Abstract
Objective
Suicide is a serious public health concern in China. In the present study, we investigated the specific mechanisms underlying relative deprivation and suicide in rural China.
Methods
A large psychological autopsy study was conducted in rural China, in which 392 suicides and 416 community-living controls were consecutively recruited. Multiple logistic regression analysis was used to assess the relationship between relative deprivation and suicide, with depression as a potential mediator.
Results
Young people who experienced relative deprivation were at a greater risk of suicide and depression. Depression plays a mediating role in the relationship between relative deprivation and suicide.
Limitations
Due to the limitations of the data, we cannot know whether there is mutual causation between relative deprivation and depression. The self-reported relative deprivation may also produce some influence on the results.
Conclusions
The current findings demonstrate the importance of relative deprivation as one of the four sources of psychological strain to explain how relative status is associated with suicide. The findings also can be translated into the clinical and preventive practice for suicide.
Introduction
Suicide is a serious public health problem that has now become a widespread social concern. According to the World Health Organization (WHO), the number of suicides in China was 116,324 (6.7/100,000) in 2019, including 72,515 males (8.6/100,000) and 43,809 females (4.8/100,000). Although the suicide rate has shown a clear downward trend over the past 20 years in China, the absolute number remains very high, accounting for approximately 1/7 of the world’s suicide deaths.
In fact, more than half of global suicides (58%) occurred before the age of 50 years. Most adolescents who died by suicide (88%) were from low- and middle-income countries. It was also reported that suicide was the fourth leading cause of death for males and the third for girls globally respectively among young people aged 15–29 in 2019. Further, this concern is even more urgent in China. According to the 2020 China Health Statistics, suicide was the second leading cause of death for both sexes in China among young people aged 15–34, following by road injury.
While the rate of suicide in China is showing signs of a decline over the past 30 years, young people are at higher risk of suicide than other age groups. The explanation is that young people are more likely to experience life transitions, such as finding a job, getting married, raising parents and children, and may encounter a series of role transition conflicts and life and work pressures. etc. (Nieuwenhuis & Chiang, 2021; Xiong et al., 2022; Zhang et al., 2010a). Especially when young people enter a new environment, they are more likely to encounter the collision of different values, the conflict between aspirations and reality, and the sense of deprivation generated in social comparison. For those who are lack of coping skills, mental disorders may arise, leading to suicide in the long run (Pak & Choung, 2020; Zhang, 2005; Zhang et al., 2013).
Relative Deprivation in the Strain Theory of Suicide
The strain theory of suicide postulates that psychological strains usually precede mental disorders and suicidal behaviors. The four sources of strain generally come from (1) conflicts of different values, (2) discrepancies between aspiration and reality, (3) relative deprivation, and (4) lack of crisis-handling skills. As one of four studies on strain and mental health, this study focused on the effect of perceived relative deprivation on an individual’s suicide risk (Zhang, 2005; Zhang et al., 2013; Zhang & Lester, 2008; Zhang & Song, 2006; Zhang & Zhao, 2013).
Conceptualization and Operationalization of Relative Deprivation
Relative deprivation is the result of social comparison, specifically referring to the perception of an individual or group of its own disadvantage compared to the reference group. First, the basis of comparability is that individuals have a certain subjective cognitive understanding of the reference group, usually composed of those who live in the same community. Second, in real life, the perception of this inferior position stems from the unequal socioeconomic status indicators such as work income, education level, occupational experience and so on (Zhang, 2005; Zhang & Tao, 2013). It is important to mention that the lack of absolute deprivation of basic material security such as food, clothing, shelter and transportation, is known as actual deprivation, which is different from the relative deprivation (Xiong et al., 2022). People experience relative deprivation only when they realize that people from the same background as themselves are wealthier, or when they are faced with things that they are entitled to but do not actually have.
From the perspective of quantitative research, many scholars use the corresponding socioeconomic dimension index scale to evaluate the level of relative deprivation. Zhao and Peng (2021) measured relative deprivation in psychological strain based on a subjective assessment of 10 statements about respondents’ relative income, attitudes towards being treated, and other situations experienced in their lives; Xiong et al. (2022) measured the relative deprivation of migrant children from five aspects: family economic status, housing conditions, housing stability, personal advantage development and parental participation in education. Gero et al. (2017) and Pak and Choung (2020) draw on the conceptualization of upward social comparisons, using different measures to measure relative deprivation in terms of relative income levels. Although the measurments are vary based on different subject of the study, they generally use socioeconomic factors as an operationalized indicator of relative deprivation.
