The differential impacts of social deprivation and social fragmentation on suicides: A lesson from Hong Kong.

INTRODUCTION: Little research has conducted to examine the association between social deprivation and social fragmentation, overall and method-specific suicide risk, and how these associations may change over time. This study investigated the association between social deprivation and social fragmentation with overall and method-specific suicide in Hong Kong from 1999 to 2018. METHODS: Suicide death data of each small tertiary planning unit (STPU) was obtained from the Census and Statistics Department of Hong Kong. Socio-economic characteristics in STPU level were obtained from Census and Bi-census. Exploratory principal component analysis was used to construct the social deprivation (SDI) and social fragmentation indices (SFI) based on the socio-economic characteristics. Bayesian hierarchical modelling was conducted to explore the association between SDI and SFI with overall and method-specific suicide over time, controlling for population density and male-to-female ratio. RESULTS: Higher risk of suicide was generally observed around Kowloon Peninsula and some parts in the Northern, Northwestern and Southwestern areas depending on methods. The effect of SDI and SFI on suicide risk varied by years and methods. In 2014-2018, for every 10% increase in SDI, the suicide risk for overall, jumping, hanging, and charcoal burning elevated by 22% (95%Crl = 10%-37%), 26% (95%Crl = 12%-41%), 31% (95%Crl = 14%-51%), and 21% (95%Crl = 4%-42%) respectively. CONCLUSION: Spatial variations and effects of SDI and SFI on overall and method-specific suicide risks varied by different periods. SDI was observed to be a stronger factor in the recent years. Situations should be monitored, and interventions should be implemented and adjusted accordingly to the changes.

The association between unemployment and suicide among employed and unemployed people in Hong Kong: A time-series analysis.

BACKGROUND: Unemployment is associated with suicide. However, it is unclear whether the influence of unemployment is consistent on suicide across subgroups with different employment status. This study aimed to explore the immediate and delayed association between unemployment and suicide among unemployed and employed people in Hong Kong. METHODS: Quarterly statistics on labor force, unemployment rate and suicide count by employment status in Hong Kong (2003-2019) were obtained from the Hong Kong Census and Statistics Department and the Coroner's Court suicide reports. Separate negative binomial autoregressive regressions were used to investigate associations between unemployment and suicide among employed and unemployed people. The models controlled for linear and non-linear time trends, seasonal variations, the number of suicide cases, Consumer Price Index, and gender ratios of the labor force in the previous quarter. RESULTS: After controlling for all covariates, every 1% increase in the present unemployment rate was associated with a 15% increase in the suicide rate among the employed people in the current quarter (Incidence Rate Ratio (IRR) = 1.14, 95% CI = 1.01-1.28), and a 13% decrease in the suicide rate among the unemployed in the next quarter (IRR = 0.87, 95% CI = 0.78-0.98). LIMITATIONS: Most recent data on suicide cannot be obtained due to processing time of death investigation. CONCLUSIONS: The influence of unemployment differed on suicide by employment status in different time periods. Employed and unemployed people have different needs in different economic conditions. Hence, it is important to provide timely, targeted and effective measures for suicide prevention to the specific group.

Using suicide notes to understand suicide among cancer patients: A mixed-method study.

BACKGROUND: Cancer patients are at risk of suicide. However, no studies have used suicide notes to investigate their expressed reasons for suicide. The objectives of this study were to compare the characteristics between note leavers and non-leavers among cancer suicide cases and to understand the patterns in expressed reasons for suicide using suicide notes. METHOD: Suicide cases (2012-2017) were identified from the Hong Kong Coroner's Court reports, which provide detailed information as well as the content of suicide notes. Bivariate tests and multiple logistic regression were performed to compare the characteristics of note leavers and non-leavers among suicide cases with cancer. Thematic analysis was performed on suicide notes to extract themes of expressed reasons for suicides by cancer status and age group. RESULTS: Among cancer suicide cases and compared to non-leavers, note leavers were younger, more likely to be male, use non-violent suicide methods, have better housing conditions, and live alone. Suffering from physical disease was a major theme identified among cancer note leavers across all age groups. Young and middle-aged non-cancer note leavers had various themes identified. Physical illness was the major theme for elderly non-cancer note leavers. CONCLUSIONS: Cancer note leavers had unique characteristics and suffering from physical illness was the major expressed reason identified in the suicide notes. Healthcare professionals should pay attention to the mental as well as the physical needs of patients. Improving quality of life and regaining control of life are vital for suicide prevention among cancer patients.

Understanding the impact of clinical characteristics and healthcare utilizations on suicide among cancer sufferers: a case-control study in Hong Kong.

BACKGROUND: Few studies have investigated whether hospital utilization patterns of cancer sufferers are associated with their suicide. This study aims to explore whether clinical profiles and healthcare utilization patterns are related to suicide among cancer sufferers. METHODS: Verified suicide cases with cancer (2012-2016) were identified. Each case was matched with two non-suicide controls suffering cancer, by birthyear, sex, and admission year. Cancer-related information, physical and psychiatric comorbidities, opioid-based painkiller usage, the number and length of inpatient admissions, and the number of outpatient and Accident & Emergency (A&E) attendances, in the six months leading up to the suicide, were identified. Conditional logistic regression models were constructed to explore the influence of clinical profiles and hospital utilization on suicide. These models were stratified by age and cancer stage. OUTCOMES: 383 cases and 766 controls were included in the analyses. Overall, younger age, metastasis/recurrent status, suffering head and neck cancer, having psychiatric comorbidities, using opioid-based painkillers, and high frequency of A&E attendances and inpatient admissions increased the odds of suicide. Being diagnosed with liver cancer, consuming high numbers of outpatient attendances, and high numbers of inpatient days decreased the odds of suicide. Stratified analyses confirmed the influence of young age and metastatic/recurrent cancer status on risk of suicide. INTERPRETATIONS: Suicidal cancer sufferers had distinctive clinical profiles and hospital utilization patterns. Detecting and mitigating suicidal risk should be incorporated as an important component in treatment of cancer sufferers in the clinical setting. FUNDING: Li Ka Shing Foundation and Hong Kong Research Grants Council.