Elderly Suicide in Hong Kong 香港長者的自殺状况研究 Prof. Helen Chiu 趙鳳琴教授 Head, Department of Psychiatry 精神科學系主任 Faculty of Medicine 醫學院 The Chinese University of Hong Kong 香港中文大學

Trend in Suicide Rates (by Age Groups) from 1990-2005 自殺率趨势 (按年齡組別 ) 1990-2005 Census and Statistics Dept of HKSAR 香港政府統計處

Latest official suicide statistics (2005) 最新官方公布的自殺率 (2005) Suicide rate per 100,000 每10万人口自殺率 Gender Ratio 男女比率 All 所有 13.6 17.6:9.9 = 1.77:1 65 and over 65歲 以上 29.9 41.6:20.7 = 2:1 Under 65 65歲 以下 11.3 14.5:8.4 = 1.73:1

Suicide in Elderly 長者的自殺狀況 Elderly suicide rates 2 to 3 times rates in younger adults in Hong Kong 香港長者的自殺率比青少年的高2至3倍 Elderly suicide rates tend to be high in Asian countries despite traditional veneration of the elderly 亞洲國家的自殺率属偏高, 儘管有著尊敬長者的傳統 Few studies on elderly suicide in Hong Kong and Asia 在亞洲及香港罕有關於長者自殺情況的研究

Suicide Rates (per 100,000) by Gender, Age and Place 自殺率 (每 10万人口) 按性別，年齡和地方組別 Country 國家 15-24 25-34 35-44 45-54 55-64 65-74 75 + 全部 年齡 Australia M 澳洲 F 22.1 5.3 35.4 8.1 29.6 7.3 24.3 7.5 21.3 5.5 21.7 4.1 30.0 3.4 21.2 5.1 Canada M加拿大 F 21.6 5.2 30.3 7.7 29.0 9.2 25.9 5.8 26.7 6.0 31.6 6.9 19.5 United M Kingdom F 英國 10.6 2.5 18.1 3.9 17.3 4.7 15.3 4.3 12.8 4.0 9.8 4.2 15.5 11.8 3.3 USA M 美國 F 17.2 3.1 22.2 4.8 22.5 6.4 22.0 6.7 20.2 25.0 41.7 4.6 17.6 來源︰WHO，2002

Suicide Rates (per 100,000) by Gender, Age and Place 自殺率 (每 10万人口) 按性別，年齡和地方組別 Country 國家 15-24 25-34 35-44 45-54 55-64 65-74 75 + 全部年齡 China M (Rural) F 中國 (農村) 8.0 12.9 20.2 33.3 19.6 26.5 28.9 34.2 43.5 40.1 83.8 70.4 139.7 102.2 20.4 24.7 (Urban) F 中國 (城市) 3.0 4.1 5.8 6.8 8.1 6.1 9.6 7.9 8.4 7.8 16.5 17.1 39.9 27.7 6.7 6.6 China M Hong F Kong 中國香港 11.2 25.8 12.8 22.5 13.0 25.1 10.6 23.0 11.5 29.9 17.0 50.3 31.4 19.5 10.9 Japan M 日本 F 7.3 28.1 11.6 37.0 10.5 56.9 15.6 65.9 46.1 22.0 60.7 34.1 36.5 14.1 Korea M 韓國 F 10.2 7.0 16.3 9.9 30.4 40.3 11.7 45.6 18.7 81.5 32.4 18.8 8.3 來源︰WHO，2002

Attempted Suicide in the elderly (Chiu et al, 1996) 長者的自殺未遂 55 subjects  65 years Male :Female 1:1.6 40% of cases occurred after 75 Self-poisoning accounted for over 90% of cases of attempted suicide in western studies But only 27.3% in our study Self-injury --- 72.7% 55 位長者 (年齡65及以上) 男女比例為 1:1.6 40% 發生於75歲以後 在西方的研究中，服毒自殺的案例佔超過90% 在我們研究中只佔27.3% 自殘 – 72.2%

