20071104 4 B(5) Elderly Suicide Prof

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

Suicide rate per 100,000 (1990-2005)每10万人口自殺率 (1990-2005)

0

5

10

15

20

25

30

35

40

45

50

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

under 65 yrs

All

Over 65 yrs

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)

14.5:8.4 =

1.73:1 11.3

Under 65

65 歲 以下

41.6:20.7 =

2:1 29.9

65 and over

65 歲 以上

17.6:9.9 =

1.77:1 13.6 All 所有

Gender Ratio

男女比率 Suicide rate per 100,000

每 10 万人口自殺率

S uic id e in Eld e rly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

來源︰ WHO ， 2002

全部全部年齡年齡

75 + 75 + 65-74 65-74 55-64 55-64 45-54 45-54 35-44 35-44 25-34 25-34 15-24 15-24 Country Country 國家 國家

17.6 17.6

4.1 4.1

41.7 41.7

4.6 4.6

25.0 25.0

4.2 4.2

20.2 20.2

5.2 5.2

22.0 22.0

6.7 6.7

22.5 22.5

6.4 6.4

22.2 22.2

4.8 4.8

17.2 17.2

3.1 3.1

USA MUSA M

美國 美國 FF

11.8 11.8

3.3 3.3

15.5 15.5

5.1 5.1

9.8 9.8

4.2 4.2

12.8 12.8

4.0 4.0

15.3 15.3

4.3 4.3

17.3 17.3

4.7 4.7

18.1 18.1

3.9 3.9

10.6 10.6

2.5 2.5

United M United M Kingdom F Kingdom F

英國 英國

19.5 19.5

5.1 5.1

31.6 31.6

6.9 6.9

26.7 26.7

6.0 6.0

25.9 25.9

5.8 5.8

29.0 29.0

9.2 9.2

30.3 30.3

7.7 7.7

22.1 22.1

5.2 5.2

21.6 21.6

5.1 5.1

Canada MCanada M加拿大加拿大 F F

21.2 21.2

5.1 5.1

30.0 30.0

3.4 3.4

21.7 21.7

4.1 4.1

21.3 21.3

5.5 5.5

24.3 24.3

7.5 7.5

29.6 29.6

7.3 7.3

35.4 35.4

8.1 8.1

22.1 22.1

5.3 5.3

Australia M Australia M 澳洲澳洲 F F

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

18.8 18.8

8.3 8.3

81.5 81.5

32.4 32.4

45.6 45.6

18.7 18.7

40.3 40.3

11.7 11.7

30.4 30.4

8.1 8.1

25.1 25.1

9.9 9.9

16.3 16.3

8.1 8.1

10.2 10.2

7.0 7.0

Korea M Korea M

韓國韓國 FF

36.5 36.5

14.1 14.1

60.7 60.7

34.1 34.1

46.1 46.1

22.0 22.0

65.9 65.9

19.5 19.5

56.9 56.9

15.6 15.6

37.0 37.0

10.5 10.5

28.1 28.1

11.6 11.6

16.5 16.5

7.3 7.3

Japan M Japan M

日本 日本 FF

19.5 19.5

10.9 10.9

50.3 50.3

31.4 31.4

29.9 29.9

17.0 17.0

23.0 23.0

11.5 11.5

25.1 25.1

10.6 10.6

22.5 22.5

13.0 13.0

25.8 25.8

12.8 12.8

11.2 11.2

6.8 6.8

China MChina M

Hong F Hong F

Kong Kong

中國香港中國香港

6.7 6.7

6.6 6.6

39.9 39.9

27.7 27.7

16.5 16.5

17.1 17.1

8.4 8.4

7.8 7.8

9.6 9.6

7.9 7.9

8.1 8.1

6.1 6.1

5.8 5.8

6.8 6.8

3.0 3.0

4.1 4.1

China MChina M

(Urban) F(Urban) F

中國 中國 (( 城市城市))

20.4 20.4

24.7 24.7

139.7 139.7

102.2 102.2

83.8 83.8

70.4 70.4

43.5 43.5

40.1 40.1

28.9 28.9

34.2 34.2

19.6 19.6

26.5 26.5

20.2 20.2

33.3 33.3

8.0 8.0

12.9 12.9

China MChina M

(Rural) F(Rural) F

中國 中國 (( 農村農村))

全部年全部年齡齡

75 + 75 + 65-74 65-74 55-64 55-64 45-54 45-54 35-44 35-44 25-34 25-34 15-24 15-24 Country Country

國家 國家

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 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

70 位自殺病例 100位社區對照長者

年齡 齡 60

結果︰1. 87%的自殺病例與 9%的

對照病例有精神紊亂，尤其抑郁 症

3. 60%的自殺長者在自殺之前曾經表示自殺的意念

Psychological Autopsy Study心理剖析研究 Results:

1. 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

4. 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)

香港長者自殺的趨势 （ 65歲及以上) （ 1987年至2004年)Suicide Trend in Elders (65 & above) in Hong Kong (1987-2004)

41.1

38.6 38.5

40.4

41.9

39.240.1

38.4

28.9

34.233.5

29.4

31.330.1

28.4

21.9

37.5

46.0

20

25

30

35

40

45

50

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

R ate

per

100,

000

Note: Poisson regression of annual suicide rate in elders using 2002 as reference year shows that suicide rates in 1987-1997 are significantlyhigher than the reference year at odds ratios of 1.34 to 1.61 (with exception to 1996), while rates in 1998-2001 do not differ from thereference year significantly, the increased suicide rate in 2003 has reached statistically significant level at odds ratio of 1.3171 relative to thesuicide rate in 2002.

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

(65 )自殺率 歲或以上 suicide rate 65 or above

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

0 1 2 3 4 5 6 7 8 9 10 11 12 13

2000

2001

2002

2003

SARS and Elderly Suicide (Chan et al, 2006) 非典型肺炎和長者自殺There is an apparent increase insuicide 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