The overall suicide rates in the world are on the rise,1 and the rates in the United States have rapidly increased by about 33%—from 10.5 per 100 000 population in 1999 to 14.0 per 100 000 population in 2017,2 regardless of prevention efforts with sufficient funding.3 In contrast, the overall suicide rate in China has decreased from 23.0 per 100 000 population in 1999 to 8.6 per 100 000 population in 2017, marking a 63% decline over the past two decades.4 The most marked decrease has been observed in young women in rural areas younger than 35 years, whose suicide rate appears to have decreased by as much as 90%.4
Compared with the United States, far less funding has been provided in China for suicide research and prevention and for a much larger population. I discuss six plausible reasons for the rapid decline in the Chinese suicide rates.
1. FAST ECONOMIC DEVELOPMENT
The Chinese gross domestic product per capita increased from $312 in 1980 to $8836 in 2017, and the average annual income increased from ¥29 229 in 2008 to ¥74 318 in 2017 for urban residents.5 In the rural regions, the central government has lifted all taxes and tariffs for the farmers since 2006 and has provided stipends for those who can sell agricultural products to the state.
Rapidly improved quality of life in both rural and urban areas of China have obviously reduced Chinese people’s strains (conflicting stressors) resulting from deprivation and frustrated aspirations. According to the Strain Theory of Suicide, lack of psychological strains resulted in less frustration, anger, and psychological pain and, therefore, lower suicide risks.6 However, when the nation’s economy slows down, its suicide rates are speculated to rise to some extent.
2. MIGRATION TO URBANIZED AREAS
The Chinese suicide rates markedly declined partly because so many rural young people who were at the highest risk for suicide moved from the rural countryside to the cities, where suicide has been less common. About 20 years ago, more than three quarters of the suicides in China were rural young people, but now most young people are working in the cities, far from the social, cultural, and economic environments that put their predecessors at a high risk for suicide. However, the left-behind children and elderly persons still may be exposed to suicide risks, and their decrease in suicide rates has been slower than that of middle-aged people.4
For many rural young women, the migration has liberated them from traditional family pressures, bad marriages, overbearing parents-in-law, and other stressors of poverty and rural life. Migrants also have stayed away from the easiest means of impulsive suicide—swallowing pesticides, the method used in nearly 60% of rural suicides. Furthermore, higher incomes and better education also may have contributed to the decrease in psychological strains among young migrants.
3. MODERNIZED SOCIAL VALUES
Traditional values such as Confucian teachings have been declining among youths as China has become more globalized and modernized since opening the door to the West in the 1980s. The traditional values concerning marriage, dating, filial piety, and women’s status that were in conflict with modern Western ideas are weakening among young people. Therefore, the psychological strains formed by conflicting values are less prevalent in this high-risk, rural, young female population.
Rural women now have more opportunities and more freedom in moving to cities, becoming educated, and finding jobs. Today, they are more socially and professionally active. Family sizes have become smaller, reducing the burden of child-rearing and providing more time for women to engage in activities outside of home.
4. ONE-CHILD-PER-FAMILY POLICY
The one-child-per-family policy that started in China about 40 years ago and ended in 2016 have created an imbalance in the sex ratio of the marriage-age population today. As the sex ratio at birth in 2000 was 119.9 boys to 100 girls, there are approximately 33 million more men than women at the age for marriage in China.7 This deficit in the numbers of women available to marry is attributed to the traditional sexism in favor of having male children, the adoption of female infants to overseas couples, and abortion and infanticide.
With fewer marriage-age women available, young women may have felt more valuable and respected. They may have more resources and enjoy life more than their predecessors and their male counterparts. Three quarters of the suicides in China were females, and the decline in female suicides has significantly contributed to the decline in the overall suicide rates in China.
5. SURVEILLANCE-BASED COUNSELING
The college student suicide rate is much lower than the national average and lower than the rate in the same-age noncollege population, as a result of the mandatory residence requirement and the administrative surveillance of the dorms commonly practiced in China. Students are typically watched and disciplined on campus. Each dorm is supervised, and every student is monitored by university-assigned psychological counselors for any signs of risk for suicidal ideation and attempts, as well as, of course, any political actions that the government does not like.
6. GOVERNMENTAL MEDIA CONTROL
Chinese government-run media typically do not report negative social events, such as crimes. Suicide incidents, sometimes reported by some small, nonofficial, and market-oriented media sources, are not encouraged by the government. A side effect of this is to prevent a suicide story from spreading and going viral, which reduces copycat behavior. Free media as a form of freedom of speech are considered responsible for the health of society and the well-being of the people. On the contrary, media can be used to promote the awareness and prevention of suicide, but China is not yet ready for this endeavor.
SUMMARY
Reduction of psychological strains may decrease suicide risk. In the past three decades, Chinese psychological strains have been lessened through rapid economic growth, social and cultural change, augmented rural-to-urban migration, and the increased life satisfaction brought about by the improved quality of life.
ACKNOWLEDGMENTS
The author acknowledges support from the US National Institute of Mental Health (grant R01 MH068560).
Note.The views expressed are those of the author and do not necessarily reflect those of the National Institutes of Health.
CONFLICTS OF INTEREST
The author has no conflicts of interest to disclose.
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