Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
Introduction
Suicide
is a global public mental health problem, the second cause of death for people
aged 15-29 in the world [1], and the first cause of abnormal death for college
students in China [2]. The detection rate of suicidal ideation of college
students in China is 7.1-41.1% [3,4], and that of attempted suicide is
1.7-4.23% [5- 7], which is 2-4 times that of the general population [8,9], and
it is increasing year by year [10]. Suicide attitude is people’s view of
suicide phenomenon, which has the characteristics of difference and stability
[11]. Suicide attitude has a strong cultural dependence.
Therefore, suicide attitude is also diverse
The
most representative views are:
a)
suicide is a criminal act.
b) suicide is immoral.
c) suicide is a manifestation of psychosis; and
d) suicide is personal freedom [11,12].
Suicide
attitude has an important influence on the suicidal ideation and behavior of
oneself or others. Those who hold a negative attitude towards suicide, think
that suicide can’t change others and can’t help solving the problem are less
likely to commit suicide than those who hold a tolerant attitude towards
suicide and think that suicide can change others and help solve the problem
[12].
Suicide
again is largely caused by others’ discrimination and hostile attitude [13,14].
The hostile attitude of medical staff towards suicide will make those who
intend to commit suicide or attempted suicide have mental impedance and hinder
treatment. If medical staff pay too much attention to, care about or praise
suicide, it may strengthen the suicide idea and behavior of the litigants [15-
17]. In fact, the influence of social attitude on individual suicide behavior
is multi axis and multi-faceted. For example, if the society holds a negative
and forbidden attitude towards suicide, even considers suicide a crime, and
holds an exclusive attitude towards the family members of suicides, it may have
a certain restrictive
effect
on those who have suicidal thoughts in deciding whether to take action. At the
same time, prejudice and discrimination may make the attempted suicide commit
suicide again. Suicide attitude is influenced by demographic factors, family
factors, personality characteristics, stressful life events and other factors
[4,7-9,11,13,17-18]. However, most of the previous studies can only prove that
suicide attitude is related to some factors but can neither prove the role of
these factors nor explain the relationship between different factors. Because
most of the above studies use one-way ANOVA or bivariate simple correlation
analysis. Based on the above analysis, this study intends to explore the
current situation and major influencing factors of college students’ suicide
attitude with a large sample multicenter epidemiological survey model and
multiple linear regression analysis.
Subjects and Methods
Objects
Sample Size Estimation
The
minimum sample size is calculated by G* Power 3 [19]. As the detection rate of
suicidal ideation among domestic college students is 7.1-41.1% [3,7], and the
test effect value is at medium level [3,7], that is, d value is 0.50-0.80 [20].
In this study, we set the effect value d = 0.70, the statistical test power 1 -
β = 0.80, the type I error probability α = 0.05, and the minimum sample size
for the survey is calculated as 786. The minimum sample size is determined as
897 due to a 20% of possible follow-up loss rate.
Sampling
A
total of 1000 undergraduates are selected by stratified random sampling from 7
full-time colleges including Guangzhou University, South China Agricultural
University, Guangdong University of technology, Guangdong Medical University,
Guangzhou Academy of fine arts, Guangzhou Institute of physical education and
Zhuhai School of Beijing Technology Institute as the survey objects. The
average score of the final evaluation of the research Objects in the last
semester is taken as the reference of academic performance, and the top 27% is
the excellent group, the last 27% is the poor group, and the middle is the
medium group. 935 valid questionnaires were collected, with an effective rate
of 93.5%. Among them, there are 464 boys and 471 girls; 351 from countries, 306
from towns and 278 from cities; 184 freshmen, 193 sophomores, 195 juniors, 191
seniors and 172 fifth year students; 241 excellent academicians, 475 middle
academicians and 219 poor academicians; 434 have ever had part-time job and 501
have never had part-time job.
