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									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   Gender Ratio
               每10万人口自殺率                  男女比率

                                          17.6:9.9 =
 All 所有        13.6
                                          1.77:1


 65 and over                              41.6:20.7 =
               29.9
 65歲 以上                                   2:1

 Under 65                                 14.5:8.4 =
               11.3
 65歲 以下                                   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   22.1    35.4    29.6    24.3    21.3    21.7    30.0   21.2
澳洲        F   5.3     8.1     7.3     7.5     5.5     4.1     3.4    5.1

Canada   M    21.6    22.1    30.3    29.0    25.9    26.7    31.6   19.5
加拿大      F    5.1     5.2     7.7     9.2     5.8     6.0     6.9    5.1

United  M     10.6    18.1    17.3    15.3    12.8    9.8     15.5   11.8
Kingdom F     2.5     3.9     4.7     4.3     4.0     4.2     5.1    3.3
英國
USA      M    17.2    22.2    22.5    22.0    20.2    25.0    41.7   17.6
美國       F    3.1     4.8     6.4     6.7     5.2     4.2     4.6    4.1


                                                                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        15-24   25-34   35-44   45-54   55-64   65-74   75 +    全部年
國家                                                                     齡
China M         8.0    20.2    19.6    28.9    43.5    83.8    139.7   20.4
(Rural) F      12.9    33.3    26.5    34.2    40.1    70.4    102.2   24.7
中國 (農村)
China M        3.0     5.8     8.1     9.6     8.4     16.5    39.9    6.7
(Urban) F      4.1     6.8     6.1     7.9     7.8     17.1    27.7    6.6
中國 (城市)
China M        11.2    25.8    22.5    25.1    23.0    29.9    50.3    19.5
Hong  F        6.8     12.8    13.0    10.6    11.5    17.0    31.4    10.9
Kong
中國香港
Japan     M    16.5    28.1    37.0    56.9    65.9    46.1    60.7    36.5
日本        F    7.3     11.6    10.5    15.6    19.5    22.0    34.1    14.1
Korea M        10.2    16.3    25.1    30.4    40.3    45.6    81.5    18.8
韓國    F        7.0     8.1     9.9     8.1     11.7    18.7    32.4    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    1:1.6                  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      在西方的研究中,服毒自殺的
    90% of cases of attempted suicide       案例佔超過90%
    in western studies
                                           在我們研究中只佔27.3%
   But only 27.3% in our study

   Self-injury --- 72.7%                  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                        70 位自殺病例
   100 community control                   100位社區對照長者
    elderly
   age  60                                年齡  60

   Results:
                                            結果︰
    1.   87% of suicide cases had a
         mental disorder compared            1.   87%的自殺病例與9%的
         to 9% of controls, in                    對照病例有精神紊亂,尤
         particular depressive illness            其抑郁症

         60% of suicide subjects had
                                                  60%的自殺長者在自殺之
    2.
                                             2.
         expressed suicidal intention
         before suicide                           前曾經表示自殺的意念
Psychological Autopsy Study
心理剖析研究
   Results:
    3.   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)
                          50



                                                          46. 0
                          45


                                                                            41. 9
                                41. 1
                                                                   40. 4                      40. 1
                          40                                                                                                                                          37. 5
                                                                                     39. 2
                                         38. 6    38. 5                                                38. 4
R ate p er 1 0 0 ,0 0 0




                          35
                                                                                                                         34. 2
                                                                                                                                  33. 5

                                                                                                                                                    31. 3
                          30                                                                                                                                 30. 1
                                                                                                                                           29. 4
                                                                                                                28. 9
                                                                                                                                                                      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 (65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                     (Chan et al, 2006)
非典型肺炎和長者自殺
There is an apparent increase in         在2003年,香港長者的自殺率
suicide rates in older persons in        有明顯的增加,這可能與
2003, which may be related to            非典型性肺炎爆發有關
SARS outbreak

Older people may be more                 長者可能更加脆弱︰
vulnerable :

   disruption of health care               健康護理被擾亂
   disruption of social network and
    support                                 社交網絡和支持被擾亂
   proneness to exaggerated
    pessimism because of high               傾向誇大悲觀,因為非典型肺
    mortality of SARS in older persons       炎在長者中有高死亡率

								
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