COHORT EFFECTS OF SUICIDE MORTALITY ARE SEX SPECIFIC IN THE RAPIDLY DEVELOPED HONG KONG CHINESE POPULATION, 1976–2010
Roger Y. Chung Ph.D.
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorBenjamin H. K. Yip Ph.D.
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorSandra S. M. Chan M.R.C.Psych., M.B.Ch.B.
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorCorresponding Author
Samuel Y. S. Wong M.D.
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
Correspondence to: Samuel Y. S. Wong, 4/F School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong. E-mail: [email protected]Search for more papers by this authorRoger Y. Chung Ph.D.
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorBenjamin H. K. Yip Ph.D.
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorSandra S. M. Chan M.R.C.Psych., M.B.Ch.B.
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
Search for more papers by this authorCorresponding Author
Samuel Y. S. Wong M.D.
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
Correspondence to: Samuel Y. S. Wong, 4/F School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong. E-mail: [email protected]Search for more papers by this authorAbstract
Background
To examine temporal variations of age, period, and cohort on suicide mortality rate in Hong Kong (HK) from 1976 to 2010, and speculate the macroenvironmental mechanisms of the observed trends.
Methods
Poisson age-period-cohort modeling was used to delineate the effects of age, period, and cohort on suicide mortality. Analysis by sex was also conducted to examine if gender difference exists for suicidal behaviours.
Results
Age-cohort model provides the best fit to the mortality data, implying that the cohort effect is likely to explain more of the contributions to HK's suicide mortality pattern than the period effect. Risk of suicide mortality increases nonlinearly with age and accelerates after age 65–69 for both sexes. Moreover, the cohort effects differ between the sexes—risk of mortality increases continually for men born after 1961, but no change is observed for women since the 1941 cohort.
Conclusions
With increased risk of suicide mortality in younger cohorts and the age effect of suicide mortality, we may see future increase in suicide mortality as these younger cohorts age. Further studies are needed to clarify plausible associations between broader sociohistorical changes in the population impacting psychological risk factors and suicidal behaviour to better inform suicide prevention strategies.
REFERENCES
- 1Hawton K, van Heeringen K. Suicide. Lancet 2009; 373: 1372–1381.
- 2Odagiri Y, Uchida H, Nakano M. Gender differences in age, period, and birth-cohort effects on the suicide mortality rate in Japan, 1985–2006. Asia Pac J Public Health 2011; 23(4): 581–587.
- 3Wasserman D, Cheng QI, Jiang G-X. Global suicide rates among young people aged 15–19. World Psychiatry 2005; 4(2): 114–120.
- 4Pomfret J. Foxconn Worker Plunges to Death at China Plant: Report. Reuters: Technology [newspaper on the Internet]. 2010 Nov 5 [cited 2015 Jun 3]. Available from: http://www.reuters.com/.
- 5 The University of Hong Kong. The Hong Kong Jockey Club Centre for Suicide Research and Prevention. Hong Kong: HKU; 2015 [cited 2015 Jun 3]. Available from: http://csrp.hku.hk/statistics/.
- 6Yip PS, Chak SG. Suicide in Hong Kong: epidemiology, changing patterns, associated phenomena and prevention. Irish Psychiatrist 2011; 12(1): 23–24.
- 7Chung RY, Schooling CM, Cowling BJ, Leung GM. How does socioeconomic development affect risk of mortality? An age-period-cohort analysis from a recently transitioned population in China. Am J Epidemiol 2010; 171(3): 345–356.
- 8Ahmad OB B-PC, Lopez AD, Murray CJL, Lozano R, Inoue M Age Standardization of Rates: A New WHO Standard. Geneva: World Health Organization; 2001.
- 9Mason W, Smith H. Age-period-cohort analysis and the study of deaths from pulmonary tuberculosis. In: W Mason, S Fienberg, editors. Cohort Analysis in Social Research. New York: Springer; 1985: 151–227.
