Suicide Prevention Strategies in response to economic Crisis: experiences from Hong Kong
Paul Yip HKJC Centre for Suicide Research and PreventionThe University of Hong Kongfor the International meeting on Suicide Prevention in Taipei13th May, 2010.
Charcoal burning suicide
First case of charcoal-burning suicide in Hong Kong, 1998
Picture of the deceased and specific details of suicide method
9 more cases in the following month
Charcoal-burning accounted for 24.8% of all the overall suicide cases.
Macau, Japan and Taiwan imitated the acts.
Suicide Deaths by Method (1997–2007)
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Jumping 453 442 383 392 454 480 584 520 496 487 488
Hanging 240 287 231 232 219 255 246 220 215 203 206
CO poisoning (Charcoal)
1 16 145 176 253 276 321 228 213 165 143
Poisoning 46 56 53 49 38 42 51 31 30 30 31
Others 44 66 56 53 55 56 62 54 42 50 37
Overall 784 867 868 902 1019 1109 1264 1053 996 935 905
Suicide Method 1981 - 2007
0%
20%
40%
60%
80%
100%
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Pro
po
rtio
n
Charcoal Burning Cutting Hanging Jumping Others Poisoning
Suicide rate & Unemployment rate in HK (Male)
0
2
4
6
8
10
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
0
5
10
15
20
25
30
UR
SR
Unemployment rate (%) Suicide rate (per 100,000)
Suicide rate & Unemployment rate in HK (Female)
0
2
4
6
8
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
0
2
4
6
8
10
12
14
UR
SR
Unemployment rate (%) Suicide rate (per 100,000)
16.0
18.0
20.0
22.0
24.0
26.0
28.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
1990 20001980
Japan-Suicide rate and unemployment ratesuicide rate (per 100,000)
unemploymentrate (%)
Suicide Rates in Japan, Taiwan, Hong Kong and South Korea (1997-2007)
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Su
icid
e R
ate
per
100
k
Japan
Taiwan
Hong Kong
South Korea
Source: Census 1991, 2001; By-census 1996, 2006. Census and Statistic Department
Proportion of Unemployment Rate in Youth(Age 15-29)
Deliberate self-harm in Hong Kong (2004-2008)
4.7
70.3
48.6
81.8
38.233.0
52.244.2
77.9
11.2
86.1102.1
50.841.6
0.0
20.0
40.0
60.0
80.0
100.0
120.0
0 - 14 15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65+
Rat
e pe
r 10
0,00
0
2004 2005 2006 2007 2008
Economic statues vs Suicide rate
No. of suicide No. of population Rate
Employed 225 3,236,300 7.0
Unemployed 304 154,900 196.3
Econ Inactive 65 994,500 6.5
594 4,385,700 13.5
2006
2003 No. of suicide No. of population Rate
Employed 349 3,042,500 11.5
Unemployed 355 249,300 142.4
Econ Inactive 111 942,000 11.8
815 4,233,800 19.2
Suicidal risk in Hong Kong employed and unemployed populations ( vs. overall population ) Year 2002-2006 Relative Risk 2002 2003 2004 2005 2006
( 95% CI) Employed population
Men Suicidal risk
0.4 0.6 0.5 0.5 0.5
(0.4,0.5)
(0.5,0.6) (0.4,0.6) (0.5,0.6) (0.4,0.6)
Women Suicidal risk
0.5 0.6 0.4 0.5 0.5
(0.4,0.6)
(0.5,0.7) (0.3,0.5) (0.4,0.6) (0.4,0.6)
Unemployed population
Men Suicidal risk
6.4 5.8 6.2 7.5 10.4
(5.7,7.3)
(5.1,6.5) (5.4,7.2) (6.4,8.7) (9.0,12.0)
Women Suicidal risk
6 8.6 10.9 13.8 21.0
(4.5,7.7)
(7.0,10.6) (8.9,13.3)
(11.3,16.8)
(17.3,25.2)
Factors that differentiate the unemployed suicide deaths and controls
Chan, W. S., Yip, P. S., Wong, P. W., & Chen, E. Y. (2007). Suicide and Unemployment: What are the Missing Links? Archives of Suicide Research, 11, 327-335
Suicide rate among now-employed group
Type of occupation 1990-1994 1999-2003
suicide case (N) rate suicide case (N) rate
High M 55 2.31 278 8.48
F 23 2.25 109 6.13
Middle M 230 10.93 212 10.58
F 110 4.47 156 5.00
Low M 233 5.50 420 11.02
F 38 2.26 89 4.38
Working group M 518 5.94 910 10.00
F 153 2.97 354 5.11
Overall (15 – 59) M 1381 13.90 2432 21.80
F 900 9.57 1246 10.49
Source: Census 1991, 2001; By-census 1996, 2006. Census and Statistic Department
Proportion of Unemployment Rate in Youth(Age 15-29)
Medical cost of deliberate self-harm (Estimation: average 3.1 days in 2008)
Female (2047episodes)51%
Male (2124episodes)49%
MaleA&ED attendance 1,535,250In-patient stay 40,018,850Total cost HK$ 41,554,100
Total Cost = HK$84,671,300
FemaleA&ED attendance 1,593,000In-patient stay 41,524,200Total cost HK$ 43,117,200
How many people in HK have thought about killing themselves?
