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Background: Suicide rate among elderly is highest either in the world or in China.It is also much higher in rural areas than in urban areas.Given that suicide is not everywhere linked with pathology but represents a culturally recognized solution to certain situations, then whats the relationship of the acceptability of suicide and suicidality among the elderly? Methods: A Multi-stage stratified random sample of rural residents from Wuan City of Hebei Province, Yuncheng City and Laiwu City of Shandong Province, and urban residents from Beijing, Shenyang, and Tianjin City were administered a comprehensive survey that included suicidality and a 24-item subscale where respondents state the likelihood they would consider suicide (on a 5-point scale) if they experienced a variety of stressors ranging from being disciplined at work to developing a chronic mental illness.The total score (range 0-100) reflects the degree to which respondents considered suicide as a reasonable response to lifes vicissitudes.Among the selected sample, 514 were aged 60 years or older.Results: Among the eldedy subjects, 17.89% indicated that they would definitely consider suicide in at least one of the 25 situations and 25.71% would never consider suicide in all of the situations.The lifetime prevalence of suicidal ideation and suicidal behaviour among urban residents were significantly lower than among rural residents (2.74% vs.11.25%; 0.30% vs.1.88%).The scores of the Scale of Acceptability of Suicide among urban subjects were not significantly different from those among rural residents, but the scores of the Scale of Acceptability of Suicide were positively correlated with the scores of past one-year suicidality.Conclusion: The suicidality of the rural elderly is higher than the urban elderly, so it is extremely necessary to conduct effective measures to identify, manage, and reduce the elderly suicidality in rural areas.The relationship between the social acceptability of suicide and the occurrence level of suicidal behaviour is so complicated that we need to conduct further research.