Academic journal article Hong Kong Journal of Psychiatry

Clinical Determinants and Short-Term Prognosis of Suicidal Behaviours in Chinese Older Persons in Hong Kong

Academic journal article Hong Kong Journal of Psychiatry

Clinical Determinants and Short-Term Prognosis of Suicidal Behaviours in Chinese Older Persons in Hong Kong

Article excerpt

Abstract

Objective: To identify the clinical characteristics and outcome of Hong Kong Chinese elderly persons who attempted suicide.

Participants and Methods: Thirty seven Chinese elders with suicidal ideas were evaluated over a 6 month follow-up period.

Results: There was a slight female predominance (1.2:1). Approximately 70% of patients had experienced stressful life events. Logistic regression showed that in these elders, medical burden was a significant predictor of suicidal attempts. Experiencing a stressful life event and severity of depression were significant determinants of the severity of suicidal ideation; 97% (n = 36) presented with depressive disorders. During the follow-up period, mortality was 5% (n = 2), the default rate was 8% (n = 3), and 3% (n = 1) attempted suicide. Suicidal ideation, severity of depression, and anxiety improved with treatment over 6 months.

Conclusions: The majority of elderly suicidal patients had depressive disorders. While the medical burden may be a modifiable risk factor, elderly with depression and stressful life events should be identified early for closer surveillance.

Key words: Aged; Depression; Prognosis; Risk factor; Suicide, attempted

Introduction

In 1998, suicide represented 1.8% of the global burden of disease. It is expected to increase to 2.4% by the year 2020. Suicide is among the 10 leading causes of death in all ages in most countries. Hong Kong's suicide rate ranks in the middle of the global scale, and is comparable to that of Singapore among Asian countries. (1) There is a clear tendency for suicide rates to increase with age, being about 2 to 3 times more frequent in the elderly than in younger persons. (2) Hong Kong has among the highest old-age suicide rates in the world, being about 4 to 5 times the average.

Suicide in the elderly is of considerable medical and social significance, has a great social impact, and leads to intense stress among families. It remains a social taboo in the Chinese population. Due to long life expectancy, the proportion of elderly is increasing. In 2003, 11.7% of Hong Kong population was older than 60 years. The figure is expected to rise to about 27% in the year 2033 (http://www. info.gov.hk/censtatd). Thus the imminent expected growth in elderly suicides warrants appropriate interventions.

Suicidal behaviour includes suicidal ideation, suicidal attempts, and completed suicides. Suicide refers to any death that is a direct or indirect result of a positive or negative act accomplished by the victim himself / herself, which he / she knows or believes will produce such a result. Suicidal ideation refers to cognition that varies from fleeting thoughts that life is not worth-living, through very concrete, well-thought-out plans for killing oneself, to an intense delusional preoccupation with self-destruction. (3) Although elderly suicidal risk factors have been extensively studied in previous studies, the focus is mainly on completed suicides. Longitudinal studies of elderly suicidal ideation and attempts are limited. (4)

There have been extensive studies about the risk factors or correlates of elderly suicide. (5-10) Findings from these studies have yielded vast differences. Old-old groups have a higher rate of suicidal ideation (11) and completed suicide. (5,12) Female gender is associated with suicidal ideation (11,13) and suicidal attempts, (14) while males have the highest risk for completed suicide. (5,15) Regarding marital status, results are inconclusive, though widowers have highest risk of having suicidal ideation. (6) Poor social support, (7) institutionalisation, and social isolation are associated with increased suicidal ideation, (13) suicidal attempts, and completed suicides. (8,16) Stressful life events like bereavement, family discord, physical illness, and other losses are risk factors of suicidal ideation. (8,9) Medical burden is strongly associated with suicidal ideation and completed suicide, (6,15,17) as is low level of functioning. …

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