Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Estimating the role of air quality improvements in the decline of suicide rates in China

Nature Sustainability volume 7, pages 260–269 (2024)Cite this article

Subjects

Abstract

Emerging evidence suggests that air pollution may play a role in shaping suicide risk by altering brain function. However, this link is difficult to quantify and has yet to be investigated in China, where 16% of global suicides occur. Here we apply a statistical model that leverages random increases in particulate pollution (PM2.5) due to meteorological conditions to comprehensive data on suicide rates across Chinese counties. We find that a 1 s.d. (σ) increase in PM2.5 raises weekly suicide rates by ∼25%. This effect occurs without delay, consistent with neurobiological evidence that PM2.5 influences emotional regulation and impulsive–aggressive behaviour. Effects are sex and age specific; women over 65 exhibit significantly higher vulnerability. We estimate that PM2.5 reductions under China’s Air Pollution Action Plan prevented 13,000–79,000 (95% confidence interval) suicides over 2013–2017, accounting for ∼10% of this period’s observed suicide rate decline. Our findings uncover a causal link between particulate pollution and suicide, adding urgency to calls for pollution control policies across the globe.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Air pollution and suicide rates in China have declined substantially in recent years.
Fig. 2: Estimated effects of air pollution on suicide rates in China.
Fig. 3: Prevented suicides attributable to recent pollution declines.

Similar content being viewed by others

Data availability

Station-level air pollution data are publicly available through the CNEMC (http://www.cnemc.cn/en/). Cleaned and processed air pollution data used in this analysis are hosted publicly on Zenodo (https://doi.org/10.5281/zenodo.10433249). Weather data are provided under restricted access from the China Meteorological Data Service Center; researchers can apply for access to these data at https://data.cma.cn/data/cdcdetail/dataCode/A.0012.0001.S011.html. Suicide data are confidential and were obtained with permission directly from the CCDC. The basemaps used in Figs. 1b and 3a and Extended Data Fig. 1b are from https://www.resdc.cn/?aspxerrorpath=/DOI,2023.DOI:10.12078/2023010101; researchers can apply for access at the same link.

Code availability

All code necessary to replicate the analysis is provided in a public GitHub repository available at https://github.com/tcarleton/suicide-pm (ref. 62).

References

  1. Suicide Worldwide in 2019: Global Health Estimates (World Health Organization, 2021); https://www.who.int/publications/i/item/9789240026643

  2. Turecki, G. et al. Suicide and suicide risk. Nat. Rev. Dis. Primers 5, 74 (2019).

    Article  PubMed  Google Scholar 

  3. Khan, M. M. Suicide prevention and developing countries. J. R. Soc. Med. 98, 459–463 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cai, Z., Chen, M., Ye, P. & Yip, P. S. F. Socio-economic determinants of suicide rates in transforming China: a spatial-temporal analysis from 1990 to 2015. Lancet Reg. Health West. Pac. 19, 100341 (2022).

    Article  PubMed  Google Scholar 

  5. Zhang, J., Lyu, J., Sun, W. & Wang, L. Changes and explanations of suicide rates in China by province and gender over the past three decades. J. Affect. Disord. 299, 470–474 (2022).

    Article  PubMed  Google Scholar 

  6. Yin, H., Xu, L., Shao, Y., Li, L. & Wan, C. Relationship between suicide rate and economic growth and stock market in the People’s Republic of China: 2004–2013. Neuropsychiatr. Dis. Treat. 12, 3119–3128 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zhang, J., Conwell, Y., Zhou, L. & Jiang, C. Culture, risk factors and suicide in rural China: a psychological autopsy case control study. Acta Psychiatr. Scand. 110, 430–437 (2004).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Law, S. & Liu, P. Suicide in China: unique demographic patterns and relationship to depressive disorder. Curr. Psychiatry Rep. 10, 80–86 (2008).

    Article  PubMed  Google Scholar 

  9. Zhong, B.-L., Chiu, H. F. K. & Conwell, Y. Elderly suicide trends in the context of transforming China, 1987-2014. Sci. Rep. 6, 37724 (2016).

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  10. Page, A. et al. Suicide by pesticide poisoning remains a priority for suicide prevention in China: analysis of national mortality trends 2006–2013. J. Affect. Disord. 208, 418–423 (2017).

    Article  PubMed  Google Scholar 

  11. Nisar, A. et al. Prevalence of perinatal depression and its determinants in mainland China: a systematic review and meta-analysis. J. Affect. Disord. 277, 1022–1037 (2020).