Effects of Relative Deprivation on Mental Health
The intensity of relative deprivation is the degree of difference between the desired situation and the person desiring it (Runciman, 1966). The previous literature suggested that the intensity of perceived relative deprivation shapes people’s mental health status (Kim, 2021). It can be imagined that when people realize that others with the same background are way richer than themselves, they will feel deprived. And the greater the difference between the individual and the reference, the greater the sense of injustice. The accumulation of negative emotional experiences such as anger, resentment and dissatisfaction will ultimately have a greater impact on personal mental health (Beshai et al., 2017; Blau & Blau, 1982).
Absolute income does not reflect this sense of deprivation. Sturm and Gresenz (2002) found that after controlling for individual absolute income levels, relative deprivation was still significantly correlated with depression and anxiety. Abrams and Grant (2012) found that relative deprivation among British adolescents was significantly correlated with their depressive experiences. Therefore, we hypothesized that there is a significant association between relative deprivation, depression and suicide.
Current Theoretical Perspectives
Theoretical Research Perspective on Suicide Influencing Factors
In the existing literature, there are three theoretical perspectives used to understand and explain the current suicide behavior. The first is based on existing medical models that explore the causes of suicidal behavior and draw conclusions from a medical perspective. For example, the three-stage theory (3ST) emphasizes that there are three specific variable categories that lead to suicidal ability: congenital factors, acquired factors, and realistic factors. Suicide can be well explained by these factors (Dhingra et al., 2019; Klonsky & May, 2014). However, this type of research is limited to abstract theories in epidemiology, and data are mostly from foreign countries; therefore, this research on suicide factors cannot be applied to Chinese people.
The second is to analyze the psychological statistics and clinical factors related to suicide from the psychological perspective. Studies have shown that suicidal ideation is significantly higher among males and people with mental health problems, family history of suicide attempts, lower self-esteem, and higher depressive symptoms (Qaddoura et al., 2022). Chinese data have supported that factor significantly associated with subsequent suicide include advancing age, history of suicide attempts, and mental disorders (Liu et al., 2022). In addition to the above two perspectives, which mainly focused on the relationship between demography, psychological factors and suicide, there are also researchers investigating the relationship between interpersonal communications, mental health and suicide. For example, Levi-Belz et al. (2022) believed those who tend to self-disclose, suffer social loneliness in interpersonal communication were greatly associated with higher risk of serious suicide attempts. The findings indicated that enhancing interpersonal coping skills and social connection contributes to relieving psychological crisis and mental stress, which consequently reduces the suicide risk (Fawcett et al., 1969; Sainsbury, 1972). However, these studies did not delve into the focus on relative deprivation and suicide using quantitative techniques.
The third explanation is to look at the existing suicide research from a sociological perspective, and the relevant factors include socio-economic status, social relations and urban-rural differences, etc; The subjects of the study are mainly adolescents, the elderly, women and the rural population. Among them, for social status, some studies believe that subjective social status is significantly negatively correlated with depression and suicidal ideation in adolescents (Vidal & Latkin, 2020), while others indicated that there is a significant direct effect between subjective social status and depressive symptoms through mediation models (Pössel et al., 2022). But unfortunately, neither of above research further analyzes the relative deprivation factor relating to subjective social status and its impact on suicide itself. Existing studies have also examined the effect of gender on suicidal ideation, showing that there are gender differences in suicide and attempted suicide among rural Chinese youth (Zhang et al., 2022). But education and family annual income were protecting factors for suicide (Zhang et al., 2010b). All these studies are useful references for our research.
Relative Deprivation, Depression, and Suicide
The effects of relative deprivation on mental health outcomes have been examined in several studies worldwide. For example, Gero et al. (2017) found that, compared to the absolute income value, relative income is positively associated with depressive symptoms among older adults in Japan. Using a Canadian sample, Beshai et al. (2017) concluded that subjective relative deprivation was associated with individuals’ cognitive vulnerability and depression. There are also studies examining the relationship between relative deprivation and suicidal ideation in terms of income (Pak & Choung, 2020), but this study did not further explore the potential factors that may affect the relationship between relative deprivation and suicidal ideation, and the age of the subjects was limited to 25 years. One study examined how relative deprivation might influence adolescent depression and tried to explain the mechanism underlying the relationship (Kim, 2021). But these two studies only examined the effect of relative deprivation on suicidal ideation or depression, without further investigating its effect on suicide itself.
