Paul W. C. Wong

Suicide in Hong Kong: a case-control psychological autopsy study

BACKGROUND The relative contribution of psychosocial and clinical risk factors to suicide among Chinese populations is an important issue. In Hong Kong, this issue requires vigorous examination in light of a 50% increase in suicide rate between 1997 and 2003. METHOD Using a case-control psychological autopsy method, 150 suicide deceased were compared with 150 living controls matched by age and gender. Semi-structured interviews were conducted with the next-of-kin of the subjects. Data were collected on a wide range of potential risk and protective factors, including demographic, life event, clinical and psychological variables. The relative contribution of these factors towards suicide was examined in a multiple logistic regression model. RESULTS Six factors were found to significantly and independently contribute to suicide: unemployment, indebtedness, being single, social support, psychiatric illness, and history of past attempts. CONCLUSIONS Both psychosocial and clinical factors are important in suicides in Hong Kong. They seem to have mediated suicide risk independently. In addition, socio-economic adversities seem to have played a relatively important role in the increasing suicide rate in Hong Kong.

Restricting the means of suicide by charcoal burning

We conducted an exploratory controlled trial to examine the efficacy of restricting access to charcoal in preventing suicides from carbon monoxide poisoning by charcoal burning in Hong Kong. All charcoal packs were removed from the open shelves of major retail outlets in the intervention region for 12 months; in the control region, charcoal packs were displayed as usual. The suicide rate from charcoal burning was reduced by a statistically significant margin in the intervention region (P<0.05) but not in the control region. We observed no significant change in the suicide rate using other methods in either location.

Suicide among adults aged 30–49: A psychological autopsy study in Hong Kong

BackgroundA surge in suicide rates in middle age people in Hong Kong and many Asian countries was recently observed. However, there is a paucity of suicide research on this subgroup of people in Asia.MethodsThe next-of-kin of 85 suicide cases and 85 community subjects aged 30–49 years were interviewed by a psychological autopsy approach. Information was triangulated by interview notes, coroners court files, and police investigation reports.ResultsA multiple logistic regression analysis identified the following risk factors for suicide among the middle age people in Hong Kong: the presence of at least one psychiatric disorder (OR = 37.5, 95% CI 11.5–121.9, p < 0.001), indebtedness (OR = 9.4, 95% CI 2.2–40.8, p < 0.01), unemployment (OR = 4.8, 95% CI 1.3–17.5, p < 0.05), never married (OR = 4.2, 95% CI 1.1–16.3, p < 0.05), and lived alone (OR = 3.9, 95% CI 1.2–13.4, p < 0.05).ConclusionThe data show that socio-economical factors had a strong impact on suicide in the target group. Further research is needed to explore any positive qualities that protect the middle-aged from suicide. The prevention of suicide in the middle-aged requires multiple strategies.

A psychological autopsy study of pathological gamblers who died by suicide

BACKGROUND Pathological gambling is associated with suicidal ideation and attempt. There is no known report on pathological gambling preceding suicide. By examining a series of 17 suicide cases with evidence of pathological gambling prior to death, we sought to generate hypotheses for further study of this under-researched but rapidly-increasing worldwide public health problem. METHOD Psychological autopsy interviews using a semi-structured format were conducted with proxy respondents for suicide and control subjects aged 15-59 years in Hong Kong SAR, China. RESULTS Of the 150 suicides and 150 controls examined, 17 suicides (11.3%) and one control case (0.6%) met criteria for the diagnosis of pathological gambling at the time of death or interview. All 17 suicide cases with pathological gambling had unmanageable debt at the time of death. Fourteen cases (82.4%) had other associated psychiatric disorders, most often major depressive disorders (n=10, 58.9%) and substance-use disorders (n=3, 17.6%). None had ever received psychiatric treatment. LIMITATIONS Descriptive, retrospective case series with a small sample size. CONCLUSIONS Along with unmanageable debt, a high proportion of the suicide cases with pathological gambling also experienced other psychiatric illnesses, most often depression, at the time of death. None sought treatment for their addictive behavior or psychiatric illness prior to death. Pathological gambling is a modifiable risk factor for suicide for which means to enhance case identification and engagement in treatment are urgently needed. Clinicians treating depression should explore the presence of pathological gambling behavior or unmanageable debts among their patients. Addressing pathological gambling should be one important component of a comprehensive suicide prevention strategy especially in countries where gambling activities are legalized and expanding.

Suicide and unemployment: what are the missing links?

The suicide rate has been paralleled by an upward trend of unemployment in Hong Kong since 1997. This study aims to explore the unknown suicide-related factors among the unemployed. This information is useful in developing culturally specific suicide prevention initiatives related to unemployment. Seventy-six suicide deceased and 15 life subjects who were unemployed were selected from a previous psychological autopsy study. Logistic regression models were employed to estimate the relative suicide risks among the unemployed people. Among the unemployed, the suicide deceased were more likely to be male, had suffered from psychiatric illness, and had attempted suicide before. They also had acquired less competent social problem solving skills. Comparison with a small control group creates a generalizability problem. Suicide prevention for the unemployed could be done through mental health awareness programs; problem-solving skills training for attempters and males; and vocational training and job opportunities for discharged psychiatric patients and rehabilitees.

