Y: Yang Rui, Presenter of the CCTV English program Dialogue

　　P: Michael R. Phillips,

　　Executive Director of Beijing Suicide Research and Prevention Center

　　Y: Suicide is becoming a serious social problem around the world. Each year, over 250,000 people kill themselves and about 2 million make such attempts. Why should these people kill themselves? What can be done to save their lives? Joining us now is Michael Phillips, Executive Director of Beijing Suicide Research and Prevention Center.

　　Y: We know China has a high suicide rate<注1>, can you give us more details in this regard?

　　P: In fact, the rate of suicide in China isn't one of the highest in the world. It is high but it's not at the very highest level. The highest levels are in Russia, in the Eastern European countries, like Latvia<注2>, Romania, and Hungary. China's rate is on the high-above-medium level. Compared to America or Britain where the suicide rates are about 11 per hundred thousand or 12 per hundred thousand, China's suicide rate, by our estimate, is 23 per hundred thousand. So it means it's twice as high as that in the United States.

　　Y: What are the characteristics of suicide in China?

　　P: In China, suicide is quite different than in other countries. Perhaps the biggest difference is suicide in rural area is three times as high in urban areas. If you look at the pattern of suicide in urban areas in China, it's very similar to Western suicide pattern. That's one characteristic. Another is that there are a lot more female suicides in China than in most other countries. China is one of the very few countries in the world that has more suicides in women than in men by about 25%, whereas most developed countries have much higher rates in men of completed suicide<注3>, of about 3 to 1. So China is almost a reverse of developed countries in that respect. We have been in a number of studies with the Chinese Academy of Preventive Medicine. We find that suicides in China are quite different. For example, there are a lot more impulsive suicides<注4> here in China than in other countries.

　　Y: How do you define impulsive suicide?

　　P: For example, in our attempted suicide research we asked people how long did you think about suicide before you actually took the act? 35% of them say less than 10 minutes. That's really very quick. That's what we call impulsive suicide attempt. Our research in many countries and what we have found in China all show the vast majority of people who actually killed themselves didn't intend to kill themselves. On one hand they want to die, on the other hand they want to live, so they have this ambiguity <注5> about it.

　　Y: Then what is the most important factor leading to their final decision?

　　P: Well, suicide is a complex problem. You can't think of only one factor. It's what we call multi-factorial. So there are often multiple factors present. The most important factors are life events, the severe stress in the person's life, the death of a family member, a severe physical illness, a major conflict, etc. So major life events are one factor. Another factor is psychological problems, such as depression or high-level anxiety. There's also the factor of available means by which people can take their lives. So in any episode of suicide, several of these factors would be present, but one factor might be more important than the other.

　　Y: Does impulsive suicide have a lot to do with one's gender or age?

　　P: We originally thought it would be much more common in females, but in fact our research shows that there's no difference. Males and females, in terms of our definition of impulsive suicide, have impulsive suicide as frequently. The male and female rates are the same. For example, we asked men and women who attempted suicide how long they have considered suicide, and the time is about the same. Impulsive suicide is much more common in the young adults. People who are elderly are much more likely to be chronically depressed and have long-term physical illness and when they decide to commit suicide, it's after a long-term problem.

　　Y: In fact, over 1 million people did not succeed in committing suicide. What do you think should be the reasons? I mean, obviously there are generally two kinds of people who want to commit suicide: A, those who are determined to end their lives; B, those who are sort of hesitant, kind of divided between wanting to live and wanting to die.

　　P: Well, our guess is those in the first group who really decided to die planned it in a way that they are certainly going to die. That's a relatively small percentage of people in China who died of suicide. Exactly how many we can't say for sure, but I think it's probably around one third of the suicides. Well, they've made a long-term plan, they've written a will, they've given their goods to other people, they've decided to die. Perhaps 20% to a third are clearly impulsive. They have no ongoing mental illness. They have a major event, a fight with their husbands for instance. They clearly don't intend to die; they are just reacting to the severe stress of their feeling. The 50% in the middle are the ones who are ambivalent<注6>. On the one hand, they think death might get rid of the problems they are having and they don't have to worry about the problem. On the other hand, they want to live, they have children, they have a future they are thinking of. So one could divide them into three groups. In terms of the attempted suicide, according to the Ministry of Health, there are at least 2 million attempts each year. From our research, it looks like almost none of them receive any psychological help at all. One of our goals is to try to raise the awareness about this problem and to try to provide some type of psychological support for them.