Given the profound influence of Chinese culture, research on relative deprivation and physical and mental health has also attracted increasing attention from researchers (Xia & Dai, 2022), with a notable focus on the relationship between relative deprivation and depression (Kim, 2021; Zhao & Peng, 2021; Zhang & Tao, 2013). The mechanism analysis of relative deprivation, depression and suicide needs further empirical test.
Research Subjects and Methods in Current Studies
In terms of research subjects, the existing ones on relative deprivation are more diverse, and the main research subjects are adolescents, the elderly, women, and rural populations. Many subgroups were included in the general classification. For example, in research on children and adolescents, studies have been conducted on the relative deprivation and suicide among Chinese immigrant children (Xiong et al., 2022), and there are studies on the relative deprivation and performance of Chinese adolescents in school (Nieuwenhuis & Chiang, 2021). There are also group classifications based on geographic location and the sociocultural environment (Shi et al., 2023; Inoue et al., 2019).
In terms of research methods, many domestic studies on suicide have focused on mediating effects. For example, some studies believe that severe parenting can affect adolescents’ non-suicidal self-injury behavior through the mediating effect of depressive symptoms (Liu et al., 2021). Studies have also shown that neuroticism can positively predict depression and non-suicidal self-injury behaviors of college students through the mediating effect of emotion regulation and depression (Liao et al., 2022). Although many domestic studies have selected depression as an intermediary variable, the selected dependent variable is non-suicidal self-injury behavior or suicidal ideation, which disregards suicide itself. In addition, most existing quantitative studies on suicide factors are insufficient for data selection. Most of these were not clinical samples. Due to social prejudice, traditional culture, and other factors, there may be data omissions and false reports that affect the accuracy of the data.
Defects and Innovations
As described above, previous literature has suggested that relative deprivation is positively associated with suicide, although some deficiencies still exist. First, owing to the difficulty in the availability of actual death data in China, most existing domestic studies either took suicidal ideation as the dependent variable or used foreign psychological autopsy data to investigate potential influencing factors. Second, studies on the influence of relative deprivation on suicide are relatively few and often limited within a certain field, and the specific mechanism by which relative deprivation affects suicidal behavior has not been fully understood.
Therefore, based on previous literature, the key points and innovations of current study are as follows. First, the suicide data come from our first-hand psychological autopsy study conducted in rural China, which is still rather scarce in China. The clinical samples obtained from this autopsy project are in line with current international studies on mortality data, which ensures the authenticity and accuracy of our data and makes it possible to compare the actual suicide status of rural China and other countries based on the same standards and time series. In addition, we investigated the detailed relationships and mechanisms between relative deprivation, depression, and suicide from the perspective of social psychology. Specifically, this study proposed and confirmed the following hypotheses based on previous literature: (1) both relative deprivation and depression are positively associated with suicide risk, and (2) depression partially mediates the effect of relative deprivation on suicide risk. Simultaneously, we also adopted the methods of local survey data and quantitative statistical research, which effectively avoided the localization defects caused by the application of Western theoretical paradigms in epidemiology. With the trend of reforming and opening up in China, social status among individuals is changing quickly, and this study can provide valuable research results and enlightening implications for suicide research in various academic circles.
Methods
Study Design and Population
The population we focus are those individuals aged 15–34 years and living in rural areas of China. This was a large psychological autopsy (PA) project investigating the correlates of completed suicide in comparison with a group of living controls. Pilot studies had demonstrated the feasibility of studying suicide by the PA method in Chinese social and cultural environments (Zhang & Norvilitis, 2002), and that the Western developed instruments are reliable and valid with the Chinese samples (Zhang et al., 2003). We used established PA methods and a case-control design to investigate the environmental and other characteristics of young rural suicides and controls.