10.1007/978-1-4613-8536-3_6 Google Scholar
- 10Collins JJ. The contribution of medical measures to the decline of mortality from respiratory tuberculosis: an age-period-cohort model. Demography 1982; 19(3): 409–427.
- 11Bell A, Jones K. The impossibility of separating age, period and cohort effects. Soc Sci Med 2013; 93: 163–165.
- 12Chia KS, Reilly M, Tan CS, et al. Profound changes in breast cancer incidence may reflect changes into a Westernized lifestyle: a comparative population-based study in Singapore and Sweden. Int J Cancer 2005; 113(2): 302–306.
- 13Holford TR. Understanding the effects of age, period, and cohort on incidence and mortality rates. Annu Rev Public Health 1991; 12: 425–457.
- 14Chung RY, Kim JH, Yip BH, et al. Alcohol tax policy and related mortality. An age-period-cohort analysis of a rapidly developed Chinese population, 1981–2010. PLoS One 2014; 9(8): e99906.
- 15Chiu HF, Yip PS, Chi I, et al. Elderly suicide in Hong Kong–a case-controlled psychological autopsy study. Acta Psychiatr Scand 2004; 109(4): 299–305.
- 16Clayton D, Schifflers E. Models for temporal variation in cancer rates. II: Age-period-cohort models. Stat Med 1987; 6(4): 469–481.
- 17Phillips MR, Li X, Zhang Y. Suicide rates in China, 1995–99. Lancet 2002; 359(9309): 835–840.
- 18Tse GM, Lee JC. A 12-month review of autopsies performed at a university-affiliated teaching hospital in Hong Kong. Hong Kong Med J 2000; 6(2): 190–194.
- 19Murphy GE, Wetzel RD. Suicide risk by birth cohort in the United States, 1949 to 1974. Arch Gen Psychiatry 1980; 37(5): 519–523.
- 20Gunnell D, Middleton N, Whitley E, et al. Influence of cohort effects on patterns of suicide in England and Wales, 1950–1999. Br J Psychiatry 2003; 182: 164–170.
- 21Solomon MI, Hellon CP. Suicide and age in Alberta, Canada, 1951 to 1977. A cohort analysis. Arch Gen Psychiatry 1980; 37(5): 511–513.
- 22La Vecchia C, Bollini P, Imazio C, Decarli A. Age, period of death and birth cohort effects on suicide mortality in Italy, 1955–1979. Acta Psychiatr Scand 1986; 74(2): 137–143.
- 23Page A, Milner A, Morrell S, Taylor R. The role of under-employment and unemployment in recent birth cohort effects in Australian suicide. Soc Sci Med 2013; 93: 155–162.
- 24Skegg K, Cox B. Suicide in New Zealand 1957–1986: the influence of age, period and birth-cohort. Aust N Z J Psychiatry 1991; 25(2): 181–190.
- 25Granizo JJ, Guallar E, Rodriguez-Artalejo F. Age-period-cohort analysis of suicide mortality rates in Spain, 1959–1991. Int J Epidemiol 1996; 25(4): 814–820.
- 26Allebeck P, Brandt L, Nordstrom P, Asgard U. Are suicide trends among the young reversing? Age, period and cohort analyses of suicide rates in Sweden. Acta Psychiatr Scand 1996; 93(1): 43–48.
- 27Moens GF, van Oortmarssen GJ, Honggokoesoemo S, van de Voorde H. Birth cohort analysis of suicide mortality in Belgium 1954–1981 by a graphic and a quantitative method. Acta Psychiatr Scand 1987; 76(4): 450–455.
- 28Bille-Brahe U, Jessen G. The frequency of suicide in individual Danish birth cohorts, 1922–1991. Suicide Life Threat Behav 1994; 24(3): 275–281.
- 29Frederick CJ. Current trends in suicidal behavior in the United States. Am J Psychother 1978; 32(2): 172–200.
- 30Maris R. Biology of Suicide. New York: Guilford; 1986.
- 31Roy A. Suicide. Baltimore: Williams & Wilkins; 1986.