　　Y: Have you talked to any of those who have made such an attempt but failed? Do they regret?

　　P: Almost all of them regretted. Occasionally you get a person who wakes up from being unconscious and say, oh, it wasn't successful. But that's very rare. The vast majority are regretful and feel that this is a shame for their family. Some of them would drink the pesticide<注7> and immediately run out and say, "Come and save me, I've taken pesticide!" They immediately regret right after they have done it.

　　Y: Coming back to the higher rate of suicide in rural areas, what do you think should be the reasons?

　　P: There are several possible explanations. Certainly, economic stress is one of the factors that everybody talks about in terms of producing suicide ideation<注8> and suicide behavior. And very intense economic problems are more common right now in rural areas than in urban areas. Some people say there's the educational level. Our research doesn't seem to confirm this. We think the major factor is the ready availability of pesticides. People in the city would take half a bottle of pills of valiums<注9> or some sleeping medication, would be taken to the emergency room and watched out, would be well and go home two hours later. In rural areas you might take half a bottle of pesticide and be dead two hours later. So our understanding is that one of the reasons for high rates in rural areas is that more of those attempted suicides are actually becoming completed, because the method they use is very dangerous and the treatment resources in rural areas are poor. In our finding, 62% of all the suicides in the country are from pesticide or from rat poison. And of those, more than half of them received medical treatment but medical treatment wasn't successful. So, if we could just improve the medical treatment they receive, we would save 50,000 lives a year, decreasing the suicide rate by 18%.

　　Y: Have you got strong support from the Chinese authorities?

　　P: Certainly our research projects have been done in collaboration with the Chinese Center for Disease Control and Prevention. We've already got the attention of national authorities to get the resources, the money, the personnel to actually implement the national plan. That requires a lot more work. Suicide, in fact, is a more important public health problem than AIDS. The national report says, by 2010, there's going to be 200,000 AIDS victims in the country. But right now there are already 250,000 suicide deaths a year and two million suicide attempts. I'm convinced, though, that we can reduce suicide rate quite significantly. Suicide is a very preventable condition, but you need resources, you need support from government agencies insgroupsto actually move that forward. That's one of the goals of our center.

　　Y: People don't seem to realize that depression is a disease. What kind of suggestions would you give on this?

　　P: Clearly, health education is needed to let people know that depression is a disease. If you have a person who is feeling low, who's lost interest in things, who has sleeping problem, eating problem, poor concentration, low energy and thinking about dying, if it lasts for a certain period of time, that's somebody who is probably depressed. Now, everybody has feelings of depression from time to time, but if it's severe, if it lasts for two weeks or more, if it's affecting social functions, like the person doesn't want to go to work or is unable to work, that person may well have a disease or psychological problem. If the person himself doesn't recognize it or if they recognize it but because of the stigma they are unwilling to seek treatment or ask other people for help, then it can gradually get worse and it can lead to suicidal ideation, suicidal behavior and death.

　　Y: What role do you think the media can play in this respect?

　　P: The media can serve a positive role and can serve a negative role.

　　Y: What do you mean by negative role?

　　P: You can give negative images about psychotic people<注10> killing people, about making fun of the mentally ill. In a culture that looks down on people with psychological problems, looks down on people who seek help from others it makes it very hard for people to move forward and seek the help that they need. But the media can also have a positive influence, like The Beautiful Mind<注11>, which is a positive picture of a person with severe mental illness who made an extremely important contribution.

　　Y: How do you detect the signs in those who are thinking about committing suicide so that you may do something to prevent the tragedy from happening?

　　P: We really believe that prevention of suicide is everyone's responsibility. Everybody needs to think about their family members and people around them. If they are having changes in behaviors that suggest suicide, they've got to do something about it. If they show a significant change in personality: before they were very open and then they become kind of clearly depressed, talking about feeling bad and they have symptoms of depression, as I've said, sleeping disorder, eating disorder, lack of interest in things they used to be interested in, concentration problems. If they start talking about these, their interest in life is sort of lost. They might actually say, "Well, I'm thinking about killing myself." A lot of family members think, "Well, they say it but they won't do it." That's wrong. The vast majority of people have signs that anybody could recognize. If those sorts of behavior happen in a friend or a family member, then you need to take action. A lot of people say, "I can't talk about this. I can't ask a person if he's thinking about killing himself. I just can't do that." It's the same in the West as it's in China. But if you don't, they'll just get worse. If you don't ask, you won't find out. And if you don't find out, you can't do anything, you can't prevent it.