Pathway Analysis of Risk Factors for Severe Suicidal Ideation: A Survey in Rural China

Background: Many studies have suggested that strategies of suicide prevention must be developed with a detailed understanding of the role of multiple risk factors. The aim of the current study was to explore the pathways of multiple risk factors for severe suicidal ideation (SSI) and provide empirical data and recommendations for suicide interventions. Methods: A door-to-door survey was administered to 3,821 rural residents aged 15 and older in rural China. The risk factor variables were socio-demographic characteristics, depression, social support, quality of life and negative life events. Univariate and multivariate logistic regression models were used to analyze risk factors related to SSI, and structural equation modeling was used to analyze the pathways of risk factors for SSI. Results: Depression, socio-economic status and negative life events had direct effects on SSI. Socio-economic status and negative life events had indirect effects on SSI via depression. The most influential factor of the direct effects was depression, and the most influential factor of the indirect effects was socio-economic status. Conclusions: The direct and indirect effect pathways of risk factors contribute to the understanding of the role of multiple risk factors as well as the corresponding intervention strategies. The intervention in the acute phase perhaps should be mainly targeted on the direct factor of depression; before the acute phase (or even earlier) or after the acute phase, it should be mainly targeted on the indirect factor of socio-economic status.