Subjects and Data Collection
Data for this study were obtained from 16 rural counties across three Chinese provinces (Liaoning, Hunan, and Shandong). In each of the 16 counties, suicides aged 15–34 years were sampled consecutively from October 2005 to June 2008. Similar numbers of community-living controls were recruited in the same counties for the same time periods. In this study, we excluded cases of accidental or natural death in which the suicidal intent was questioned. As China does not have a medical examiner system, and all deaths are required to be sent to a health agency for a death certificate, hospitals are the primary place for the Centers for Disease Control and Prevention (CDC) to locate cases for the study. Each hospital uses a standard protocol to determine the cause of death. In remote rural areas far from a hospital, village doctors are responsible for furnishing death certificates and are required to report death to the Xiang (township) health agency. All hospitals and clinics in the county are supervised by the county CDC.
Sampling
In our study, all suicidal deaths were reported to each county CDC by telephone or fax on a daily basis, and the information gathered at the county CDC was then forwarded on a monthly basis to the provincial CDC. For those suicidal deaths that were not recognized by any health agency, our mortality registry system allowed village treasurers, who collect fees for each burial or cremation and are aware of all the deaths in the village, to notify the Xiang health agency or the county CDC. Whenever necessary, an investigation with the village board and villagers was conducted by the research team to ensure that no suicide cases were missed or reported erroneously—these procedures were implemented to minimize false classifications.
The epidemiological assumption is that controls are representative of the general population in terms of probability of exposure (suicide risk) and that controls have the same possibility of being selected or exposed as the cases (Timmreck, 2002). To optimize the scientific validity of our study, we did not use accidental deaths for the control group because they might be biased in certain ways (e.g. higher likelihood of substance misuse or impulsive risk-taking behavior). Instead, the community-living controls were from the same counties and among the living general population within the same age group of suicides. In each province, we used the 2005 census database of counties in our research. For each suicide, we used the database of the county where the deceased lived to randomly select a living control in the same age range (15–34 years). Regarding gender, the random selection of controls aged 15–34 years from each county database yielded approximately equal numbers of males and females, which approximated the gender distribution of the suicide cases in the study. The control sample did not exclude individuals who had been diagnosed with mental disorders or had previous suicide attempts. Thus, the prevalence of mental disorders and suicide attempts could be assessed in the rural general population aged 15–34 years, and more importantly, the effects (direct, mediating, and intervening) of mental disorders on completed suicide could also be studied.
Information Sources
For each suicide and each control, we interviewed two informants, with very few exceptions (for two subjects only one informant was available for each). However, we recognized that the type rather than the number of informants used in PA studies is an important and complex consideration (Kraemer et al., 2003). We selected the informants based on the context or environment (how people observe the target; for example, home vs. non home setting). In this way, each informant was carefully selected to optimize the information available on each case so that home, work, family and non-family aspects were included in the data.
Based on the above considerations, we used the following four guidelines for the inclusion of informants: (1) suicide informants were recommended by the village head and the village doctor and then selected by the research team based on familiarity with the subject’s life and circumstances, availability for and willingness to consent to in-person interviews, whereas control group informants were recommended by the controls themselves and then selected by the research team with similar principles. (2) Although target persons could be as young as 15 years of age, informants had to be aged ≥18 years. Characteristics of the informants for both suicides and controls were noted in a standardized fashion (i.e. most recent contact, number of contacts in the past month, frequency of contacts in the past year, number of years informant has known the target, relationships, and the informant’s impression of their familiarity with target persons). (3) For both suicides and controls, the first informant was always a parent, spouse or another important family member, and the second informant was always a friend, co-worker or neighbor. (4) Wherever possible, we avoided recruiting husbands and in-laws of those female suicides associated with family disputes. Interviewing these people could result in very biased reports, if marital infidelity and family oppression were possible causes of suicide. Similarly, in selecting the male suicide informants and the control informants we tried to avoid this type of biased informant when family disputes were noted before hand.
Interviewing Procedure
Face-to-face interviews were conducted with members of households in the villages. Informants were first approached by the local health agency or the village administration by a personal visit. Upon their agreement by written informed consent, the interview was scheduled between 2 and 6 months after suicide incident (Lin & Zhang, 2017). Interviews with informants regarding living controls were scheduled as soon as the control targets and their informants were identified. Each informant was interviewed separately by one trained interviewer, in a private place in a hospital/clinic or the informant’s home. The average time for each interview was 2.5 h. As the cases were deceased and controls were living, blinding of raters to case status was not possible. Inter-rater reliability was established and maintained by limiting the principal data-gathering role to the 24 trained clinical interviewers and by comparison of duplicate ratings of the interviewers on a regular basis. The same interviewers participated in data collection for both case and control samples, promoting inter-rater reliability across the study (Zhang et al., 2010a).
