and the AIC and BIC were used as the criteria to select the best model, and the Portmanteau (Q) statistics was used to test whether the residual series from ARMA(p,q) model is the white noise. All statistical analyses were carried out with STATAversion 9.2 (Stata Corporation, College Station, TX, USA). All reported probabilities ( p-values) were two-sided, and that less than 0.05 hiatry 25 (2010) 159–163 was considered statistically significant. Table 1 Suicide and Income Data in Shandong from 1982 to 2005. Year Suicide rates in urban Suicide rates in rural G Male Female Both Gender Male Female Both Gender 1982 13.10 9.78 11.54 36.03 31.36 33.67 5 1983 9.95 10.10 10.02 38.93 49.23 44.06 5 1984 13.78 12.92 13.37 37.02 38.98 38.00 6 1985 9.23 10.29 9.73 33.20 43.00 38.10 7 1986 11.07 7.78 9.51 37.55 44.65 41.09 7 1987 8.70 4.42 6.62 37.56 39.97 38.76 8 1988 6.04 4.43 5.31 29.34 35.36 32.34 9 1989 3.74 3.18 3.47 30.05 39.67 34.84 9 1990 6.03 4.68 5.39 35.56 41.14 38.34 10 1991 8.31 6.18 7.31 41.07 42.60 41.83 11 1992 7.11 6.95 7.04 38.93 38.99 39.00 13 1993 9.29 5.92 7.70 34.51 33.75 34.13 16 1994 9.39 10.33 9.83 34.84 41.46 38.13 18 1995 4.27 4.24 4.26 34.51 38.20 36.34 21 23 25 28 31 34 37 41 46 53 61 J. Zhang et al. / European Psyc 3. Results 1996 6.56 8.75 7.61 29.62 27.69 28.67 1997 5.98 6.02 6.00 27.87 31.04 29.44 1998 8.84 5.42 7.18 31.19 26.11 28.68 1999 4.61 2.94 3.80 25.92 27.40 26.65 2000 8.19 7.79 8.00 24.83 22.67 23.77 2001 5.90 3.35 4.66 27.29 24.01 25.66 2002 2.76 4.82 3.77 23.61 19.46 21.63 2003 6.30 1.92 4.18 23.16 17.26 20.24 2004 2.60 3.75 3.15 20.79 15.49 18.17 2005 5.47 2.74 4.16 21.59 16.94 19.29 The overall suicide rates and the GDP per capita in Shandong Province for the 24 years from 1982 to 2005 are illustrated in Fig. 1. The negative correlation of the two variables over the years is visually obvious. The comparatively lower suicide rates before 1985 might be due to the unsophisticated reporting system for suicide mortalities in the beginning years of the economic reform in China. The big drop of suicide rates in Shandong Province is noted for 1989. The same observation was made in the suicide rates in a national sample of China [22]. A possible explanation of the Fig. 1. Overall trends of suicide rate and GDP per capita in Shandong from 1982 to 2005. drop of suicide rates around 1989 is the student democratic demonstrations that happened during middle of the year all over DPPC Urban average income Rural average income Urban adjusted income Rural adjusted income 15 525 300 523 297 81 537 361 539 344 75 639 395 631 372 47 748 408 679 353 85 854 449 738 374 81 987 518 782 401 76 1163 584 764 386 94 1349 631 766 351 17 1466 680 812 364 50 1688 764 880 393 37 1974 803 948 395 02 2515 953 1053 423 55 3444 1320 1150 482 03 4264 1715 1219 531 45 4890 2086 1265 593 87 5191 2292 1301 636 46 5380 2453 1353 688 13 5809 2550 1461 725 13 6490 2659 1613 761 34 7101 2805 1745 784 50 7615 2954 1896 827 87 8400 3150 2077 869 71 9438 3507 2270 925 54 10,745 3931 2557 1012 hiatry 25 (2010) 159–163 161 China and brought about hundreds of casualties among the Chinese civilians. The trends of the suicide rate changes in Shandong Province from 1982 to 2005 are shown in Table 2. The suicide rates significantly decreased over time both for male, female and both genders in both urban and rural areas, respectively. Table 3 demonstrates the relationship between suicide rates and economic growth. The urban average income, rural average income, and GDPPC are all negatively associated with the urban, rural, and overall suicide rates. 4. Discussion China’s fast growing economy in the past few decades did not come with increased suicide rates, and instead, the suicide rates in Shandong province have been consistently going down over the years for both rural and urban populations and for both males and females. Similar findings have also been documented in other studies with either national or provincial level data of China [12,18,20,21]. The traditional postulation that economic growth leads to high suicide rates in society [3] is challenged by the current Chinese data as well as some western data in previous studies [4,5]. The psychiatric model of suicide popularized in the West, that focuses on the mental illness leading to suicidal behaviors, may not work well in China as we speculate (although without much documented evidence) that mental health services have not been significantly improved in China although the psychiatric disorders are on the rise during Table 2 The trend of the suicide rate from 1982–2005. District Variables b S.E. t p Urban male Year �0.0400 0.0090 �4.42 0.000 Constant 81.6540 18.0290 4.53 0.000 r �0.119 DW statistic 1.9369 Urban female Year �0.044 0.0125 �3.55 0.002 Constant 90.2975 24.9457 3.62 0.002 r 0.0886 J. Zhang et al. / European Psyc162 DW statistic 2.0605 Urban both genders Year �0.0401 0.0103 �3.89 0.001 Constant 81.6855 20.5395 3.98 0.001 r 0.1539 DW statistic 2.0577 Rural male Year �0.0234 0.0052 �4.46 0.000 Constant 50.0587 10.4526 4.79 0.000 r 0.5123 DW statistic 1.8103 Rural female