自殺與社會環境因素自殺與社會環境因素之探討之探討陳映燁陳映燁

台北市立聯合醫院松德院區主治醫師台北市立聯合醫院松德院區主治醫師國立陽明大學副教授國立陽明大學副教授

學歷與經歷學歷與經歷現職現職 台北市立聯合醫院松德院區主治醫師（台北市立聯合醫院松德院區主治醫師（ 9494 年年 11 月至今）月至今） 陽明大學兼任副教授 （陽明大學兼任副教授 （ 9999 年年 22 月至今）月至今）經歷經歷 台大醫院精神部住院醫師 （台大醫院精神部住院醫師 （ 8383 年年 66 月月 - 87- 87 年年 66 月）月） 台大醫院精神部主治醫師 （台大醫院精神部主治醫師 （ 8787 年年 77 月月 - 89- 89 年年 77 月）月） 陽明大學兼任助理教授 （陽明大學兼任助理教授 （ 9494 年年 88 月月 -99-99 年年 11 月）月）學歷學歷 中山醫學系醫學士 （中山醫學系醫學士 （ 7676 年年 1010 月～月～ 8383 年年 66 月）月） 哈佛大學社會與健康行為學碩士哈佛大學社會與健康行為學碩士 // 博士博士 Department of Health and Social Behavior, Harvard University, USA Department of Health and Social Behavior, Harvard University, USA （（ 8989 年年 99 月月 - 92- 92 年年 1111 月）月）

社會環境因子與自殺社會環境因子與自殺社會環境因素造成個人比較難以繼續生活，社會環境因素造成個人比較難以繼續生活，而視自殺為一種選擇，可能是直接的影響而視自殺為一種選擇，可能是直接的影響（例如金融海嘯後失業、欠債走投無路），（例如金融海嘯後失業、欠債走投無路），或是比較間接的方式（例如促使人們認同或是比較間接的方式（例如促使人們認同自殺是一種問題解決模式）自殺是一種問題解決模式）

Common socio-Common socio-environmental determinants environmental determinants

of suicideof suicide1.1. Social integration: Social integration: marital statusmarital status, religious , religious integration, deviancy (Durkheim) integration, deviancy (Durkheim) 2.2. Cultural perspective: Cultural perspective: gendergender, race, nation, race, national culture, al culture, media and suicidemedia and suicide3.3. Economic factors: Economic factors: unemploymentunemployment, labor , labor market conditions, incomemarket conditions, income4.4. Urban/ruralUrban/rural differences and suicide differences and suicide5.5. Opportunity theory (methods accessibiliOpportunity theory (methods accessibility)ty)

Outline of the SpeechOutline of the Speech Media and SuicideMedia and Suicide Opportunity theory and suicide – the Opportunity theory and suicide – the

case of jumping suicide in Taipei case of jumping suicide in Taipei CityCity

Economic fluctuations and suicideEconomic fluctuations and suicide

Media and Media and suicidesuicide

Media and SuicideMedia and Suicide Media reporting of suicide events could induce Media reporting of suicide events could induce

suicide imitationsuicide imitation The copycat effect is particularly significant in The copycat effect is particularly significant in

celebritycelebrity suicide suicide Imitation effect is more prominent when the Imitation effect is more prominent when the

event is reported in the event is reported in the front pagefront page and when the and when the report is report is extensive and prolongedextensive and prolonged

Copycat effect is more significant in Copycat effect is more significant in true suicide true suicide storiesstories than fictional stories than fictional stories

Vulnerable groups: younger age groups, suicide Vulnerable groups: younger age groups, suicide attempters and patients of depressive disordersattempters and patients of depressive disorders

Media Environment in Media Environment in TaiwanTaiwan

The “invasion” of Hong Kong based The “invasion” of Hong Kong based “Next Media” Group – “Next Media” Group – tabloid/paparazzi journalism were tabloid/paparazzi journalism were introduced introduced 2001 Next Magazine2001 Next Magazine 2003 Apple Daily 2003 Apple Daily 2009 Web-based animated news2009 Web-based animated news

7.9

26.722.7

4.5

10.911.7

6.7

16.818.8

0.0

5.0

10.0

15.0

20.0

25.0

30.0

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Suic

ide

deat

hs p

er 1

00,0

00

Male Female Total

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Suic

ide

deat

hs p

er 1

00,0

00 Hanging

Solid / Liquid poisoning

Jumping

Charcoal burning

Celebrity suicides and non-Celebrity suicides and non-celebrity suicides celebrity suicides

First generation papers explored a First generation papers explored a variety of suicide stories (not restricted variety of suicide stories (not restricted to celebrities) on the risk of suicides to celebrities) on the risk of suicides (e.g. Phillips 1974; Kessler 1980)(e.g. Phillips 1974; Kessler 1980)

Recent papers were by and large Recent papers were by and large focused on celebrity suicides, focused on celebrity suicides, particularly entertainment celebrities particularly entertainment celebrities (e.g. Cheng/Fu/Yip, review see Stack (e.g. Cheng/Fu/Yip, review see Stack 2005)2005)

Celebrity SuicideCelebrity Suicide Effect of media reporting of the suicide of a singer

in Taiwan: the case of Ivy Li. – by Chen YY et al – by Chen YY et al (Social Psychiatry and Psychiatric Epidemiology. 2010;45:363-369)