    Article  PubMed  Google Scholar 

  12. Li, Y., Li, Y. & Cao, J. Factors associated with suicidal behaviors in mainland China: a meta-analysis. BMC Public Health 12, 524 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Davoudi, M. et al. Association of suicide with short-term exposure to air pollution at different lag times: a systematic review and meta-analysis. Sci. Total Environ. 771, 144882 (2021).

    Article  ADS  CAS  PubMed  Google Scholar 

  14. Heo, S., Lee, W. & Bell, M. L. Suicide and associations with air pollution and ambient temperature: a systematic review and meta-analysis. Int. J. Environ. Res. Public Health 18, 7699 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Braithwaite, I., Zhang, S., Kirkbride, J. B., Osborn, D. P. J. & Hayes, J. F. Air pollution (particulate matter) exposure and associations with depression, anxiety, bipolar, psychosis and suicide risk: a systematic review and meta-analysis. Environ. Health Perspect. 127, 126002 (2019).

  16. Kim, C. et al. Ambient particulate matter as a risk factor for suicide. Am. J. Psychiatry 167, 1100–1107 (2010).

    Article  PubMed  Google Scholar 

  17. Kim, Y. et al. Air pollution and suicide in 10 cities in northeast Asia: a time-stratified case-crossover analysis. Environ. Health Perspect. 126, 037002 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lin, G.-Z. et al. The impact of ambient air pollution on suicide mortality: a case-crossover study in Guangzhou, China. Environ. Health 15, 90 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ragguett, R.-M. et al. Air pollution, aeroallergens and suicidality: a review of the effects of air pollution and aeroallergens on suicidal behavior and an exploration of possible mechanisms. Rev. Environ. Health 32, 343–359 (2017).

    Article  CAS  PubMed  Google Scholar 

  20. Pandey, G. N. Biological basis of suicide and suicidal behavior. Bipolar Disord. 15, 524–541 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Brunekreef, B. & Holgate, S. T. Air pollution and health. Lancet 360, 1233–1242 (2002).

    Article  CAS  PubMed  Google Scholar 

  22. Filik, R. et al. The cardiovascular and respiratory health of people with schizophrenia. Acta Psychiatr. Scand. 113, 298–305 (2006).

    Article  CAS  PubMed  Google Scholar 

  23. Collins, E., Tranter, S. & Irvine, F. The physical health of the seriously mentally ill: an overview of the literature. J. Psychiatr. Mental Health Nurs. 19, 638–646 (2012).

    Article  CAS  Google Scholar 

  24. Fu, S., Viard, V. B. & Zhang, P. Air pollution and manufacturing firm productivity: nationwide estimates for China. Econ. J. 131, 3241–3273 (2021).

    Article  Google Scholar 

  25. Graff Zivin, J. & Neidell, M. The impact of pollution on worker productivity. Am. Econ. Rev. 102, 3652–3673 (2012).

    Article  Google Scholar 

  26. Carleton, T. A. Crop-damaging temperatures increase suicide rates in India. Proc. Natl Acad. Sci. USA 114, 8746–8751 (2017).

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  27. Bakian, A. V. et al. Acute air pollution exposure and risk of suicide completion. Am. J. Epidemiol. 181, 295–303 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  28. Astudillo-García, C. I., Rodríguez-Villamizar, L. A., Cortez-Lugo, M., Cruz-De la Cruz, J. C. & Fernández-Niño, J. A. Air pollution and suicide in Mexico City: a time series analysis, 2000–2016. Int. J. Environ. Res. Public Health 16, 2971 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lee, H., Myung, W., Kim, S. E., Kim, D. K. & Kim, H. Ambient air pollution and completed suicide in 26 South Korean cities: effect modification by demographic and socioeconomic factors. Sci. Total Environ. 639, 944–951 (2018).

    Article  ADS  CAS  PubMed  Google Scholar 

  30. Ng, C. F. S., Stickley, A., Konishi, S. & Watanabe, C. Ambient air pollution and suicide in Tokyo, 2001–2011. J. Affect. Disord. 201, 194–202 (2016).

    Article  CAS  PubMed  Google Scholar 

  31. Casas, L. et al. Does air pollution trigger suicide? A case-crossover analysis of suicide deaths over the life span. Eur. J. Epidemiol. 32, 973–981 (2017).

    Article  CAS  PubMed  Google Scholar 

  32. Maclure, M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am. J. Epidemiol. 133, 144–153 (1991).

    Article  CAS  PubMed  Google Scholar 

  33. Jacobson, M. Z. Atmospheric Pollution: History, Science, and Regulation (Cambridge Univ. Press, 2002).

  34. Arceo, E., Hanna, R. & Oliva, P. Does the effect of pollution on infant mortality differ between developing and developed countries? Evidence from Mexico City. Econ. J. 126, 257–280 (2016).