Suicidality Aged 15-59
(N = 2,220)
Aged 15-19
(N = 715)
Life-time suicidal ideation 28.4% 28.1%
Past-year suicidal ideation 6.5% 6.2%
Had made a plan of attempting suicide
2.3% 3.1%
Had made past-year suicide attempt(s)
1.7% 2.8%
Had made a suicide attempt in the past year that required medical care
0.2% 0.3%
*8.98% of the response suffers from serious depression symptoms in general
Definition of Mental Health
The World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.
Discussions
Employment is very important:
Unemployed: mind set change, social support
Employed: mental health among workers are important
Our local unemployed individuals are not benefiting from the recovery of Hong Kong economy. Even worse, their risks for suicide are markedly increased.
A public health approach
Universal:
To raise awareness about suicide prevention in the general population
Family and/or community support system are essential
Mass media contagious effect: self fulfilling prophency To provide training for gate-keepers and develop effective intervention programs to facilitate early identification and efficacious treatment of suicidal behaviour
Restriction of means
Selective: Some particular high risk groups, mental health patients, unemployed, persons on parole, family and social support
The use of the Geographical Information system to track down high risk districts and deploy appropriate resources to tackle the problem.
A community network is an effective one how to mobilize the resources within the district, The local council, police, hospital, NGOs and school to work together.
Indicative: To improve service provision for people at high risk of suicide, suicide attempts and discharge mental patients.
85+80 - 8475 - 7970 - 7465 - 6960 - 6455 - 5950 - 5445 - 4940 - 4435 - 3930 - 3425 - 2920 - 2415 - 1910 - 14
5 - 90 - 4
Age Group
85+80 - 8475 - 7970 - 7465 - 6960 - 6455 - 5950 - 5445 - 4940 - 4435 - 3930 - 3425 - 2920 - 2415 - 1910 - 14
5 - 90 - 4
Age Group
Thousand persons
400 300 200 100 0 100 200 300 400
男Male
女Female
Population Pyramid (2009)
Year Aged 65+ All population
1981 344 300 (6.6%)
(1 in 15 Persons)
5183 400
2008 890 800 (12.7%)
(1 in 8 persons)
7 008 900
2021 1 413 900 (18%)
(1 in 6 persons)
7 784 000
2036 2 261 000 (26%)
(1 in 4 persons)
8 570 200
Number of elderly population in future
Year Aged 80+ All population
1981 46 300 (0.9%)
(1 in 112 Persons)
5183 400
2008 238 400 (3.4%)
(1 in 29 persons)
7 008 900
2021 342 000 (4.4%)
(1 in 23 persons)
7 784 000
2036 667 000 (7.8%)
(1 in 13 persons)
8 570 200
Rapidly growing number of oldest-old in future
203619781988199820082021
85+80 - 8475 - 7970 - 7465 - 6960 - 6455 - 5950 - 5445 - 4940 - 4435 - 3930 - 3425 - 2920 - 2415 - 1910 - 145 - 90 - 4
Age Group
85+80 - 8475 - 7970 - 7465 - 6960 - 6455 - 5950 - 5445 - 4940 - 4435 - 3930 - 3425 - 2920 - 2415 - 1910 - 14
5 - 90 - 4
Age Group
Thousand persons400 300 200 100 0 100 200 300 400
男Male
女Female
Demographic Window
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
19
50
19
60
19
70
19
80
19
90
20
00
20
10
20
20
20
30
20
40
20
50
TDR
Young DR
Old DR
Source: Yip et al. (2010) Asian Population Studies
More HK people dying at advance age
Hong Kong Life Table – female, 1971, 2006, 2036
0
5
10
15
20
25
30
35
40
45
50
50 55 60 65 70 75 80 85 90 95
Th
ou
san
ds
197120062036
Heart Disease, Stroke, Cancer
Low Disability Moderate Disability High Disability
Alzheimers, Dementia, Arthritis, Osteoporosis,Vision and Hearing Impairment
e(0)=75.33 e(0)=85.54 e(0)=88.28
M=84M=90
M=92
48% people survive to aged 80 in 1971; 75% in 2006 and 83.4% by 2036
Limiting access to charcoal – a pilot programme in Tuen Mun
Limiting access to charcoal by relocating the charcoal pack from over-the-counter to closed shelf
A joint project with 7 Eleven, Circle K, China Resource Vanguard, ParkNShop and Wellcome
Preliminary evidence showing its efficacy
Good reference to Taiwan and Japan where are suffering from suicides by charcoal burning
Care for Suicide Survivor Project Tailored for the physical and
psychological needs of people bereaved by suicide, and investigates the efficacy of follow-up services
Support services including information, immediate psychological assistance, and medium-term counseling help.
NORTH
TAI PO
SHATIN
WANCHAIISLANDSEASTERN
TUEN MUN
SOUTHERN
SAI KUNG
YUEN LONG
TSUEN WAN
KWUN TONG
KWAI TSING WONG TAI SINSHAM SHUI PO
KOWLOON CITYYAU TSIM MONG
CENTRAL & WESTERN
All cases
Distribution of suicide cases
2008_Total
1.5 - 2.3 Std. Dev.
0.50 - 1.5 Std. Dev.
-0.50 - 0.50 Std. Dev.
< -0.50 Std. Dev.
/ 0 14,000 28,0007,000 Meters
標準差的分佈 (2008)
Suicidal risk μ1μ2
% o
f p
opu
lati
on
Critical suicidal risk
Public Health Approach on Suicide
Reduction in number of suicides
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