Autopsy Chinese Female YouTube
Javon Baker
In this article, we report on 19 autopsy cases in China in which the cause of death was poisoning by toxic plants. The emphasis is on analyses of the target organs or tissues affected by these plants. The mechanism of poisoning and cause of death are approached on the basis of the pathologic changes, and associated problems relating to forensic medicine are discussed.
Objective: To compare the characteristics of suicides in the four main demographic groups: urban males, urban females, rural males and rural females in order to help clarify the demographic pattern of suicides in China.
Methods: A detailed psychological autopsy survey instrument was independently administered to 895 suicide victims in family members and close associates from 23 geographically representative locations from around the country.
Results: Pesticide ingestion accounted for 58% (519) of all suicides and 61% (318/519) of deaths were due to unsuccessful medical resuscitation. A substantial proportion (37%) of suicide victims did not have a mental illness. Among the 563 victims with mental illness, only 13% (76/563) received psychiatric treatment. Compared to other demographic groups, young rural females who died from suicide had the highest rate of pesticide ingestion (79%), the lowest prevalence of mental illness (39%), and the highest acute stress from precipitating life events just prior to the suicide.
Studies conducted in China identified some unique risk factors for suicide, such as being female [4], rural residence [5], single status [5], religious belief [6], mental disorders [6], high chronic stress [7], low social support [8], high impulsivity [9], severe psychological strain [10], conflicts with family members [5], and previous suicidal behavior [11]. A growing body of studies used the strain theory of suicide to explain suicide in China and showed evidence that psychological strains were significantly associated with suicide [2, 12, 13].
The data for this study was derived from a case-control psychological autopsy study. The survey was designed to explore potential risk factors for suicide among Chinese rural young adults, such as mental disorders, impulsivity, and strain. The target population of the study was rural young adults aged 15-34 years old who died by suicide in comparison with community-living controls from the same village. In this study, we focused on the association between family position and suicide risk.
The survey was carried out in three provinces in China, including Liaoning, Hunan, and Shandong. A total of 16 counties were randomly selected in the 3 provinces, with 6 in Liaoning, 5 in Hunan, and 5 in Shandong. Within each county, all village doctors were trained on study procedures and were required to report suicide deaths to the local Centers for Disease Control and Prevention (CDCs) by telephone or fax within 24 hours after the suicide occurred. If suicidal deaths were not recognized by any health agency, village treasurers (village chair), who collected fees for each burial or cremation and were aware of all deaths in the village, were required to notify the county CDC. To ensure that no cases of suicide were missed, we conducted investigations with the village board and villagers whenever necessary. Subsequently, all the suicide information gathered at the county CDCs was transferred monthly to the provincial CDC. Finally, we collected 393 suicide cases among 15-34-year-olds from October 2005 to June 2008, with 178 female and 214 male subjects.
We randomly selected living comparison individuals within the same age range (i.e., 15-34 years) and the same county, based on the 2005 census database of the 16 countries. Finally, 416 comparison subjects were collected, with 214 females and 202 males.
The data collection yielded 392 suicide cases and 416 community living controls in rural China. All the subjects were aged between 15 and 34 years at the time of death or interview. As shown in Table 1, suicide cases were more likely to have a low position in family. For example, 11.24% and 16.82% of female and male cases had lower positions in family, while the corresponding proportions for living females and males were only 1.87% and 1.49%, respectively.
Suicides were more likely to occur among the unmarried. There was no significant difference in working status between suicide cases and controls. Both suicide females and males had lower educational levels and were more likely to be from families with lower annual income than controls. There was no significant difference in personal annual income between female cases and female controls, while male cases had significantly lower annual income than their controls. Compared with living females, more female cases had a lower annual income than the family average annual income (), while there was no significant difference between male cases and their controls. Compared with living controls, more cases had mental disorders, lower social support, and lower coping skills.