- 32Agid O, Shapira B, Zislin J, et al. Environment and vulnerability to major psychiatric illness: a case control study of early parental loss in major depression, bipolar disorder and schizophrenia. Mol Psychiatry 1999; 4(2): 163–172.
- 33Whitlock FA. Suicide in Brisbane, 1956 to 1973: the drug-death epidemic. Med J Aust 1975; 1(24): 737–743.
- 34Christophersen O, Rooney C, Kelly S. Drug-related mortality: methods and trends. Popul Trends 1998;(93): 29–37.
- 35Johns MW. Self-poisoning with barbiturates in England and Wales during 1959–74. Br Med J 1977; 1(6069): 1128–1130.
- 36Fowler RC, Rich CL, Young D. San Diego Suicide Study. II. Substance abuse in young cases. Arch Gen Psychiatry 1986; 43(10): 962–965.
- 37Allebeck P, Allgulander C. Suicide among young men: psychiatric illness, deviant behaviour and substance abuse. Acta Psychiatr Scand 1990; 81(6): 565–70.
- 38Andreasson S, Romelsjo A, Allebeck P. Alcohol, social factors and mortality among young men. Br J Addict 1991; 86(7): 877–887.
- 39Marks A, Abernathy T. Toward a sociocultural perspective on means of self-destruction. Life Threat Behav 1974; 4(1): 3–16.
- 40Monk M. Epidemiology of suicide. Epidemiol Rev 1987; 9: 51–59.
- 41Shaffer D, Gould MS, Fisher P, et al. Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry1996; 53(4): 339–348.
- 42Marttunen MJ, Aro HM, Lonnqvist JK. Adolescence and suicide: A review of psychological autopsy studies. Eur Child Adolesc Psychiatry 1993; 2(1): 10–8.
- 43Mulsant BH, Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psychiatry 1999; 60 (Suppl 20): 9–15.
- 44Paradiso S, Robinson RG. Gender differences in poststroke depression. J Neuropsychiatry Clin Neurosci 1998; 10(1): 41–47.
- 45Kessler RC, McGonagle KA, Swartz M, et al. Sex and depression in the National Comorbidity Survey. I: Lifetime prevalence, chronicity and recurrence. J Affect Disord 1993; 29(2–3): 85–96.
- 46Lavretsky H, Lesser IM, Wohl M, Miller BL. Relationship of age, age at onset, and sex to depression in older adults. Am J Geriatr Psychiatry 1998; 6(3): 248–256.
- 47Chan WS, Yip PS, Wong PW, Chen EY. Suicide and unemployment: what are the missing links? Arch Suicide Res 2007; 11(4): 327–335.
- 48Platt B, Hawton K, Simkin S, Mellanby RJ. Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2012; 47(2): 223–240.
- 49Bartley M. Health Inequality. An Introduction to Theories, Concepts and Methods. Cambridge: Polity Press; 2004.
- 50Waldron I. Trends in gender differences in mortality: relationships to changing gender differences in behavior and other causal factors. In: AK Hunt, editor. Gender Inequalities in Health. Buckingham: Open University Press; 2005.
- 51 Census and Statistics Department, Government of the Hong Kong Special Administrative Region. Hong Kong Statistics. Hong Kong: Government Logistics Department; 2010 [updated 2012 Jun 15; cited 2015 Jun 3]. Available from: http://www.censtatd.gov.hk/hkstat/.
- 52Oyama H, Watanabe N, Ono Y, et al. Community-based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females. Psychiatry Clin Neurosci 2005; 59(3): 337–344.
- 53Rutz W, von Knorring L, Walinder J. Frequency of suicide on Gotland after systematic postgraduate education of general practitioners. Acta Psychiatr Scand 1989; 80(2): 151–154.
- 54De Leo D, Dello Buono M, Dwyer J. Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy. Br J Psychiatry 2002; 181: 226–229.
- 55Chan SS, Leung VP, Tsoh J, et al. Outcomes of a two-tiered multifaceted elderly suicide prevention program in a Hong Kong Chinese community. Am J Geriatr Psychiatry 2011; 19(2): 185–196.