Rural-Urban Differences in the Association between Social Capital and Suicidal Ideation Among the Older Adults in Anhui, China

Background: Social capital has been found to be associated with lower risk of suicidal ideation in the West. However, there is limited empirical research on social capital and suicidal ideation in China, especially among older adults. Meanwhile, around 60% of older individuals live in rural areas in China. Additionally, China’s unique socioeconomic and political structures in rural and urban regions could affect the level of social capital and its relationship with suicidal ideation. Therefore, this study aims at clarifying the differences in the association between social capital and suicidal ideation among older people in rural and urban communities in China. This study got IRB approval from the Biomedical Ethics Committee of Anhui Medical University, China.

Methods: A cross-sectional in-person survey was conducted among the older adults aged 60 years and above in Anhui, China, in 2013. The participants were selected through cluster random sampling. Firstly, one county was selected using a computer-based random selection procedure from the complete lists of counties in the four geographically distinct regions in Anhui Province. Next, one urban and one rural community were selected randomly from each of the selected counties. Overall, 3,452 eligible older adults were recruited, and 3,010 individuals were included in final analysis.

Suicidal ideation was measured by a question: have you ever seriously considered suicide in the last 12 months? The measurement of social capital was adapted from the Word Bank’s Social Capital Assessment Tool and previous studies which covers the five main aspects: social participation, trust, social connection, reciprocity, and a sense of community belonging. The validity and reliability of the social capital questionnaire, as well as its scoring methods was described by Wang (2013). Demographic information were also collected as control variables. The binary logistic regression was used to explore the impact of social capital on suicidal ideation.

Results: The prevalence of suicidal ideation was significantly higher in rural respondents (7.1%) than that in urban respondents (3.4%). Participants in rural areas tend to have higher levels of reciprocity, social connection, trust, and a sense of community belonging than in urban areas (69.0% vs. 61.9%, 53.4% vs.38.6%, 39.2% vs. 33.6%,76.4% vs.71.3%, respectively). After controlling age, gender, education, GHQ-12, adverse life events, and living regions, the logistic regression results  showed  that lower level of reciprocity was associated with a greater likelihood of having suicidal ideation in rural areas (odds ratio [OR]=2.0, 95% CI=1.3 to 3.1), whereas no significant association between reciprocity and suicidal ideation was found in urban respondents. The other components of social capital had no association with suicidal ideation no matter in urban or rural areas. 

Implications and Conclusions: The findings indicated that rural participants have higher level of social capital than urban participants and social capital had significant impact on older adults in rural regions, but not in urban regions. This study calls for more efforts on the suicidal prevention in rural regions and more interventions aims at maintaining or rebuilding social capital for the older adults in rural China.