More elderly people giving up on lifeChina's overall suicide rate might have plunged dramatically, but the number of elderly people taking their own lives could be rising.
Last month, a six-year study by Wuhan University covering villages in 11 provinces provoked much hand-wringing about "moral decay" in China's society.
Led by sociologist Liu Yanwu, the researchers found heartrending story after heartrending story of elderly suicide in the face of indifference and neglect by their children. Many had been left behind when their children moved to the cities to work.
One sick man from Jingshan county in Hubei province was asked by his son, who had taken leave to return to their village, when he was going to die.
"I have taken only seven days' leave from work to settle your funeral rites," the son told the old man, according to Dr Liu. The old man swallowed pesticide.
In his study, which covered 40,000 rural Chinese in 34 villages, Dr Liu found that the suicide rate among the elderly jumped from 100 per 100,000 persons in 1980 to 500 per 100,000 persons in 2009.
Urbanisation has also changed the power dynamic in families, he found.
"In 1980, when there was conflict, the daughter-in-law committed suicide. Now, the mother-in-law does," he noted.
Most elderly suicides took place after a stroke or a major illness. The lack of adequate medical care and their desire not to become a burden to their children prompted their actions, say researchers.
In Donghao village in northern Hebei province, the 72-year-old father of Madam Ou Zhenping committed suicide in the late 1980s after he suffered a stroke and gradually lost his mobility.
One day, he hauled himself to a corner of the house where pesticide was kept and swallowed some.
"We didn't take care of him well. Sometimes, he would lie there for a long time after soiling himself," Madam Ou, now 58, recalled.
"We didn't know how to take care of him, and we were also busy working," she added.
Dr Liu has drawn criticism from those who believe that such things belong in the past. They say that his study focused on only the poorer, more backward provinces, and that the 604 suicides covered did not give a representative picture of elderly suicide.
Still, the larger-scale Hong Kong University study that showed an overall drop in China's suicide rate has also flagged a rise in suicides among the elderly since 2008. For rural men aged 70 to 74, the study found a rate of 41.7 per 100,000 persons - over four times the national figure of 9.8.
Moreover, experts and volunteers say, not enough attention is being paid to the plight of lonely senior citizens who live in China's cities. Even though they are better off financially, they lack social and psychological support groups.
Madam Xu Kun, founder of Love Delivery Hotline, a non-governmental organisation (NGO) that supports troubled seniors, says she often meets older women who are depressed because their husbands died or left them for a younger woman.
Take Beijinger Madam Jiang, 68. The mother of one, who did not want her full name published, said she could hear her then husband carrying on with prostitutes, even from her side of their divided courtyard home. They divorced after she caught him having sex with their housekeeper.
Madam Jiang called the hotline after seeing it advertised on television. Now, eight years later, she is a volunteer at Love Delivery.
Early this year, she rushed to the home of an elderly man who had called the hotline. His wife had just died and he was thinking of suicide.
Madam Jiang and some friends made dumplings with him to eat as it was Chinese New Year.
"I've been there and I know what they are going through," she said. "That's why I can help them."
One in four Chinese will be at least 65 years old by 2050.
Madam Xu said support groups like Love Delivery are all too rare. The NGO is trying to get demographic data from the Beijing municipal government, so that volunteers can identify senior citizens at risk and help organise programmes in neighbourhoods where the elderly are concentrated. But its efforts have hit a roadblock.
"I cannot get the data from them because they are suspicious of what we want to do with it," said Madam Xu. "This is the attitude that the government has towards groups like ours."
As growth dips, will suicides rise?Many in China are keeping a watchful eye as money gets tight
By Rachel Chang Donghao (Hebei)
Madam Li Suxiang was 28 and a mother of two when she waded into the water at Beidaihe beach in northern Hebei province and tried to kill herself.
When asked what was going through her mind at that time, she said as she teared up: "My children wanted ice cream. And I couldn't afford to buy any."
Recalling her despair, Madam Li, now 48 with a four-year-old grandson, added:"We were too poor. Life was too hard. I just didn't want to live."
A street vendor pulled her out of the water, saving her from becoming a statistic - at that time, according to the World Health Organisation, a young rural woman committed suicide every four minutes.
For months afterwards, Madam Li's family kept a close watch on her. She remembers the years passing by in a depressed fog. But slowly, as China opened up, her village of Donghao began to change - and so did her life.
About seven years after her suicide attempt, her husband bought a lorry with money borrowed from relatives and they started travelling from village to village to sell clothing that she bought at wholesale prices.
By the mid-noughties, they were making up to 2,000 yuan (S$407) a day. They built a house and bought a DVD player. The children could have ice cream whenever they wanted.