49.1% had depression 49.1% 有抑郁症 lower than most published data (70-90%) 比大部分发表的文獻數據為低 (70-90%) 36% no psychiatric diagnosis 36% 沒有確診為精神病

FU for 2 to 4 years --- 2 至 4年跟進計劃 Repetition rate of 3.6% is low compared with previous studies in western countries (around 8 to 20%) 與西方國家的研究(大約8到20%) 作比較，有3.6%較低的重複率 Rate of completed suicide --- 5.5% 自殺死亡率 --- 5.5% Rates of 2-8% in studies in western countries 西方國家的自殺死亡率為2-8%

Psychological Autopsy Study 心理剖析研究 retrospective study of elderly suicide by interviewing informants 通過对家属或亲友進行回顧性研究 case control study 病例對照研究法 identify risk factors 鑑定危險因素

Psychological Autopsy Study (Chiu et al, 2004) 心理剖析研究 70 位自殺病例 100位社區對照長者 年齡  60 結果︰ 87%的自殺病例與9%的對照病例有精神紊亂，尤其抑郁症 60%的自殺長者在自殺之前曾經表示自殺的意念 70 suicide cases 100 community control elderly age  60 Results: 87% of suicide cases had a mental disorder compared to 9% of controls, in particular depressive illness 60% of suicide subjects had expressed suicidal intention before suicide

Psychological Autopsy Study 心理剖析研究 Results: 75% of suicide subjects had consulted a doctor within 1 month of death compared with 39% of control 與39%的對照病例相比較，75%的自殺长者在的1個月內曾經看过醫生 Suicide cases -- negative life events, no. of physical illness, cancer, pain, past hx of attempted suicide 自殺长者 – 有較多的; 負面生活事件，普通科疾病， 癌症，痛症，自殺未遂史

Suicidal attempts in the elderly (Tsoh et al, 2005) 長者自殺未遂 66 suicide attempters 66位有自殺未遂的长者 91 subjects from community 91位來自社區的對照组 68.2% of suicide attempters had major depression 68.2% 位有自殺未遂的病例患有重型抑郁症 Major depression associated with 60-fold increased risk for attempted suicide 患有重型抑郁症會有自殺未遂的風險比其他高出60倍 Past suicidal attempts, poor ADL, arthritis, low conscientiousness  risk 有自殺史，自理能力較差，有關節炎症，低自覺性有較高風險 Co-residence with children  risk 與子女同住者風險较低

Clues to suicide prevention in HK (Chiu et al, 1996; 2004; Tsoh et al, 2005) 香港預防自殺的線索 Psychiatric illness, esp. depression is an important risk factor of suicide 精神病 ，尤其是抑郁症是一個重要的自殺危險因素 Attention should be paid to those with past suicidal attempt and those expressing suicidal ideas 需要密切关注有自殺未遂史和曾經表示有企圖自殺的人 Poor health and pain  suicide risk 身体差和有病痛均會增加自殺風險 Primary care doctors may be gate keepers to detect suicidal elderly 社区前線醫生可為偵查長者自殺把關

SARS and Elderly Suicide in Hong Kong 非典型肺炎和香港的長者自殺 (Chan et al, 2006)

Surveillance data on rate of completed suicide 自殺死亡率的監測數據

SARS and Elderly Suicide (Chan et al, 2006) 非典型肺炎和長者自殺 There is an apparent increase in suicide rates in older persons in 2003, which may be related to SARS outbreak Older people may be more vulnerable : disruption of health care disruption of social network and support proneness to exaggerated pessimism because of high mortality of SARS in older persons 在2003年，香港長者的自殺率 有明顯的增加，這可能與 非典型性肺炎爆發有關 長者可能更加脆弱︰ 健康護理被擾亂 社交網絡和支持被擾亂 傾向誇大悲觀，因為非典型肺炎在長者中有高死亡率