The central findings are that all four types of strain are associated with suicide, although the association for the value strain is not significantly observed in the multiple regression model. The aspiration strain, deprivation strain, and coping strain are all strong predictors of suicide even after controlling for psychiatric diagnosis, age, education, and religion. Strain is a psychological frustration resulting from at least two conflicting stressors. A single stressor does not necessarily lead to frustration, such as absolute poverty, high expectation for future, a personal crisis, and an extreme cultural value. Frustration or strain occurs only if the stressor confronts a competing stressor.
When everyone is living in poverty, poverty is not a stressor. With everything else being held equal, a person's miserable living condition is perceived in relation to others, and the person feels frustrated. Relative poverty or deprivation may be objectively measured, but must be subjectively perceived by the individual who is at suicide risk. Agnew (1992)
derived much of his strain theory from the justice literature and linked the psychological frustration resulting from the perceived injustice to deviant behaviors.
High aspiration for future can also become frustration and strain if the reality does not allow the individual to move to or to reach the goal the individual aspired. We divided the subjects who had an aspiration into those who realized their wishes and those who did not realize their wishes and confirmed that a failed aspiration is a strain that leads to suicide. For the suicides in the current sample, the top four failed aspirations were (1) making more money, (2) harmonious family, (3) love and marriage, and (4) job security. Most people should have experienced a crisis in life, but few people in crisis situation were so frustrated as to kill themselves.
Only those who do not have a coping ability become extremely frustrated and seek death as a solution to solve the problems inflicted by the crisis. We measured the coping skills with a standardized instrument and confirmed that those individuals who have better coping skills have lower suicide risk.
Mental illness is a mediator in Chinese suicide. Psychological strains increased the level of mental illness, and mental illness then increased the risk of suicide. However, approximately half of the Chinese suicides in this study were not diagnosed with any psychiatric problems. Psychological strain by itself can also be a strong predictor of suicide in Chinese culture.
The effect of religion/religiosity is reversed in the Chinese culture -- it tends to be detrimental for Chinese rural young people in terms of suicidality. Because of beliefs and social integration, sociologists since Durkheim have argued that religion protected people from suicide (Stack, 2000
). Previous studies noted suicide rates are lower in religious countries than in the secular ones (Breault, 1986
; Stack, 1983
) and low religiosity is associated with suicidal ideation, as well as suicidal behaviors (Cook, Pearson, Thompson, Black, & Rabins, 2002
), although no studies have established an association between specific religious denomination (i.e., Catholic versus Protestant) and suicidal behavior (Dervic et al., 2004
). In China, Buddhism and Taoism, foundations of traditional Chinese culture, are different from Western religions in terms of supernatural being, afterlife, rituals, and organization (Zhang & Xu, 2007
). In Chinese religions, there is not a single God to worship, and there is a lack of social support system and coping mechanisms, as the majority of the religious people do not meet regularly. Compared with an institutionalized religion, social interaction and social support are absent in private worships (Pescosolido & Georgiana, 1989
). Different from all the mainstream religions in the West, Chinese religions are often associated with superstition as the saying of zongjiao mixin
(religious superstition). To some Chinese individuals, being religious is equivalent to being superstitious, and death is a solution to all the problems and the beginning of a new life (incarnation). Therefore, it is possible that those who take religion to the extreme are likely to think about starting a new life by ending this current one quickly.
We should also understand the finding that religiosity is related to Chinese suicide, in line with the strain theory of suicide. As an atheist country, China now has less than 10 percent of its population claiming themselves religious, and this percentage has reflected the rapid growth in the past 30 or so years since China opened its door to the West (Badham, 2008
; Yao & Badham, 2008
). Church and prayer are still considered to be deviant to the majority of the Chinese (Zhang, et al., 2010
). Additionally, those churchgoers in China may also experience the psychological frustration caused by their religious beliefs that conflict with the mainstream culture in the larger society. The value conflict strain increases when the two conflicting values are both internalized in an individual. In sum, three differences between the Western and Chinese religious practices account for the different effects of religion on suicidality between the two cultures: (1) the lower level of institutionalization of religions in China offers less social support to believers than in the West; (2) the Buddhist incarnation may encourage the superstitious believers to gloriously end their own life; (3) the Chinese religious believers are treated as a minority group, both due to its small percentage and political disadvantage. Value strains can be experienced between the main stream values in society and their subcultural values.
Psychological strains are presumed to be the up-stream reason that leads to both mental problem and suicidality. Further studies in various populations and more sophisticated measures should be conducted to improve and refine this strain theory of suicide, as this knowledge may be critical for reducing suicides at all three levels of prevention. For first degree prevention (universal), the government needs to carry out and reinforce the policies that help reduce economic polarizations in society so as to bring down certain individuals' anger and frustration caused by the aspiration strain, as well as the relative deprivation strain. At the behavioral level, efforts to reduce strain include increasing coping skills through early childhood education interventions. For second degree prevention (selective), for support reasons, we need to identify individuals who are outliers socially in a village or community (relatively poorer than their peers), and social welfare systems should work for those people in need. For third degree prevention (indicated), we have to develop some psychological counseling strategies (strain reduction through cognitive therapy) to care those individuals at the suicidal edge, or screen and refer for treatment people who develop mental illness.
One unique contribution of this study to sociological research of suicide is that it employed a rare blend between psychiatric and social predictors of suicide, where the Chinese version of the SCID was administered to measure psychiatric disorders of both suicides and living controls. The study shows that social factors influence suicide risk independent of the dominant risk factor for suicide, psychiatric illness. Further, the strain theory is first tested in Chinese culture. Hopefully, the present paper will stimulate work in other cultures to test the strain theory of suicide and in a variety of fields beyond just suicide studies.
One limitation of the study is the measurement through the psychological autopsy process. People could question the validity of the responses from proxy informants on behalf of the target persons. It may be difficult, if not impossible, for a proxy to understand the psychological process of a suicide. Recall bias could be another concern. It is noted that, for aspiration strain, family members of the suicide could be more likely to report that the wish of the deceased was not fulfilled to justify the suicidal incident. Another weakness of the proxy method is shown in the measure of value conflicts of the suicides. This may account for the insignificant fit of value conflicts strain in the comprehensive model predicting Chinese rural youth suicide. Future studies may interview suicide attempters to directly obtain the information for the targets' personal values. Nonetheless, psychological autopsy may be the only cost-effective way to assess the background and experiences of the deceased before the suicide incident (Hawton et al., 1998