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Research ReportEldery Suicides In Hong Kong | Youth Suicides In Hong Kong |
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EXECUTIVE SUMMARY Introduction This is a monograph on youth completed suicides in Hong Kong. Completed suicides refer to those deaths caused by self-initiated destructive behaviours. We do not intend to discuss those youngsters who express suicidal wishes, plan to hurt themselves, or have unsuccessful attempts to hurt themselves before. The latter groups are far larger population, equally important, but they bear quite different characteristics compared to completed suicides. Youth, in the present report, refers to those age under 25 years. The importance of having local data on an apparently universal phenomenon, youth suicides, cannot be over-emphasized. It helps to document the universal aspects and unique characteristics of youth suicides, and hence an appreciation of the various factors behind the phenomenon. In terms of service, relevant data suggest what strategies are applicable or feasible in the local context. Results There has been intensive research efforts in youth suicides in the past 2 decades in the West. Wide ranges of risk factors for youth suicides have been reported. They include psychiatric disturbances, family dysfunction, unemployment, exposure to suicides, probably genetic predisposition and abnormalities in neurobiological findings, and other psychosocial adversities. It becomes obvious that no single aetiological factor is adequate to explain youth suicide. Youth suicides in Hong Kong bear a number of characteristics similar to that reported in the West. It begins to appear around early adolescence. There is a clear cirannual rhythm with peak incidences occurring around summer months. Large proportion of them are mentally ill and a significant percentage has received psychiatric service in their past. The common types of disturbances include depression, psychosis, conduct problems, and substance abuse. Many age normative stressors, especially interpersonal conflicts, appear to be the last straw precipitating suicides. These precipitating stressors do not occur in random but seem to interact with the pre-existing vulnerabilities. There are detectable clues prior to youth suicides, like suicidal communications and previous suicidal attempts. Relatively few suicidal youngsters leave suicidal note. When they leave notes, they do write in lengths, try to explain their acts, talk about their difficulties, express strong emotions, and beg to be forgiven. On the other hand, youth suicides in the territory have some features quite different from that found in the West. The trend of youth suicides in the past 16 years, fortunately, is not increasing tremendously. The youth suicide rate is lower than that of the general population . The male-to female ratio is relatively low. An increasing proportion of cases killed themselves by jumping from heights. Compared to that reported in the West, suicidal youngsters in Hong Kong have less substance abuse problems. However, the problem is still over-represented in the suicidal population. At a macroscopic level, there are evidences suggesting suicidal youngsters are not well integrated with the society or they are alienated in some ways or the other. A significant minority of them are not living with parents which probably suggest that they have limited family support. As a group, they have a much higher unemployment rate than their peers. Despite the growing interests in the development and evaluation of prevention efforts in youth suicides in the West, relatively little is known if they are truely effective and how applicable are they in the local settings. These programs may include the training of front-line workers to recognize and assess at risk youths, school-based prevention programs, health screening, peer support programs, hotline service, coordinated strategies to prevent suicide clusters, effective treatment of those mentally disturbed, and restricted access to suicidal means. Discussion and Recommendations Compared with the West, there are shared and non-shared psychosocial factors behind youth suicides in Hong Kong. Suicide is best to be conceptualized as the tragic endpoint of a number of vulnerabilities (e.g. mental illness) interacting with some precipitating crisis (e.g. interpersonal conflicts) rather than as a simple reaction to stress (e.g. they kill themselves because their parent scold them). Some of the specific characteristics of youth suicides in the local scene can be explained by a differential distribution of risk factors. Hong Kong has a lower prevalence of some of these risk factors (e.g. family disintegration, unemployment, drug abuse), yet they are over-represented in the suicide population and operate in the same direction. In the near future, there are worrying trends that these risk factors may get worse and so will youth suicide. Some of the characteristics (e.g. sex ratio) remain beyond our understanding. Little is known if prevention efforts in the West can be adopted locally in a feasible, systematic, and coordinated manner. Obviously, the acid test is whether these prevention efforts can genuinely decrease youth suicide rates in Hong Kong. Thus the evaluations of any prevention strategies are of paramount importance. Based on the researches and experiences in the West and the limited local data, we believe it is important to develop a multi-disciplinary and coordinated policy, This should include :
systematic data collection,
support front-line workers and build up referral network,
systematic application of school-based suicide prevention programs,
strategies to reach at risk groups,
coherent approaches to counteract deleterious effects of exposure
to suicides, and provide
effective service*-s to those youngsters who are mentally disturbed,
express suicide ideas and even attempts.The early loss of life through suicide is not only a personal tragedy. To the society, it is a loss of productive force. To the family, it is a devastating experience. To the peers, it brings along adverse impact and may trigger imitative suicide cluster. It is our wish that this monograph may stimulate more local research and therefore broaden our understandings on this complex phenomenon. Instead of knee-jerk responses to every case of widely publicized youth suicides, it is important to translate what we have already known into what we can do to prevent it from happening. |
