The acceptability of suicide among rural residents, urban residents, and college students from three locations in China: a cross-sectional survey

Abstract

Background: Community attitudes about suicide and their relationship to suicidal behavior have not been adequately investigated in low- and middle-income countries.

Aims: To compare the acceptability of suicide in different population cohorts in China, identify factors that affect the degree of acceptability, and assess the relationship of cohort-specific acceptability of suicide and suicide rates.

Methods: A multistage stratified random sample of 608 rural residents, 582 urban residents, and 629 college students were administered a 25-item scale studying the likelihood they would consider suicide (on a 5-point Likert scale) if they experienced a variety of stressors ranging from "being disciplined at work" to "developing a chronic mental illness." The internal consistency and test-retest reliability for the scale are excellent (Cronbach's alpha = 0.92, ICC = 0.75).

Results: College students had the most permissive attitudes about suicide, and urban residents were significantly more accepting of suicide as a response to serious life stressors than were rural residents. Multivariate analysis found that the overall acceptability score was higher in women, decreased with age, and increased with years of education.

Conclusions: There was no clear relationship between cohort-specific acceptance of suicide and reported rates of suicide, highlighting the complexity of the relationship between attitudes about suicide (of which acceptability is only one component) and suicidal behavior.