We performed logistic regressions to estimate the association between position in family and suicide for females and males separately and reported ORs in Table 2. The table showed suicide risk estimates for demographic factors, family income, and position in family, with the first two columns for females and the last two columns for males.
As Table 2 illustrates, males aged 25 years and above had a significantly higher risk of suicide than males younger than 25 years old (see column 4), while it was not significant among females (see column 2). Lower educational levels and unmarried status were strong predictors of suicide, and the effects were stronger among males than among females. Family economic status was highly associated with suicide. Females and males from low-income families () were more likely to commit suicide than individuals from high-income families ().
Column 2 and column 4 in Table 2 showed that the ORs of low position in family were 7.1 () for females and 9.1 () for males. In other words, compared with females (males) having high positions in family, females (males) with low positions in family were 7.1 (9.1) times more likely to commit suicide.
Table 3 showed that the coefficients of personal economic status variables (including individual absolute income, having individual income or not, and income higher than family average level or not) were not significant at the 5% level both for females (see columns 2-4) and males (see columns 6-8), and coefficients of position in family remained the same as those in Table 2 (columns 2-4 for females and columns 6-8 for males). It indicated that personal income was not directly associated with suicide risk after controlling for family income per capita income and other control variables, indicating that the impact of personal position in family on suicide did not stem from personal economic status.
Furthermore, we explored the association between mental health, social support, coping strain, and suicide risk and examined how the coefficients of position in family would change when these variables were added to the model. In Table 5, we added the above variables gradually to identify the potential mediators for females in columns 1-4 and males in columns 5-8. (Take the female model as an example, in column 1 of Table 4, only control variables and the explanation variable (position) were included in the model. In columns 2-4, new covariate variables (variables of potential underlying mechanism) were added into the model gradually, including mental disorder, social support, and coping strain. In column 4, all the covariates were included in the model.)
We added the variable of mental disorders in column 2 for females and column 6 for males and found that females and males with mental disorders were 13.36 times and 32.51 times more likely to commit suicide in comparison to living subjects, respectively (see column 2 for females and column 6 for males). The OR magnitude and significance of low position in family declined after the variable of mental disorders was added in the female model (OR declined from 7.09 to 3.81), while the corresponding coefficient was barely affected among males (see columns 5 and 6). It indicated that a low position in family might influence suicide risk by affecting the mental health of females.
We further added social support variables in column 3 for females and column 7 for males in Table 5. Social support was significantly associated with suicide risk for both females and males. For females, the coefficient of low position in family declined substantially after controlling for social support variables and was no longer significant (OR declined from 3.81 to 1.19). For males, there was also a sharp decline in the coefficient of low position in family (OR declined from 9.60 to 4.89). The above results indicated that social support might play an important role in mediating the effect of a low position in family on suicide for both females and males.
Finally, we added the coping strain variable in column 4 for females and column 8 for males. Females and males having high coping strain (low coping skills) were 29 times and 18 times more likely to commit suicide than living controls, respectively. The coefficient of low position in family for males declined to a certain extent after controlling for coping strain (OR declined from 4.89 to 3.71). It indicated that coping strain could be a partial mediator in the association between low position in family and the risk of suicide for males.
Based on the stepwise regression method to study the mechanism effect, we further employ the KHB method [37] to explore the contributions of mediators to the association between low position in family and suicide risk. Tables 6 and 7 reported the average partial effects of a low position in family on suicide before and after controlling for potential mediating factors. On average, the probability of suicide was 13.7 times higher for females with a low position in family compared to those with a high position in family. After controlling for mental health, social support, and coping strain, the difference in suicide probability was no longer significant among individuals with low and high positions in family. Similarly, after controlling for the above three potential mechanisms, the probability of suicide reduced from 34 times to 4 times for males with low positions in family, and the corresponding significance was reduced to a 5% significance level. The above results indicated that mental health, social support, and coping strain are the main mediators underlying the association between suicide risk and low position in family for both females and males.
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