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.

27% of decrease from 2003 to 2008(Hong Kong)

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

A series of lawsuits for suicide from over work have been filed since 1990’s.

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.

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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

WARNING!!!!

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

Training for Media ProfessionalsProf. Keith Hawton (University of

Oxford)

Recommendations on Suicide Reporting for Media Professional

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)

Elderly DSH in Kwsi Tsing, 2004-2008葵青區老人自我傷害的分佈 (2004-2008)

Adolescent DSH in Kwsi Tsing, 2004-2008葵青區少年自我傷害的分佈 (2004-2008)

3rd Asia Pacific Regional Conference (International Association

for Suicide Prevention)

Visit of Selina Tsang

Meeting with WHO

what does it mean?

That’s what the present government is trying to do

Suicidal risk μ1μ2

% o

f p

opu

lati

on

Critical suicidal risk

Public Health Approach on Suicide

Reduction in number of suicides

Not every suicide is preventable

We all certainly can make a difference!

社區在防止自殺工作中扮演重要角色

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