The geography of suicide in older adults in Hong Kong: An ecological study

Suicide prevention in Hong Kong: pushing boundaries while building bridges

Hong Kong is a natural laboratory for studying suicides-small geographic footprint, bustling economic activity, rapidly changing socio-demographic transitions, and cultural crossroads. Its qualities also intensify the challenges posed when seeking to prevent them. In this viewpoint, we showed the research and practices of suicide prevention efforts made by the Hong Kong Jockey Club Centre for Suicide Research and Prevention (CSRP), which provide the theoretical underpinning of suicide prevention and empirical evidence. CSRP adopted a multi-level public health approach (universal, selective and indicated), and has collaboratively designed, implemented, and evaluated numerous programs that have demonstrated effectiveness in suicide prevention and mental well-being promotion. The center serves as a hub and a catalyst for creating, identifying, deploying, and evaluating suicide prevention initiatives, which have the potential to reduce regional suicides rates when taken to scale and sustained.

Spatial-temporal analysis of suicide clusters for suicide prevention in Hong Kong: a territory-wide study using 2014-2018 Hong Kong Coroner's Court reports

Background

This study aimed to (i) identify high-risk suicide-methods clusters, based on location of residence and suicide incidence; and (ii) compare the characteristics of cases and spatial units inside and outside clusters.

Methods

Suicide data of 4672 cases was obtained from the Coroner's Court reports in Hong Kong (2014-2018). Monthly aggregated suicide numbers based on location of residence, and suicide incidence, were obtained in small tertiary planning units (STPUs). Community-level characteristics and population of STPUs were retrieved from 2016 Census. Retrospective space-time analyses were performed to identify locations with elevated suicide rates over specific time periods, i.e., spatial-temporal clusters. Clusters were evaluated for overall suicide (any method), as well as jumping, hanging, and charcoal burning methods, in location of residence and suicide incidence. Bi-variate analysis was performed to compare the characteristics of cases, and spatial units, inside and outside the clusters.

Findings

Suicide clusters involving jumping and charcoal burning were identified, but no hanging clusters were found. The within-cluster distribution of types of housing was different from that of outside. For most of the overall suicide and suicide by jumping clusters, spatial units within the clusters were more socially disadvantaged compared to those outside.

Interpretation

Clusters varied by suicide methods, location of residence and location of incidence. The findings highlighted the need for consistent and concerted support from different stakeholders within suicide clusters, to ensure appropriate design, implementation and sustainability of effective suicide prevention programs.

Funding

General Research Fund (37000320) and seed fund from the University of Hong Kong (104006710).

Associations between social fragmentation, socioeconomic deprivation and suicide risk across 1887 municipalities in Japan, 2009-2017: a spatial analysis using the Bayesian hierarchical model

OBJECTIVE

Previous studies have indicated that spatial variation in suicide mortality is associated with area-specific socioeconomic characteristics, such as socioeconomic deprivation and social fragmentation. However, most of these studies have been conducted in the West and findings from Asian countries are limited. This study aims to investigate associations between socioeconomic characteristics and suicide mortality rates across 1887 municipalities in Japan between 2009 and 2017. We also assessed these associations by gender and age group.

METHODS

Suicide data were obtained from the suicide statistics of the Ministry of Health, Labour and Welfare in Japan and included information on the number of suicides by gender, age and municipality location. Social fragmentation, socioeconomic deprivation and urbanicity were used as socioeconomic characteristics in this study and were created from survey data obtained from the 2010 census. Bayesian hierarchical models were used to examine associations between socioeconomic characteristics and suicide risk.

RESULTS

Suicide rates were significantly higher in municipalities with higher levels of deprivation, with a rate ratio of 1.13 (95% credible interval: 1.10 to 1.17) in the highest quartile compared with the lowest. Higher levels of urbanicity had significantly lower suicide rates, with a rate ratio of 0.79 (95% credible interval: 0.77 to 0.82) in the highest quartile compared with the lowest. However, associations between exposures and suicide varied considerably by gender and age. Among both men and women aged 0-39 years, fragmentation was significantly associated with suicide, with rate ratios of 1.07 and 1.15 for men and women, respectively, in the highest quartile compared with the lowest.