Description of Demographic Characteristics in Suicide and Control Samples.
Note. *p < .1, **p < .05, ***p < .01.
Measures
Outcome (Suicide)
The dependent variable was a dichotomous variable, where 1 represented a higher risk of death and 0 represented a lower risk of death.
Indicator (Relative Deprivation)
Relative deprivation is a subjective emotional perception that is often aroused due to one’s comparison to social members living within the same area. Previous studies have confirmed that the sense of relative deprivation is closely related to the social hierarchy in which people stand (Beshai et al., 2017; Blau & Blau, 1982; Gero et al., 2017; Zhang, 2005; Zhang & Tao, 2013). Those with a lower socioeconomic status tend to have a stronger sense of relative deprivation.
This study took the “status of family in village” as the indicator of relative deprivation. First, Compared with urban community residents, people living in rural areas are not so open in terms of the scope, object and content of communication. It mainly because of the remote geographical location and poor traffic which restrict people’s interpersonal mobility. Therefore, when making social comparison, individuals living in rural areas tend to take native villagers as their reference; Second, status of family in village is a comprehensive indicator of subjective cognitive comparison of the social status of the family. For those individuals who feel good about their family status in the village, they are less likely to feel the sense of deprivation of economic, political, cultural and other social status disadvantages.
Thus, those whose family status in the village was “fair, good, or very good” were recoded as “0 = low,” while others with “poor or very poor” status of family in village were recoded as “1 = high,”. The independent variable is dichotomous, where 1 represents high relative deprivation perception and 0 represents low relative deprivation perception.
Potential Mediator (Depression)
The Hamilton Depression Rating (HAMD) Scale was designed to evaluate the degree and variance in depression and has quickly become the standard measure of depression severity in clinical trials of antidepressants. The HAMD Scale has been the gold standard for the assessment of depression for 40 years and is currently the most commonly used measure of depression. For each of the 24 items in the full version of the scale, respondents were asked to rate the severity of their depression by probing their mood, feelings of guilt, suicidal ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms. The translation of the 24-item scale has already been tested in Chinese inpatients with depression, showing good reliability and validity (Zhang & Jia, 2007). In our study, the Cronbach’s alpha coefficient of the internal consistency reliability is 0.973. Two proxy interviews were conducted for each suicide case and living control. The vast majority of the responses for the target person were the same or similar. For different responses pertaining to the target person, we selected the response representing a positive symptom because the other informant may not have had the opportunity to observe the specific characteristic or behavior. The potential HAMD scores ranged from 0 to 76. A higher score indicated more severe depression.
Control Variables
Suicide is a major social and public health problem in China. Not only individual factors, but also a range of social factors have been considered in attempts to explain suicidal behavior. The predictive control variables included gender, age, marital status, education, family status, having children, physical health, personal income, and education.
Gender was assessed as a binary variable, with 1 = male and 0 = female. Their ages ranged from 15–34 years, and they were divided into two groups. The two groups were adolescents were less than 25 years old and young adults are older than 26 years old (1 = adolescents, 2 = young adults). To investigate the effect of marital status on suicide risk in rural China, we computed a variable using two categories. Marital status was coded as 1 = not currently married (including those who had never been married, divorced, separated, or widowed) or 2 = currently married (including those who were currently married or involved in cohabitation). For the question “whether having children,” the respondents were asked to mark “1 = yes” for positive responses and “0 = no” for negative responses. In addition to considering the HAMD depression score, we examined a self-reported measure of physical health, categorized as “0 = not good” or “1 = good”. Based on this scale, family status was categorized as “1 = low,” “2 = average,” or “3 = high.” Personal annual income was measured in Chinese renminbi (RMB), which was divided into three levels based on the scale mean: 1 = low (≤2,500), 2 = average (2,500–10,000), or 3 = high (≥10,000). One U.S. dollar was equivalent to approximately 7.50 RMB at the time. Educational status was indicated by a continuous variable of years of schooling. A higher number indicates a higher level of education.