    Article  Google Scholar 

  35. Chen, S., Oliva, P. & Zhang, P. The effect of air pollution on migration: evidence from China. J. Dev. Econ. 156, 102833 (2022).

    Article  Google Scholar 

  36. Anderson, T. W. & Rubin, H. Estimation of the parameters of a single equation in a complete system of stochastic equations. Ann. Math. Stat. 20, 46–63 (1949).

    Article  MathSciNet  Google Scholar 

  37. Stock, J. H. & Wright, J. H. GMM with weak identification. Econometrica 68, 1055–1096 (2000).

    Article  MathSciNet  Google Scholar 

  38. Deryugina, T., Heutel, G., Miller, N. H., Molitor, D. & Reif, J. The mortality and medical costs of air pollution: evidence from changes in wind direction. Am. Econ. Rev. 109, 4178–4219 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Lin, W. & Wooldridge, J. M. in Panel Data Econometrics (ed. Tsionas, M.) 21–43 (Elsevier, 2019).

  40. Dominski, F. H. et al. Effects of air pollution on health: a mapping review of systematic reviews and meta-analyses. Environ. Res. 201, 111487 (2021).

    Article  CAS  PubMed  Google Scholar 

  41. Kim, C. S. & Hu, S. C. Regional deposition of inhaled particles in human lungs: comparison between men and women. J. Appl. Physiol. 84, 1834–1844 (1998).

    Article  CAS  PubMed  Google Scholar 

  42. Clougherty, J. E. A growing role for gender analysis in air pollution epidemiology. Environ. Health Perspect. 118, 167–176 (2010).

    Article  CAS  PubMed  Google Scholar 

  43. Bishop, K. C., Ketcham, J. D. & Kuminoff, N. V. Hazed and confused: the effect of air pollution on dementia. Rev. Econ. Stud. https://doi.org/10.1093/restud/rdac078 (2022).

  44. Wang, X. et al. Association of improved air quality with lower dementia risk in older women. Proc. Natl Acad. Sci. USA 119, e2107833119 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Zucca, M. et al. High risk of suicide in behavioral variant frontotemporal dementia. Am. J. Alzheimers Dis. Other Demen. 34, 265–271 (2019).

    Article  PubMed  Google Scholar 

  46. Chen, J.-C. et al. Ambient air pollution and neurotoxicity on brain structure: evidence from women’s health initiative memory study. Ann. Neurol. 78, 466–476 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  47. Phillips, M. R., Li, X. & Zhang, Y. Suicide rates in China, 1995–99. Lancet 359, 835–840 (2002).

    Article  PubMed  Google Scholar 

  48. Kim, Y. et al. Association between air pollution and suicide in South Korea: a nationwide study. PloS ONE 10, e0117929 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  49. Biermann, T. et al. The hypothesis of an impact of ozone on the occurrence of completed and attempted suicides. Med. Hypotheses 72, 338–341 (2009).

    Article  CAS  PubMed  Google Scholar 

  50. Aguilar-Gomez, S., Dwyer, H., Graff Zivin, J. & Neidell, M. This is air: the “nonhealth” effects of air pollution. Ann. Rev. Resour. Econ. 14, 403–425 (2022).

    Article  Google Scholar 

  51. Wei, H. et al. Role of oxidative stress and DNA hydroxymethylation in the neurotoxicity of fine particulate matter. Toxicology 380, 94–103 (2017).

    Article  CAS  PubMed  Google Scholar 

  52. Gładka, A., Rymaszewska, J. & Zatoński, T. Impact of air pollution on depression and suicide. Int. J. Occup. Med. Environ. Health 31, 711–721 (2018).

    PubMed  Google Scholar 

  53. Fiske, A., O’Riley, A. A. & Widoe, R. K. Physical health and suicide in late life: an evaluative review. Clin. Gerontol. 31, 31–50 (2008).

    Article  Google Scholar 

  54. Wooldridge, J. M. Econometric Analysis of Cross Section and Panel Data (MIT Press, 2010).

  55. Greenstone, M., He, G., Li, S. & Zou, E. Y. China’s war on pollution: evidence from the first 5 years. Rev. Environ. Econ. Policy 15, 281–299 (2021).

    Article  Google Scholar 

  56. Ma, Z., Liu, R., Liu, Y. & Bi, J. Effects of air pollution control policies on PM2.5 pollution improvement in China from 2005 to 2017: a satellite-based perspective. Atmos. Chem. Phys. 19, 6861–6877 (2019).

    Article  ADS  CAS  Google Scholar 

  57. Zhao, P. & Yu, Z. Investigating mobility in rural areas of China: features, equity, and factors. Transp. Policy 94, 66–77 (2020).