Tools
Suicide attitude questionnaire, QSA
It
is compiled [21]. There are 29 questions, divided into four dimensions:
“attitude to suicidal behavior (its nature) ”, “attitude to suicides (including
those who died and attempted suicide) ”, “attitude to the families of suicides”
and “attitude to euthanasia”. The Liketer 5-points scoring method is used to
score from 1 to 5 points corresponding to“not at all” to “completely yes”. If
the total average score or some dimension average score of the scale is less
than or equal to 2.5, the object would be considered hold a positive, approval,
understanding and tolerant attitude towards suicide (or the dimension content);
if the total average score or some dimension average score of the scale is more
than 2.5 and less than 3.5, the object would be considered hold a contradictory
or neutral attitude towards suicide (or the dimension content); if the total
average score or some dimension average score of the scale is more than or
equal to 3.5, the object would be considered hold an attitude of opposition,
negation, exclusion and discrimination towards suicide (or the dimension
content). In this study, the Cronbach's a coefficient of the total scale is
0.875, and the Cronbach's a coefficient of each dimension is 0.787-0.831.
Psychological capital scale for college
students, PCSCS
Compiled
[22], PCSCS has 45 questions, divided into six dimensions: hope,
self-confidence, cooperation, optimism, resilience and gratitude. The liketer
7-points scoring method is used to score from 1 to 7 points corresponding to
“completely non-compliant” to “completely compliant”. The higher the total
score, the higher the psychological capital. In this study, the Cronbach's a
coefficient of the total scale is 0.835, and the Cronbach's a coefficient of
each dimension is 0.677-0.804.
General well-being schedule, GWB
It
was compiled by Fazio (1977) and revised by Duan Jianhua (1996) into Chinese
version [27]. There are 18 items, which are divided into six factors:
satisfaction and interest in life, worry about health, energy, melancholy or
happy, control of emotion and behavior, relaxation and tension. The higher the
score, the higher the happiness. In this study, the Cronbach's a coefficient of
the total scale is 0.914, and the Cronbach's a coefficient of each dimension is
0.803-0.864.
Self-compiled questionnaire for general
information and living conditions of college students
The
CNKI, Wanfang database, VIP database, Baidu, Pubmed and other search engines
were used to search the literatures about suicide and suicides among
undergraduates (4538 in Chinese and 64410 in foreign). Based on that, the basic
contents of the questionnaire were constructed, with a total of 14 items.
Combined with the results of 3 collective discussions with 10 representatives
of undergraduates and 5 experts in the field of higher education, 3 items were
deleted, and 2 items were added. The final questionnaire for general
information and living condition of college students consists of 13 items,
including gender, grade, school category, major category, academic performance,
part-time job, family economic status, place of origin, only child or not,
father's education level, mother's education level, father's occupation,
mother's occupation, etc.
Results
Descriptive statistics of the total score and
factor scores of each scale
It
can be seen from Table 1 that the total scores of CSPCS and GWB of college
students are (179.98±8.23) and (79.55±5.71), respectively, which are higher
than the norm [22,23]. The score of "attitude to suicidal behavior "
in QSA was lower than 2.5, the total score of QSA and the other three
dimensions were higher than 2.5 but lower than 3.5.
Table 1: Descriptive
statistics of the scores of each scale (n=935).
Suicide attitude of college students
On
the attitude to the phenomenon of suicide, 24 students hold the attitude of
affirmation, recognition, understanding and tolerance, 417 students hold the
attitude of contradiction and neutrality, 494 students hold the attitude of
opposition, negation, exclusion, and discrimination. On the attitude to
suicidal behavior, students people hold the attitude of affirmation,
recognition, understanding and tolerance, 638 students hold the attitude of
contradiction and neutrality, and one student holds the attitude of opposition,
negation, exclusion, and discrimination. On the attitude to suicides, 11
students hold the attitude of affirmation, recognition, understanding and
tolerance, 730 students hold the attitude of contradiction and neutrality, 194
students hold the attitude of opposition, negation, exclusion, and
discrimination. On the attitude to families of suicides, 89 students hold the
attitude of affirmation, recognition, understanding and tolerance, 805 students
hold the attitude of contradiction and neutrality, 41 students hold the
attitude of opposition, negation, exclusion, and discrimination. On the
attitude to euthanasia, 173 students hold the attitude of affirmation,
recognition, understanding and tolerance, 705 students hold the attitude of
contradiction and neutrality, 57 students hold the attitude of opposition,
negation, exclusion, and discrimination.