Data Analysis and Certification of the Methods
STATA 16.0 and SPSS 26.0 were used for all statistical analyses. Coefficients were converted to odds ratios (ORs) for interpretation, and 95% confidence intervals were reported. All authors certify responsibility for the methods used in the data collection and data analyses.
Results
Descriptive Analysis
As mentioned above, our study data were obtained from a survey of 808 rural villagers in the Liaoning, Hunan, and Shandong provinces of China. In Table 1, we divided the total sample into a suicide group (N = 392) and a control group (N = 416) for descriptive demographic statistics. It could be seen that the proportion of people with relative deprivation was 31.19% (N = 252). The age group was divided into adolescents (≤25) and young adults (>26), with males accounting for 51.49% (N = 416). More than half of the respondents believed that they were healthy (67.33% vs. 32.67%), and those with poorer physical health were more inclined to commit suicide (p < .01). Meanwhile, family status also significantly differed between the two groups, with only 1.69% of the control group holding low family status in the village, which was much lower than that in the suicide group (14.32%). Regarding the control group, a smaller proportion of respondents in the suicide group had a higher income (8.95% vs. 21.58%) and a slightly lower education period (7.39 vs. 9.14 years). The average years of education of the respondents was 8.28 years, which is basically in line with the educational level of rural youth groups in China from 2005 to 2008. The average HAMD-24 depression score in the suicide group was much higher than that in the control group (14.70 vs. 0.37), indicating that depression was almost nonexistent in the control group.
The results of the chi-square and Cramer’s φ (Phi) tests showed that relative deprivation had a statistically significant effect on suicide (χ2 = 125.55, p < .01, φ = 0.394, Cohen’s d = 0.858), and the independent sample t test showed that depression had a statistically significant effect on suicide (t = −19.80, p < .01, Cohen’s d = 1.453). Both the far-from-zero effect sizes suggested that relative deprivation and depression differed significantly between the two groups, and there was no pseudo-correlation due to the large sample size. In addition, using the chi-square test or t test, we found that all covariates, including personal and social factors, had a significant influence on suicide at different confidence levels. These statistical findings laid the foundation for further regression analysis.
Regression Analysis
Logistic Multiple Regression Results of Impacts of Relative Deprivation on the Suicide.
Note. Standard errors (S.E.) in parentheses. *p < .1. **p < .05. ***p < .01.
Model 2 included the independent variable (relative deprivation) based on Model 1, and the outcomes showed a significant positive correlation between relative deprivation and suicide. Specifically, controlling for all covariates, the risk of suicide in the group that had experienced relative deprivation was 4.029 times more likely to commit suicide than those who did not suffer relative deprivation (p < .05), which tentatively confirmed our proposed research hypothesis that relative deprivation had a positive effect on villagers’ suicide risk and was in accordance with the findings of previous academic studies (Inoue et al., 2016; Pak & Choung, 2020; Zhang & Lester, 2008).
Furthermore, in Model 3, we added a potential mediating variable (depression). The results revealed a significant positive correlation between depression and suicide. For every additional point on the HAMD-24 Depression Status Scale, the suicide risk increased by 81.9% (p < .01). It is notable that, at that point, compared to Model 2, the group that experienced relative deprivation showed a distinct decrease in the odds ratio of suicide risk compared to the group without the feeling of relative deprivation, controlling for other variables (from 4.029 to 3.208). To some extent, the results showed a mediating role of depression in the effects of relative deprivation on suicide, which needs to be further verified.
Regarding the regression analysis of control variables and the dependent variable (suicide), only gender and years of education had significant differences in the influence of the dependent variable. Specifically, in Model 3, controlling for other covariates, the odds ratio of suicide in men was 37.3% lower than that in women (p < .1). For each additional year of schooling, the odds ratio of suicide decreased by 17.6% (p < .01). Age, marital status, having children, physical health, and personal income level had no significant effect on suicide risk (p > .1). Significance can be observed between each covariate, and the dependent variable differed greatly between Models 1 and 3. By calculating the effect size of each variable on the dependent variable (suicide), we found that the insignificant effect of control variables on suicide is because relative deprivation and depression are largely obscured the effects of control variables on the dependent variable.