    Article  Google Scholar 

  58. Pigeon, W. R., Pinquart, M. & Conner, K. Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J. Clin. Psychiatry 73, 11734 (2012).

    Article  Google Scholar 

  59. Bento, A. M., Miller, N., Mookerjee, M. & Severnini, E. A unifying approach to measuring climate change impacts and adaptation. J. Environ. Econ. Manag. 121, 102843 (2023).

    Article  Google Scholar 

  60. Andrews, I., Stock, J. H. & Sun, L. Weak instruments in instrumental variables regression: theory and practice. Ann. Rev. Econ. 11, 727–753 (2019).

    Article  Google Scholar 

  61. Wang, Y. & Liang, X. The Dataset on Disease Surveillance Point of China (Military Medical Science Press, 2011).

  62. Carleton, T. & Zhang, P. suicide-pm. GitHub https://github.com/tcarleton/suicide-pm (2023).

Download references

Acknowledgements

We thank B. Sun, J. Rico-Straffon and T. Mangin for excellent research assistance. We thank J. Proctor and participants of the London School of Economics Environment Week conference, the University of Delaware School of Marine Science & Policy seminar series and the Bren School of Environmental Science & Management seminar at the University of California, Santa Barbara for comments and suggestions. P.Z. acknowledges support from the National Natural Science Foundation of China (grant number 72203193) and Natural Science Foundation of Guangdong Province, China (grant number 2023B1515020065).

Author information

Author notes

  1. These authors contributed equally: Peng Zhang, Tamma Carleton.

Authors and Affiliations

  1. School of Management and Economics, The Chinese University of Hong Kong, Shenzhen, China

    Peng Zhang

  2. Shenzhen Finance Institute, Shenzhen, China

    Peng Zhang

  3. Bren School of Environmental Science and Management, University of California, Santa Barbara, Santa Barbara, CA, USA

    Tamma Carleton

  4. National Bureau of Economic Research, Cambridge, MA, USA

    Tamma Carleton

  5. School of Economics, Shanghai University of Finance and Economics, Shanghai, China

    Liguo Lin

  6. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

    Maigeng Zhou

Authors
  1. Peng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamma Carleton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liguo Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maigeng Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

P.Z. and T.C. conceptualized the study. P.Z., L.L. and M.Z. obtained and processed the data. P.Z. and T.C. conducted data analysis. T.C. designed and made display items. T.C. wrote the paper and P.Z. edited the paper.

Corresponding authors

Correspondence to Tamma Carleton, Liguo Lin or Maigeng Zhou.

Ethics declarations

Competing interests

The authors declare no competing interests.

Peer review

Peer review information

Nature Sustainability thanks the anonymous reviewers for their contribution to the peer review of this work.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Extended data

Extended Data Fig. 1 Suicide data from the Chinese Center for Disease Control and Prevention Disease Surveillance Point (DSP) system.

a, Population-weighted average weekly suicide rate per 1 million population for males (black) and females (green) across weeks of the sample (‘w1’ indicates the first week of the year). Spring months (April, May, and June) are shaded in grey each year. b, Map of the 597 nationally representative counties for which suicide data are available through the DSP system. Basemap in b for 2015 from the Chinese Resource and Environmental Science Data Registration and Publishing System (https://www.resdc.cn/?aspxerrorpath=/DOI,2023.DOI:10.12078/2023010101).

Extended Data Table 1 Summary statistics
Full size table
Extended Data Table 2 Impact of thermal inversions on PM2.5
Full size table
Extended Data Table 3 Comparison of two-way fixed effects to instrumental variables
Full size table
Extended Data Table 4 Robustness of main specification to definition of instrumental variable
Full size table
Extended Data Table 5 Robustness of main specification to spatio-temporal controls
Full size table
Extended Data Table 6 Robustness of main specification to weather controls
Full size table
Extended Data Table 7 Robustness of main specification to clustering of standard errors
Full size table
Extended Data Table 8 Lagged effects of thermal inversions on suicide rates
Full size table

Supplementary information

Supplementary Information

Supplementary Notes 1 and 2, Tables 1–3 and references.

Reporting Summary

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, P., Carleton, T., Lin, L. et al. Estimating the role of air quality improvements in the decline of suicide rates in China. Nat Sustain 7, 260–269 (2024). https://doi.org/10.1038/s41893-024-01281-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41893-024-01281-2

Search

Advanced search

Quick links

Nature Briefing Anthropocene

Sign up for the Nature Briefing: Anthropocene newsletter — what matters in anthropocene research, free to your inbox weekly.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing: Anthropocene