CONCLUSION

Suicide prevention in Japan should particularly focus on areas with high levels of deprivation or low levels of urbanicity. Furthermore, young Japanese people residing in the most fragmented municipalities were also at high risk of suicide, and appropriate measures need to be taken.

Valuing the impact of self-rated health and instrumental support on life satisfaction among the chinese population

Background

Research has highlighted that satisfaction in health, and instrumental support (IS) are key areas of life affecting an individual’s wellbeing. Many social and public health initiatives use these two intervention mechanisms to improve individual’s wellbeing. For the purpose of cost-benefit assessment, there has been growing interest in expressing these intervention effects in economic terms. However, only a handful of studies have ever estimated these effects in economic terms, none of which examined them in a Chinese context. The aim of this study is to extend this line of valuation work to the Chinese population, estimating the implicit willingness-to-pays on the effects of improving individuals’ self-rated health (SRH) status and IS on their life satisfaction (LS).

Methods

Using data from a two-wave representative panel survey in Hong Kong (n = 1,109), this study conducted a cross-lagged analysis with a structural equation modelling technique to examine the causal effects of SRH and IS on LS. The use of this cross-lagged approach was an effort to minimise the endogeneity problem. Then, substituting the respective estimates to the formulae of compensating surplus, the marginal rate of substitution of SRH and IS with respect to individual’s equivalised monthly household income (HI) were estimated and were then expressed as the implicit willingness-to-pays on the effect of improving individuals’ SRH and IS on their LS.

Results

The cross-lagged analysis ascertained the causal effects of SRH (β = 0.074, 95% Confidence Interval: 0.021, 0.127) and IS (β = 0.107, 95% Confidence Interval: 0.042, 0.171) on individuals’ satisfaction with life. Translating into the concept of compensating surplus, the implicit monetary values of improving the sample’s SRH from “poor health” to “excellent health” and their perceived IS from “little support” to “a lot of support” are equivalent to an increase in their equivalised monthly HI by US$1,536 and US$1,523 respectively.

Conclusions

This study is the first to derive the implicit monetary values of SRH and IS on individual’s LS in a predominantly Chinese society, and it has implications for the cost-benefit assessment in wellbeing initiatives within the population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13626-7.

Quantitative Methods to Detect Suicide and Self-Harm Clusters: A Systematic Review

Suicide and self-harm clusters exist in various forms, including point, mass, and echo clusters. The early identification of clusters is important to mitigate contagion and allocate timely interventions. A systematic review was conducted to synthesize existing evidence of quantitative analyses of suicide and self-harm clusters. Electronic databases including Medline, Embase, Web of Science, and Scopus were searched from date of inception to December 2020 for studies that statistically analyzed the presence of suicide or self-harm clusters. Extracted data were narratively synthesized due to heterogeneity among the statistical methods applied. Of 7268 identified studies, 79 were eligible for narrative synthesis. Most studies quantitatively verified the presence of suicide and self-harm clusters based on the scale of the data and type of cluster. A Poisson-based scan statistical model was found to be effective in accurately detecting point and echo clusters. Mass clusters are typically detected by a time-series regression model, although limitations exist. Recently, the statistical analysis of suicide and self-harm clusters has progressed due to advances in quantitative methods and geospatial analytical techniques, most notably spatial scanning software. The application of such techniques to real-time surveillance data could effectively detect emerging clusters and provide timely intervention.

Exploring the geography of suicide threats and suicide attempts: An application of Risk Terrain Modeling

The purpose of this research is twofold: first, the spatial distribution of 911 emergency calls for service to the police for suicides in progress and threats of suicide in the City of Detroit, Michigan will be explored to determine whether these events exhibit different patterns of spatial clustering. Second, this research will explore the utility of Risk Terrain Modeling (RTM) to assist in our understanding of the locations of calls for service to the police related to suicide threats and suicides in progress. The results suggest that these events are different social phenomenon, both with respect to the spatial clustering of these events as well as qualitative differences in the environmental factors that may contribute to their occurrence.