Multiple stepwise linear regression analysis
of factors related to the attitude towards suicide among undergraduates
Variable assignment
First,
values are assigned to the possible situations (alternative answers) of
demographic and psychosocial classification variables that may affect the total
score of QSA, and the results are shown in Table 2.
Table 2: Aariable
Assignment.
Multiple stepwise linear regression analysis
of factors related to suicide attitude among undergraduates
Taking
the total score of QSA and the scores of its four dimensions as dependent
variables, respectively, the 6 dimensions of PCSCS, 6 dimensions of GWB and 13
factors that may be related to the total score of QSA (including demographic
variables and psychosocial factors) as independent variables, the multiple
stepwise linear regression analysis was carried out within 95% confidence
interval. From Table 3, it can be found that major category, academic
performance, part-time job, mother's occupation, control of emotion and
behavior, melancholy and happiness, gratitude, worry about health and
resilience, were positively correlated with the total score of QSA (β =. 104 ~.
759, all P < 0.05). Gender was negatively correlated with the total score of
QSA(β =-.228, P < 0.05). Seven factors such as part time job, academic
performance, gratitude, optimism, resilience, melancholy or happiness, control
of emotion and behavior, were positively correlated with the score of attitude
to suicidal behavior (β =.155 ~.707, all P < 0.001). Father's education
level was negatively correlated with the score of attitude to suicidal behavior
(β =-.161, P < 0.05). Six factors such as Major category, part-time job,
gratitude, resilience, melancholy or happiness, control of emotion and behavior
were positively correlated with the score of attitude to suicides (β=.159
~.606, all P < 0.01). worry about health was negatively correlated with the
score of attitude to suicides (β=-.244, P < 0.01). Part time job, gratitude,
cooperation and mother's educational level were positively correlated with the
score of attitude towards the families of suicides (β =.106 to.338, P <
0.05), while major category and gender were negatively correlated with the
score of attitude towards the families of suicides (β = -.172, -.231; P <
0.01). Mother's occupation, academic performance, part-time job or not were
positively correlated with the score of attitude to euthanasia (β=.197 to .285,
all P < 0.05), while gender and worry about health were negatively
correlated with the score of attitude to euthanasia (β = -. 301, -. 433; P <
0.01).
Table 3: multiple
stepwise linear regression analysis of influencing factors related to the total
score and scores of the four dimensions of SAQ.
Discussion
In
the total score and four dimensions of QSA, more than 44.60% (417 / 935) of
college students hold contradictory and neutral attitude, which is consistent
with the results of previous literature [7,9,24-26], suggesting that the
attitude of college students towards suicide is vague in general. College
students lack sufficient cognition of the nature and harm of suicide
phenomenon, and they still hope for the role of suicide (whether it can change
the behavior of others, whether it can change the progress of the situation,
and even solve problems, etc.). This may be due to the fact that college
students are in the forming stage of values and world outlook, immature
understanding of suicide and immature coping styles when they encounter
setbacks. In addition, the popularity of Internet media in recent years and the
frequent reports of star suicides make college students have a one-sided understanding
of death and blindly imitate it [14]. Multiple stepwise linear regression
showed that major category, part-time job, gratitude, mother’s occupation,
academic performance, control of emotion and behavior, Melancholy or happy,
worry about health and resilience were positively correlated with the total
score of SAQ, while gender was negatively correlated with the total score of
SAQ.
