Age-varying associations between attitudes toward suicide and suicidal ideation in Chinese psychiatric outpatients

Attitudes toward suicide hold clinical value as indirect indicators of suicide risk in psychiatric outpatients, yet these attitudes are culturally sensitive. Within China's ongoing shift from traditional death taboos and collectivism toward more diversified sociocultural context, examining generational differences in such attitudes and their links to suicidal ideation (SI) can enhance their clinical application. However, no prior study has explored how attitudes toward suicide and their associations with passive and active SI (PSI and ASI) vary by age among in Chinese context.

This study included 4737 Chinese outpatients (70.5% female; M_age = 23.22, SD = 11.96). We assessed age differences in four attitudes toward suicidal behaviors, suicidal individuals, family members, and euthanasia. Using time-varying effect modeling and network tree analyses, we then examined their age-varying associations with PSI and ASI from variable-centered and person-centered perspectives, respectively.

Attitudes toward suicide tended to be more conservative with increasing age among participants. Accepting attitudes toward suicidal behaviors were positively associated with both PSI and ASI across most ages. Compassionate attitudes toward family members were negatively associated with both types of SI in young and middle-aged adults. Accepting attitudes toward euthanasia were positively associated with PSI and ASI from adolescence through middle adulthood. However, attitudes toward the suicidal individuals consistently showed no association with SI.

Preliminary evidence from this cross-sectional study suggests age-specific associations between attitudes toward and suicidal ideation in Chinese psychiatric outpatients. Further longitudinal research is needed to determine whether addressing these attitudes could inform risk assessment.