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Elderly suicide in Hong Kong—a case-controlled psychological autopsy study
Abstract
Objective: To examine some of the risk factors for late life suicide in Hong Kong Chinese using a case‐controlled psychological autopsy approach. Method: Informants of 70 subjects aged 60 or above who had committed suicide as well as a community sample of 100 elderly controls were interviewed. Subjects and controls were assessed for the presence of mental illness, history of suicide attempt and data on health care utilization. Results: Eighty‐six per cent of suicide subjects suffered from a psychiatric problem before committing suicide, compared with 9% of control subjects. Among the psychiatric problems, major depression was the commonest diagnosis. Seventy‐seven per cent of suicide subjects had consulted a doctor within 1 month of suicide. One‐third of suicide subjects had a history of suicide attempt. Rates of current psychiatric diagnosis, rates of medical consultation and history of suicide attempt are all significantly higher in suicide subjects than controls. Conclusion: Our findings support the view that depressive disorders and a past history of suicide attempt are risk factors of late‐life suicide in the Chinese population of Hong Kong, similar to findings in western studies.
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“a variety of investigators have applied it in case control studies that provide remarkably consistent findings (7-21).”
From Suicide in older adults (2011) · cites this paper as [9]
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“Rates of problem drinking, for example differ markedly in the East (9) and West (21).”
From Suicide in older adults (2011) · cites this paper as [9]
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Prospective cohort study of suicide attempters aged 70 and above: One-year outcomes
Wiktorsson, S., Marlow, T., Runeson, B., Skoog, I. G., & Wærn, M. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.06.010 · Cited by 34
Chan, S. S. M., Chiu, H. F. K., Chen, E. Y. H., Chan, W. S. C., Wong, P. W. C., Chan, C., Law, Y. W., & Yip, P. S. F. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.8.1135 · Cited by 32
Self-citationWei, K., & Chua, H. C. (2008) · International Review of Psychiatry · doi:10.1080/09540260802397446 · Cited by 31
Chan, K. Y., Yip, T. P. S., Yap, D. Y. H., Sham, M. K., & Tsang, K. W. (2020) · Journal of Palliative Medicine · doi:10.1089/jpm.2019.0424 · Cited by 30
Yang, Y.-T., Wang, Y.-H., Chiu, H.-T., Wu, C.-R., Handa, Y., Liao, Y.-L., & Hsu, Y. E. (2015) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2015.07.005 · Cited by 30
Self-citationBehavior Characteristics and Risk Factors for Suicide Among the Elderly in Rural China
Liu, B.-P., Qin, P., & Jia, C.-X. (2017) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000728 · Cited by 30
Schneider, B., Kõlves, K., Blettner, M., Wetterling, T., Schnabel, A., & Värnik, A. (2009) · Psychiatry Research · doi:10.1016/j.psychres.2008.03.022 · Cited by 30
“, 2002), and a very recent Chinese study (Chiu et al., 2004).”
BackgroundResultPlanning of suicide attempts among depressed inpatients ages 50 and over
Conner, K. R., Duberstein, P. R., Beckman, A. M., Heisel, M. J., Hirsch, J. K., Gamble, S., & Conwell, Y. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.06.003 · Cited by 30
“The large majority of middle-aged and older adults complete suicide in the context of a depressive episode (Beautrais, 2002; Chiu et al., 2004; Conwell et al., 2000).”
BackgroundSelf-citationMixed Methods Analysis of Sex Differences in Life Stressors of Middle-Aged Suicides
Stone, D. M., Holland, K. M., Schiff, L. B., & McIntosh, W. L. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2016.07.021 · Cited by 30
Case-control study of suicide attempts in the elderly
Liu, I., & Chiu, C. (2009) · International Psychogeriatrics · doi:10.1017/s1041610209990056 · Cited by 29
Influencing and protective factors of suicidal ideation among older adults
Huang, L., Tsai, Y., Liu, C., & Chen, Y. (2016) · International Journal of Mental Health Nursing · doi:10.1111/inm.12247 · Cited by 28
Differences Between Suicide Victims Who Leave Notes and Those Who Do Not
Paraschakis, A., Michopoulos, I., Douzenis, A., Christodoulou, C., Koutsaftis, F., & Lykouras, L. (2012) · Crisis · doi:10.1027/0227-5910/a000150 · Cited by 28
“Thanks to psychological autopsy studies, we now know that the majority – varying between 70% and 90% – of suicide victims suffered from at least one psychiatric disorder in the final months before their death (Cavanagh et al., 2003; Chiu et al., 2004; Ernst et al., 2004; Houston, Hawton, & Shepperd, 2001; Kelly & Mann…”
BackgroundCrawford, M., Kuforiji, B., & Ghosh, P. (2009) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2008.084145 · Cited by 29
A Community-Based Survey and Screening for Depression in the Elderly
Oyama, H., Sakashita, T., Hojo, K., Watanabe, N., Takizawa, T., Sakamoto, S., Takizawa, S., Tasaki, H., & Tanaka, E. (2010) · Crisis · doi:10.1027/0227-5910/a000007 · Cited by 27
“Recent psychological autopsy studies demonstrate that depression is a major cause of suicide among older adults (Chiu et al., 2004; Conwell, Duberstein, & Chaine, 2002; Waern et al., 2002).”