There
is a positive correlation between major category and total score of QSA, which
is reflected in the positive correlation between major category and attitude
towards suicides and the negative correlation between major category and
attitude towards families of suicides, which is consistent with the results of
previous studies [7,24,27]. It is suggested that students of different majors
have different opinions on the personality characteristics and the consequences
of suicide. Compared with students of science and engineering, students of
other majors more inclined to think that suicides are cowardly, incompetent, impulsive
and irresponsible, so they are more opposed and rejected to suicides, and more
sympathetic to the pain of their families. Gratitude is positively correlated
with the total score of QSA, which is reflected in the positive correlation
between gratitude and the attitude towards suicidal behavior and suicides, and
the negative correlation between gratitude and the attitude towards suicides’
families, which is consistent with the results of previous research [28],
suggesting that gratitude is helpful to improve college students’ sympathy and
understanding for the families of suicides, and make them more inclined to
oppose suicidal behaviors and suicides. The positive correlation between
control of emotion and behavior and QSA total score is reflected in the
positive correlation between control of emotion and behavior and attitude
towards suicidal behavior and suicides, which is consistent with the previous
research results [12,26,28], suggesting that college students with high ability
of control of emotion and behavior are more inclined to think that suicide is
an impulsive, irrational and irresponsible behavior, so suicides are not worthy
of sympathy [29] and put forward the “stress susceptibility model” from the
perspective of neurobiology, and found that different individuals have
different responses to the same experience or encounter, which is closely
related to the individual’s performance in face-to-face stimulation and how the
quality factors interact with the environment. Selfcontrol is the key quality
characteristic of interaction between individual and environment. Those with
strong self-control ability are more difficult to be disturbed by life events,
and they advocate and insist on calm response when encountering life events and
solve problems reasonably (control environment).
Conclusion
Melancholy
or happy is positively correlated with the total score of QSA, which is
reflected in the positive correlation between Melancholy or happy and the
attitude towards suicidal behavior and suicides, which is consistent with the
results of previous research [30], suggesting that mood can affect attitude.
Happy can make college students experience the fun and meaning of life, love
and cherish life, and tend to oppose suicidal behavior and suicides; depressed
is on the contrary. Resilience is positively correlated with the total score of
QSA, which is reflected in the positive correlation between resilience and
attitudes towards suicidal behavior and suicides, which is consistent with the
results of previous research [28], suggesting that people with different levels
of resilience have different evaluations on the nature of suicidal behavior and
the quality of suicides. People with high resilience think that individuals can
recover from setbacks with their own efforts, and suicide is to avoid problems,
not to help solve problems, and suicides are cowardly and irresponsible, so
they are against suicidal behavior and suicides. There is a positive
correlation between part-time job and the total score of QSA, which is
reflected in the positive correlation between part-time job and the scores of
four dimensions: attitude to suicidal behavior, attitude to suicides, attitude
to suicides’ families, and attitude to euthanasia, which is consistent with the
results of previous research [27], suggesting that social practice experience
can comprehensively affect the individual’s concept of phenomena related to
suicide. Part time job exerts the ability of college students, makes them have
a clearer goal and reasonable expectation for their future, have a more
objective understanding of themselves, others and society, and have a firmer
belief in life. They are more able to deal with life setbacks rationally and
cherish life more [31]. Academic performance is positively correlated with the
total score of QSA, which is reflected in the positive correlation between
academic performance and the score of attitude towards suicidal behavior, and
the negative correlation between academic performance and the score of attitude
towards euthanasia, which is consistent with the results of previous studies
[18,26], suggesting that those with high academic performance can treat life
more rationally (not just cherish life). They prefer to face difficulties
bravely, actively solve problems, and oppose suicide as a way to solve
problems, but they prefer euthanasia as a way to solve end-stage pain.
There
is a negative correlation between gender and the total score of QSA, which is
reflected in the significant negative correlation between gender and the scores
of attitude towards the families of suicides and the attitude towards
euthanasia. Female students are more sympathetic to the families of suicides
than male students, and more identify with euthanasia, which is consistent with
the results of previous studies [7,18,26,27]. It is suggested that gender has a
significant effect on suicide attitude. What are the reasons? Whether it is due
to the effect of sex hormones [32] or the influence of parenting style [31,32]
remains to be proved by follow-up studies. The positive correlation between the
occupation of mother and QSA total score is reflected in the positive
correlation between the occupation of mother and the score of attitude to
euthanasia, which is consistent with the result of previous study [11],
suggesting that as the main caregiver, the mother’s view of life and death has
an important influence on the attitude of death of children. The reason may be
that the mother’s occupation can affect her own attitude to death [8], and then
influence the children’s death attitude (euthanasia attitude) through words and
deeds. Worry about health is negatively correlated with the total score of SQA,
which is reflected in the negative correlation between worry about health and
the attitude towards suicides and euthanasia, which is consistent with the
result of previous research [17], suggesting that worry about health c may
reduce college students’ evaluation of the value of life and make them more
inclined to sympathize with and tolerate suicide.
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