The Mediation Effect Test of Depression Between Relative Deprivation and Suicide
We further tested whether depression mediates and influences the effects of relative deprivation and suicide risk. First, using the SPSS macro program Process 4.0 and Model 4 formulated by Hayes (Hayes, 2022), the mediating effect of depression between relative deprivation and suicide was examined. Specifically, in this model, relative deprivation was entered as the independent variable (X), depression as the mediator variable (M), and suicide as the dependent variable (Y). Then, using at least 5000 bootstrap samples, 95% bias-corrected and accelerated bootstrap confidence intervals were calculated. Regression analyses showed that relative deprivation(X) was significantly associated with depression (M) (a = 3.940, S.E. = 0.937, t = 4.204, p < .01), and depression (M) was significantly associated with suicide (Y) (b = 0.599, Z = 9.583, S.E. = 0.063, p < .01).
When analyzing mediation of depression, we found that: (1) The total effect (Path c) of relative deprivation (X) on suicide (Y) was significant with the positive value of the coefficient (b = 3.562, p < .01), indicating that an increase in relative deprivation was accompanied by an increase in suicide risk; (2) the bias-corrected bootstrap 95% CI of indirect effect (Path a*b) did not include zero (b = 2.361, Boot S.E. = 0.808, bootstrapped 95% CI = 1.029–4.275), suggesting a significant indirect impact of relative deprivation on suicide, and the effect was mediated through depression according to the mediation concept of Baron and Kenny (Baron & Kenny, 1986); and (3) the direct effect (Path c’) was still significant (b = 1.201, S.E. = 0.276, z = 4.354, p < .01, bootstrapped 95% CI = 0.660–1.742), accounting for 33.7% of the total effect, meaning depression played an active partially mediating role in the relative deprivation affecting suicide risk. The specific effect path values are shown in Figure 1. Graph of the mediating effects of depression on relative deprivation on suicide. Note. *p < .1, **p < .05, ***p < .01; Standard errors in parentheses.
Discussion and Conclusion
Relative Deprivation, Depression and Suicide
Previous studies have found that relative deprivation significantly affects mental health (Kim, 2021; Zhao & Peng, 2021; Zhang & Tao, 2013) and suicide (Inoue et al., 2016; Pak & Choung, 2020) and mental health also significantly affects suicide (Bender et al., 1999; Garlow et al., 2008; Wei et al., 2018). However, relatively few studies have included relative deprivation, depression, and suicide simultaneously in a unified analytical framework, suggesting that the mechanisms that account for this relationship are not yet fully understood. We are particularly interested in whether an individual’s sense of relative deprivation can induce depression, and thus, a higher risk of suicide. That is, our current research addresses the question of how depression mediates the effect of relative deprivation on suicide.
Profound social status changes have been triggered since the reform and opening up (Knight, 2014; Zhang et al., 2010b). Although the overall well-being and life satisfaction of Chinese youth have gradually improved with the prosperity and growth of the economy, with the acceleration of the urbanization process, the frequent geographical flow of young people and diverse career choices have intensified the reproduction of internal inequality, resulting in huge differences in individual socio-economic status. China’s domestic reform had broken the traditional socialist pot-luck, and the disparity in socioeconomic status among villagers living in the same rural area became increasingly notable and even resulted in economic polarization (Knight, 2014; Knight et al., 2009). When individuals consciously or unconsciously compare their socioeconomic status with those living in the same social group in interpersonal interactions, the side with a relatively disadvantaged economic status often loses belief in social equality, and feels deprived of the opportunity to reach their full potential, and eventually triggers a sense of relative deprivation (Blau & Blau, 1982; Kim, 2021). This perceived relative deprivation deteriorates social relationships and increases psychological tension within the individual (Kim, 2021). Depression arises when individuals fail to adjust to such psychological stress without perceived social support (Hayes, 2022; Zhao & Peng, 2021), and suicide occurs when depression accumulates to a certain level with no appropriate coping skills (Phillips et al., 2002; Pickett & Wilkinson, 2015; Zhang & Tao, 2013; Zhang & Zhao, 2013).