BackgroundSuicide and Suicide Prevention in Later Life
Conwell, Y. (2013) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.11.1.39 · Cited by 28
Self-citationGrek, A. (2007) · The Canadian Journal of Psychiatry · doi:10.1177/07067437070526s105 · Cited by 26
Introducing the Psychological Autopsy Methodology Checklist
Conner, K. R., Chapman, B. P., Beautrais, A. L., Brent, D. A., Bridge, J. A., Conwell, Y., Falter, T., Holbrook, A., & Schneider, B. (2021) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12738 · Cited by 29
“…et al., 1999; Beautrais, 2001; Brent et al., 1999; Brent et al., 1993; Chan et al., 2009; Chen et al., 2006; Cheng, 1995; Cheng et al., 2000; Chiu et al., 2004; Conner et al., 2003; Conwell et al., 2010; De Leo et al., 2013a; De Leo et al., 2013b; Foster et al., 1999; Freuchen et al., 2012;…”
Self-citationSuicide in later life: A comparison between cases with early-onset and late-onset depression
Voshaar, R. C. O., Kapur, N., Bickley, H., Williams, A., & Purandare, N. B. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.02.008 · Cited by 27
“About 90% of all suicides are preceded by axis I psychiatric disorders, in later life most often a depressive disorder (Conwell et al., 1996; Chiu et al., 2004).”
BackgroundThe WHO/START Study: Promoting Suicide Prevention for a Diverse Range of Cultural Contexts
Leo, D. D., & Milner, A. J. (2010) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2010.40.2.99 · Cited by 24
A multidimensional risk factor model for suicide attempts in later life
Chan, S. S. M., Chiu, H. F. K., LAM, L. C. W., Wong, C. S. M., & Conwell, Y. (2014) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s70011 · Cited by 24
“Significant life events in the past 12 weeks before the research interview (among comparison subjects) or within 12 weeks prior to the index suicide attempt (among suicide attempters) were charted using an adapted Paykal’s life event checklist that was used in previous psychoautopsy studies on Hong Kong Chinese older…”
InfluentialSelf-citationThe Usefulness of Coroners' Data on Suicides for Providing Information Relevant to Prevention
Bennewith, O., Hawton, K. E., Simkin, S., Sutton, L., Kapur, N., Turnbull, P., & Gunnell, D. (2005) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2005.35.6.607 · Cited by 23
Prevention and Treatment of Suicidality in Older Adults
Leo, D. D., & Arnautovska, U. (2016) · Wiley eBooks · doi:10.1002/9781118903223.ch18 · Cited by 22
Holm, A. L., Salemonsen, E., & Severinsson, E. (2021) · Nursing Open · doi:10.1002/nop2.789 · Cited by 21
Gender Differences in Suicidal Behavior in Korea
Hur, J.-W., Lee, B.-H., Lee, S.-W., Shim, S.-H., Han, S.-W., & Kim, Y.-K. (2008) · Psychiatry Investigation · doi:10.4306/pi.2008.5.1.28 · Cited by 19
Prevention and Treatment of Suicidality in Old Age
Leo, D. D., & Arnautovska, U. (2011) · Wiley eBooks · doi:10.1002/9781119998556.ch18 · Cited by 21
Heisel, M. J., & Flett, G. L. (2020) · Aging & Mental Health · doi:10.1080/13607863.2020.1857690 · Cited by 20
Metadata
- Authors
- Chiu, H. F. K., Yip, P. S. F., Chi, I., Chan, S., Tsoh, J., Kwan, C. W., Li, S. F., Conwell, Y., & Caine, E.
- Affiliations
- Chinese University of Hong Kong (HK)
- University of Hong Kong (HK)
- University of Rochester Medicine (US)
- Corresponding author
- Chiu, H. F. K.
- Chi, I.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2004-03-03
- Volume
- 109
- Issue
- 4
- Pages
- 299-305
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2096654221
- Cited by
- 180
- References
- 23
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 2 · 2022: 6 · 2021: 7 · 2020: 5 · 2019: 4 · 2018: 6 · 2017: 8 · 2016: 11 · 2015: 12 · 2014: 7 · 2013: 13 · 2012: 13
- FWCI
- 12.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Funders
- University of Hong Kong
- Chinese University of Hong Kong
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- elderly suicide, late-life suicide, risk factors, major depressive disorder, suicide attempt history, mental illness, medical consultation, Hong Kong Chinese, psychological autopsy
- MeSH terms
- Age Factors, Aged, Autopsy, Female, Hong Kong, Humans, Male, Middle Aged, Risk Factors, Suicide, Case-Control Studies
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