As the people's lives improved in Donghao, which has a population of 2,600, the number of suicides declined. In the 1980s and 1990s, according to village elders, there were at least 25 suicides, by mostly young women and the old and infirm. There were almost none over the past decade.
The story of Donghao and villagers like Madam Li is a common one in China.
It is an astounding and unprecedented turnaround for a country that once had one of the world's highest suicide rates, with young women making up an abnormally large proportion of victims.
In a study published late last year, researchers from Hong Kong University's Centre for Suicide Research and Prevention found that between 2009 and 2011, China's average suicide rate was 9.8 per 100,000 persons.
This is lower than Singapore's, which was 10.3 in 2012, and far lower than the 31 in South Korea and 24 in Japan.
Suicides across all demographic groups in China have fallen since the late 1990s, when it was a shocking 23.2 per 100,000 persons, according to a 2002 study published in the Lancet medical journal.
In particular, the suicide rate among young women in rural China was 37.8 per 100,000 persons, or double that for young men - a gender imbalance in contrast to the global norm.
The turnaround, say researchers, is thanks largely to economic development and the opening up of China's rural areas.
Gaige kaifang (reform and opening up) literally gave rural young women a new lease of life. Leaving the village to work in the city provided them with an escape from stifling marriages or overbearing mothers-in-law, and also financial independence.
It also meant they could not lay their hands on pesticide - the poison of choice in over 60 per cent of all rural suicides in the late 1990s.
The immediate impact of economic improvement on suicide rates is due to the fact that many suicides in China were impulsive acts and not linked to mental illness, said sociologist Zhang Jie of the Buffalo State University of New York.
In a 2010 study of 392 suicides in China's rural areas, Dr Zhang found that more than half took place after family fights or because of economic setbacks. This ran counter to the norm in developed countries in the West, where mental illness is a factor in 90 per cent of suicides.
The findings showed that many suicides in China were the result of "psychological strain", Dr Zhang said, which is "the discrepancy between people's aspirations and their reality".
But after reform and opening up, everything developed so fast that the people did not have psychological strain.
"Women had the freedom to go anywhere, they were not tied to unhappy marriages. A lot of things happened that Chinese people did not expect. Housing, cars, food - it all developed faster than their expectations," he noted.
Opening up also allowed new ideas and trends to spread to the villages.
In 2004, for example, the Beijing Cultural Development Centre for Rural Women, a non-governmental organisation (NGO), sent representatives to speak to Donghao women about self-reliance, psychological coping methods and conflict management.
It resonated with 54-year-old Li Guimin, who tried to drink pesticide in the late 1980s but was stopped by her father-in-law just in time.
She had been scolded by her husband for making a mistake when cutting a sheet of glass for a customer's windows.
"My husband didn't know how to cut glass, I did. I was the one doing all the work and yet always being blamed," she recalled.
The Beijing NGO's classes taught her how to communicate better with her spouse.
"Village people are simple-minded; in our minds, it's either life or death. But these classes taught me how to take someone else's point of view and also that life can be about helping others," said the grandmother of three.
Using her own experience and what she had learnt, Ms Li counselled women in her village who might be contemplating suicide. She turned the front room of her home into a little library where village women could gather.
But as China's economy slows down after more than three decades of rapid growth, researchers are split over how its suicide rate will change in the next decade.
In the cities, stories of overworked, stressed-out young Chinese committing suicide have proliferated, leading some to predict that the suicide rate in China may rise again and catch up with that in Japan or South Korea.
Health-care infrastructure, particularly mental health facilities, must improve and expand in China if the suicide rate is to be kept down, said Hong Kong University social sciences professor Paul Yip, who headed the suicide rates study.
"It really depends now on the commitment of the Chinese government," he said. "So far, China is still reaping the benefits of urbanisation and improvements in the quality of life. But with the uncertainty of economic development and urban diseases starting to affect the population's well-being, I would not be surprised to see the downward trend slow or even reverse."
To Dr Zhang, the good life that most Chinese have enjoyed over the past two decades is just not sustainable.
"It cannot last forever. China is dealing with corruption, the economy is slowing down. There may not be more new surprises for the people. They will have to live with the lives they have now for a long time," he said.
"Every country has a natural rate of suicides. I think China will go back to its natural rate, but we don't know what that is."
Madam Li, saved from a watery death 20 years ago, says that life is becoming harder.
Her family still owes money on the house and her clothing business has suffered with the growing popularity of Internet shopping.
"Young people shop online and rich people go to the cities to the nice, big shops," she said, adding that she makes only 200 yuan a day.
She also needs expensive medication for chronic joint and back pain.
While she is "very scared" of sliding into poverty again, she says she is sure of one thing.
"No matter what, I won't think of dying again. If I had succeeded then, I would not have seen all this."