Year �0.0388 0.0074 �5.24 0.000 Constant 80.8388 14.7882 5.47 0.000 r 0.4201 DW statistic 1.9866 Rural both genders Year �0.0303 0.0062 �4.90 0.000 Constant 63.8509 12.3415 5.17 0.000 r 0.5360 DW statistic 1.9678 DW statistic: Durbin–Watson statistic (transformed). the past 20 or so years [23]. The relationship between economic growth and suicide reduction in China will have to be understood within the Chinese cultural contexts. Strain Theory of Suicide [24–26] assumes that people who are at high risk of suicide have usually experienced one or more types of strains, a psychological frustration resulted from some unsolvable conflicts. The theory includes four mutually inclusive sources of strain: � value conflicts; � discrepancy between aspiration and reality; � perceived relative deprivation; � coping deficiency in front of life crisis. In China since 1980s, people’s living standards have been tremendously improved, and the improvements are mostly unexpected. For an individual in China experiencing constant Table 3 Relationship between suicide rate and adjusted average income. District Variables b S.E. z p Urban both gender Urban income �0.5724 0.2006 �2.85 0.004 Constant 5.8369 1.3970 4.18 0.000 Rural both genders Rural income �0.6818 0.0555 �12.28 0.000 Constant 7.7095 0.3479 22.16 0.000 Overall both genders GDPPC �0.4640 0.1116 �4.16 0.000 Constant 6.7707 0.0150 6.09 0.000 AR (1) 0.6357 0.0932 6.82 0.000 changes and living standards on the rise each year, strains, especially those caused by too much aspiration or economic deprivation will hardly occur. For rural young women, who used to be confined to the village life dealing with the traditional relationships and poverty, chances are now available for them to leave the countryside and work in the cities to improve her economic life. All those changes are not possible without today’s economic advancement in China. In other words, economic growth and living standard improvement can be therapeutic for suicidal populations. Results from another study recently conducted in China by Li et al. [8] have supported the above arguments. After rural young people migrated to urban areas to work, their mental health scores became higher than those staying in the countryside, although still lower than that of the urban residents. It was certainly a surprise to those modernization theorists including Durkheim [3] who postulate that migration is associated with increased vulnerability to mental health problems. Explanations of the results were argued to be from a sense of well-being associated with upward economic mobility and improved opportunities and the relatively better living conditions in the immigrant communities [8]. Accord- ing to the Strain Theory of Suicide, upward mobility and improved living conditions can help reduce the psychological strains resulted from high aspiration and relative deprivation [24,25]. A more recent study by Chang et al. revealed that the widespread economic crisis in Asia during 1997–1998 increased the suicide rates in Asia, but only in the Asian societies where unemployment was on the rise [2]. High unemployment rates may have increased the level of social anomie, and the unemployment status augment a person’s relative deprivation as well as the discrepancy between aspiration and reality. Rural suicide rates are four to five times higher than the urban suicide rates, although it is also true that the suicide rate decrease trends are larger for rural populations than for urban people. These findings in China as well as the similar findings from the European studies by Hill et al. [4] and Kapusta et al. [5] can be explained by the economic and opportunity differences between rural and urban areas. As in the poor and underdeveloped rural areas, lack of opportunities and affluence may lead to aspiration / reality discrepancy and relative deprivation for the people. With China’s fast growing economy, rural people have tremendously benefited from the economic reform and their life has been significantly improved from extreme poverty to being enough in terms of food, clothing, and shelter. They must have felt more rewarded than the urbanites by China’s economic development. It is also noted that over the 24 years, the economic improvement was greater for the urbanites than for the rural residents in Shandong Province, but the suicide rates drop were larger for rural residents than for the urbanites. Similar findings were documented in an academic report comparing individual happiness and life satisfaction between rural and urban Chinese, and the rural Chinese scored significantly higher than the urban Chinese on happiness and satisfaction [13]. hiatry 25 (2010) 159–163 These findings further evidenced the Strain Theory of Suicide J. Zhang et al. / European Psychiatry 25 (2010) 159–163 163 that postulates that it is not the absolute poverty or prosperity but the relative deprivation or blessings perceived by the individuals that increases or decreases psychological strains. An urbanite with higher aspirations than a peasant may not necessarily feel bles