Prevalence and Correlates of Video and Internet Gaming Addiction among Hong Kong Adolescents: A Pilot Study

This pilot study investigated the patterns of video and internet gaming habits and the prevalence and correlates of gaming addiction in Hong Kong adolescents. A total of 503 students were recruited from two secondary schools. Addictive behaviors of video and internet gaming were assessed using the Game Addiction Scale. Risk factors for gaming addiction were examined using logistical regression. An overwhelming majority of the subjects (94%) reported using video or internet games, with one in six (15.6%) identified as having a gaming addiction. The risk for gaming addiction was significantly higher among boys, those with poor academic performance, and those who preferred multiplayer online games. Gaming addiction was significantly associated with the average time spent gaming per week, frequency of spending money on gaming, period of spending money on gaming, perceived family disharmony, and having more close friends. These results suggest that effective educational and preventative programs or strategies are needed.

Responses to a Self-Presented Suicide Attempt in Social Media A Social Network Analysis

BACKGROUND The self-presentation of suicidal acts in social media has become a public health concern. AIMS This article centers on a Chinese microblogger who posted a wrist-cutting picture that was widely circulated in Chinese social media in 2011. This exploratory study examines written reactions of a group of Chinese microbloggers exposed to the post containing a self-harming message and photo. In addition, we investigate the pattern of information diffusion via a social network. METHODS We systematically collected and analyzed 5,971 generated microblogs and the network of information diffusion. RESULTS We found that a significant portion of written responses (36.6%) could help vulnerable netizens by providing peer-support and calls for help. These responses were reposted and diffused via an online social network with markedly more clusters of users--and at a faster pace-- than a set of randomly generated networks. CONCLUSIONS We conclude that social media can be a double-edged sword: While it may contagiously affect others by spreading suicidal thoughts and acts, it may also play a positive role by assisting people at risk for suicide, providing rescue or support. More research is needed to learn how suicidally vulnerable people interact with online suicide information, and how we can effectively intervene.

A study of sexual satisfaction and frequency of sex among Hong Kong Chinese couples.

There have been several studies in Western societies on the causes and consequences of sexual satisfaction within marriage. Little is known, however about the marital sexual relationship in Chinese societies. Moreover, most published studies used married individuals rather than married couples as participants. The present study examined data from a well-established knowledge, attitude, and practice (KAP) survey of 1,124 Hong Kong Chinese couples on martial sexual relationship. A conceptual model was tested using structural equation modeling (SEM). Interest in sex was found to be the strongest predictor of both sexual satisfaction and frequency of sex for both husbands and wives. Among the sociodemographic variables, the following two were significantly associated with lower frequencies of sex: for wives, that of having a full-time job; and for husbands, the factor of age. Theoretical implications for research on the interplay among culture, marriage, and sex in non-Western societies are discussed.

An empirical study of characteristics and types of homicide–suicides in Hong Kong, 1989–2005

BACKGROUND Clinical classification of types of homicide-suicide (HS) was proposed, but no information on empirical-based classification and prevalence of different types of HS was available. This paper aimed to empirically classify HS events into different clusters and to discuss specific evidence-based prevention initiatives. METHOD Data of HS offenders from Coroners Court were analyzed through a two-step cluster analysis. Number of clusters and appropriate allocations of cases were obtained. External background variables were tested through post hoc tests to explore the differences among clusters. RESULTS Two hundred and thirty-one people died in 98 episodes in the study period (1989-2005). The majority of HS offenders were male (n=68, 68.7%) and aged 30-49 (n=62, 62.6%). Domestic killing was the major type of HS in which over 60% of the homicide motivation was related to spousal conflicts or altruistic reasons. Spouses (n=46, 46.5%) and children (n=47, 47.5%) were predominantly the victims. The common killing methods included chopping with weapons (n=33, 33.3%) and charcoal burning (n=22, 22.2%). Six clusters of HS were derived from the cluster analysis and were further reduced to four major classes. Four major classes were dispute, conflicts in a relationship, altruistic, and mental illness. These classes could be differentiated by methods of homicide and suicide, gender of perpetrator, relationship with victim, and indebtedness. CONCLUSIONS Financial problem, dispute and domestic violence are significant precipitants of HS in Hong Kong. Those people associated with the precipitating factors should be the targets for intervention and prevention.

Temporal and computerized psycholinguistic analysis of the blog of a Chinese adolescent suicide

BACKGROUND Text analysis of personal documents provides insight into the cognition of those who complete suicide. Many personal documents are digitalized and easily found on the Internet, which can be used to advance suicide research. AIMS (1) To examine the temporal relationships between posting intensity and language use to sketch the suicidal process of a young man on the basis of his blog entries. (2) To investigate whether digitalized personal documents and paper documents of suicide cases have similar or different language patterns. METHOD Firstly, 193 blog entries of a 13-year-old boy posted during the year prior to his suicide were analyzed using the Chinese Linguistic Inquiry and Word Count (CLIWC) program. The temporal relationships between posting intensity and language use were illustrated by time series visualization. Secondly, the findings of this case study were compared with previous case studies from a systematic search of three Ovid databases. RESULTS Posting frequency and language use in the blog helped sketch the suicidal process of the young boy. In this case study, the ratio of positive to negative emotion words was associated with the posting trend. Progressive self-referencing appeared to be a primary predictive sign of suicide. However, the comparison did not show other clearly consistent patterns. CONCLUSION Digitalized personal documents, when interpreted with other information of the individual, provide insight into the suicidal process of completed suicides. This study extends the findings of psycholinguistic analyses of suicides to the Chinese social context and online document form.