Control Variables Influencing Suicide
Additionally, rural females had a higher risk of suicide than males, which we presume is closely linked with their social development status 15 years ago. On the one hand, large-scale migrations of young rural male labor to developed regions drastically changed the original family structure; females needed to bear the pressure of both productive life and education of their children when the adult male labor force was outside the home. On the other hand, although the Chinese government had done much to reduce the unequal treatment of women, traditional patriarchal rules and feudal ideologies still perpetuated discrimination against women at that time (Ji et al., 2001; Qin & Mortensen, 2001; Zhao, 2020). Moreover, the pressures of productive life and long-term gender discrimination make rural women suffer great psychological strain, eventually ending their lives due to lack of adequate coping skills. We also see a positive impact of education on reducing suicide risk, probably resulting from the important role that education plays in improving individuals’ knowledge of coping skills. Adolescents and young adults in rural China who received higher education were better trained in coping skills and, thus, were able to positively adjust to their relative deprivation perceptions to reduce suicide risk. To some extent, encouraging higher education and providing job training can improve people’s self-cognition, better understand the meaning of success, and also reduce the individual’s deprivation pressures due to their social value aspirations, so as to improve their coping strategies (Zhao & Zhang, 2015).
Limitations and Implications
The innovation of this study is that we chose a large psychological autopsy study to investigate the effect of relative deprivation on suicide risk, and unlike previous epidemiological or sociological perspectives, we considered the perspective of social psychology to interpret the mechanism between relative deprivation, depression, and suicide risk. This study successfully supported the hypothesis that relative poverty may lead to depression, and thus, influence suicidal behavior. Therefore, this study argues that improving the living conditions of the poor and reducing economic polarization within communities may be an effective way to reduce mental disorders (including major depression) and avoid the risk of suicide.
This study has the following limitations. First, while we found a significant correlation between depression and relative deprivation, we did not generate a causal relationship. The endogenous question of whether depression enhances individuals’ sense of relative deprivation and thus induces suicide risk or whether depression is influenced by relative deprivation remains to be addressed in subsequent studies. Second, due to the considerable costs associated with such psychological autopsy investigations, the available sample size was very limited and the research was difficult to sustain, making our conclusions solely reflect the relationship between suicide risk and relative deprivation in some rural areas of China more than a decade ago. Despite these limitations, our new findings on the theoretical mechanisms of relative deprivation influencing suicide may help other countries better understand the causes of suicide to make early predictions and interventions in response to the risk of suicide.
Further Exploration
Along with the process of rural revitalization and agricultural modernization in the past decade, the implementation of a financial inclusion strategy greatly enhances the conditions of disadvantaged groups in terms of employment, income, and education (Kim et al., 2018). This narrowing of the socioeconomic status gap among members within the same community has greatly reduced the sense of relative deprivation of the original vulnerable groups (Huang & Zhang, 2020). Previous studies have shown that suicide rates are significantly and negatively correlated with economic development and population mobility (Zhang et al., 2010b, 2014). Looking across the 40-year history of reform and opening-up development, the environmental conditions and quality of life in which rural people live have exceeded their past expectations, greatly reducing individuals’ perceptions of relative deprivation and even eliminating the pressure to commit suicide, thus decreasing the overall suicide rate in China.
At the same time, the status of women in the family has greatly improved over the past decades. In terms of gender distribution, female suicide rates are significantly lower, and in some areas, male suicide rates are higher than female suicide rates (Zhang et al., 2014). There is a lack of further discussion on the relationship between gender, marital status, and suicide risk among people with relative deprivation. It is not clear whether some new issues emerging from urbanization and industrialization will have new implications for the relationship between relative deprivation and suicide. All the above research questions can be further explored in future studies.
Footnotes
Author Contributions
No conflict of interest exits in the submission of this manuscript, and manuscript is approved by all authors for publication. I would like to declare on behalf of my co-authors that the work described was original research that has not been published previously.
Acknowledgments
This research was supported by a grant of US NIMH: R01 MH068560. We thank our research collaborators in Liaoning, Hunan, and Shandong provinces of China.
Ethical Approval
The study protocol was approved by the Institutional Review Board of the State University of New York College at Buffalo, as well as by three institutions (Central South University, Hunan; Provincial Centre for Disease Prevention and Control, Liaoning; and Shandong University, Shandong) in China where data collection was conducted.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute of Mental Health (R01 MH068560), and Beijing Municipal Social Science Foundation (19SRC013).
