Transcript Elderly Suicide in Hong Kong 香港長者的自殺状况研究 Prof. Helen Chiu Head, Department of Psychiatry

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)
under 65 yrs
50
All
45
Over 65 yrs
40
35
30
25
20
15
10
5
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 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
All 所有
65 and over
65歲 以上
Under 65
65歲 以下
Gender Ratio
男女比率
13.6
17.6:9.9 =
1.77:1
29.9
41.6:20.7 =
2:1
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
加拿大
M
F
21.6
5.1
22.1
5.2
30.3
7.7
29.0
9.2
25.9
5.8
26.7
6.0
31.6
6.9
19.5
5.1
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
5.1
11.8
3.3
USA
美國
17.2
3.1
22.2
4.8
22.5
6.4
22.0
6.7
20.2
5.2
25.0
4.2
41.7
4.6
17.6
4.1
M
F
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
China M
(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
6.8
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
日本
M
F
16.5
7.3
28.1
11.6
37.0
10.5
56.9
15.6
65.9
19.5
46.1
22.0
60.7
34.1
36.5
14.1
Korea
韓國
M
F
10.2
7.0
16.3
8.1
25.1
9.9
30.4
8.1
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

55 位長者 (年齡65及以上)

Male :Female

男女比例為 1:1.6

40% of cases occurred after 75

40% 發生於75歲以後

Self-poisoning accounted for over
90% of cases of attempted suicide
in western studies

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%
1:1.6

But only 27.3% in our study

Self-injury --- 72.7%

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
心理剖析研究

70 suicide cases
100 community control
elderly
age  60

Results:


1.
87% of suicide cases had a
mental disorder compared
to 9% of controls, in
particular depressive illness
2.
60% of suicide subjects had
expressed suicidal intention
before suicide
(Chiu et al, 2004)

70 位自殺病例
100位社區對照長者

年齡  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
2.
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:
3.
4.
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
長者自殺未遂
(Tsoh et al, 2005)
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)
50
46. 0
45
41. 9
41. 1
40. 4
R ate p er 1 0 0 ,0 0 0
40
38. 6
40. 1
37. 5
39. 2
38. 5
38. 4
35
34. 2
33. 5
31. 3
30
29. 4
28. 9
30. 1
28. 4
25
21. 9
20
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Note: Poisson regression of annual suicide rate in elders using 2002 as reference year shows that suicide rates in 1987-1997 are significantly
higher 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 the
reference year significantly, the increased suicide rate in 2003 has reached statistically significant level at odds ratio of 1.3171 relative to the
suicide rate in 2002.
Surveillance data on rate of completed suicide
自殺死亡率的監測數據
自殺率 (6 5 歲或以上) suicide rate 65 or above
4.50
4.00
3.50
3.00
2000
2.50
2001
2002
2.00
2003
1.50
1.00
0.50
0.00
0
1
2
3
4
5
6
7
8
9
10
11
12
13
SARS and Elderly Suicide
非典型肺炎和長者自殺
(Chan et al, 2006)
There is an apparent increase in
suicide rates in older persons in
2003, which may be related to
SARS outbreak
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
Older people may be more
vulnerable :
長者可能更加脆弱︰



disruption of health care
disruption of social network and
support
proneness to exaggerated
pessimism because of high
mortality of SARS in older persons

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