The impact of media reporting of the suicide of a singer on suicide rates in Taiwan – by Chen YY et al (Social Psychiatry and Psychiatric Epidemiology. 2010 DOI: 10.1007/s00127-010-0331-y )

Non-celebrity suicideNon-celebrity suicide The Impact of Media Reporting of Suicide on

Actual Suicides in Taiwan, 2002-2005 – by Chen YY et al (Journal of Epidemiology and Community Health. 2010;65(10):934-940 )

Media representation of gender patterns of suicide in Taiwan. – by Chen YY et al ( – by Chen YY et al (The Journal of Crisis The Journal of Crisis Intervention and Suicide PreventionIntervention and Suicide Prevention. 2011, . 2011, accepted)accepted)

Celebrity SuicidesCelebrity Suicides Several prior studies have Several prior studies have

demonstrated the influence of demonstrated the influence of entertainment celebrity suicides on entertainment celebrity suicides on suicide rates in Taiwan, for example suicide rates in Taiwan, for example the case of Nee MJ in 2005the case of Nee MJ in 2005

Celebrity Suicide – the case Celebrity Suicide – the case of Ivy Liof Ivy Li

Ivy Li: a young (age 24) rising singing Ivy Li: a young (age 24) rising singing star who completed suicide by burning star who completed suicide by burning charcoal in her own car in Nov. 2008. charcoal in her own car in Nov. 2008.

The reporting was sensational. Love The reporting was sensational. Love frustration was depicted as the single frustration was depicted as the single reason of suicide.reason of suicide.

Research Question – charcoal burning Research Question – charcoal burning was relatively fewer among young was relatively fewer among young females, did Ivy Li’s suicide induce females, did Ivy Li’s suicide induce age*method*gender modeling? age*method*gender modeling?

Media and SuicideMedia and SuicideBiweekly number of charcoal-burning suicides among young age group (<30 y/o) Aug~ Dec, 2008

0

2

4

6

8

10

12

14

16

18

20

Aug 7|

Aug 20

Aug 21|

Sep 3

Sep 4|

Sep17

Sep 18|

Oct 1

Oct 2|

Oct 15

Oct 16|

Oct 29

Oct 30|

Nov 12

Nov 13|

Nov 26

Nov 27|

Dec 10

Dec 11|

Dec24

numb

er o

f sui

cide d

eath

s

CO <30 y/o CO <30 y/o (male) CO <30 y/o (female)

Adjusted relative risk for factors Adjusted relative risk for factors associated with the risk of suicide after associated with the risk of suicide after

media reporting of the suicide of a media reporting of the suicide of a celebrity during November 2008 in celebrity during November 2008 in

Taiwan, by subgroups of age, gender and Taiwan, by subgroups of age, gender and methods of suicide -1methods of suicide -1

Subgroup N Adjusted relative risk

95% CI P value

Age <35 35-49 >=50

299540105462

1.490.991.06

(1.35, 1.63)(0.82, 1.19)(0.86, 1.31)

<0.00010.890.58

Gender Male Female

85553912

1.121.34

(0.95, 1.32)(1.14, 1.56)

0.170.0003

Methods of suicide Charcoal burning Others

38918576

1.091.14

(0.79, 1.51)(1.01, 1.28)

0.590.03

Adjusted relative risk for factors Adjusted relative risk for factors associated with the risk of suicide after associated with the risk of suicide after

media reporting of the suicide of a media reporting of the suicide of a celebrity during November 2008 in celebrity during November 2008 in

Taiwan, by subgroups of age, gender and Taiwan, by subgroups of age, gender and methods of suicide -2methods of suicide -2

Subgroup N Adjusted relative risk

95% CI P value

Age by gender Male <35 35-49 >=50

198328943678

1.381.001.12

(1.13, 1.69)(0.74, 1.35)(0.91, 1.38)

0.00150.990.29

Female <35 35-49 >=50

101211161784

1.781.271.15

(1.59, 1.98)(1.24, 1.31)(0.88, 1.52)

<0.0001<0.00010.31

Adjusted relative risk for factors Adjusted relative risk for factors associated with the risk of suicide after associated with the risk of suicide after

media reporting of the suicide of a media reporting of the suicide of a celebrity during November 2008 in celebrity during November 2008 in

Taiwan, by subgroups of age, gender and Taiwan, by subgroups of age, gender and methods of suicide -4methods of suicide -4

Subgroup N Adjusted relative risk

95% CI P value

Gender by method Male Charcoal burning Others

28505705

1.071.09

(0.73, 1.55)(0.94, 1.25)

0.730.25

Female Charcoal burning Others

10412871

1.441.23

(1.20, 1.72)(1.03, 1.46)

<0.00010.0204

Non-celebrity SuicideNon-celebrity SuicideThe Impact of Media Reporting of The Impact of Media Reporting of

Suicide on Actual Suicides in Suicide on Actual Suicides in Taiwan, 2002-2005Taiwan, 2002-2005

(Chen YY et al, (Chen YY et al, Journal of Journal of Epidemiology and Community Epidemiology and Community HealthHealth. 2010;65(10):934-940. 2010;65(10):934-940 ))

Research QuestionsResearch Questions Did the “invasion” of Apple Daily change Did the “invasion” of Apple Daily change

the reporting style of traditional the reporting style of traditional newspapers (i.e. China Times and United newspapers (i.e. China Times and United Daily) in Taiwan ?Daily) in Taiwan ?

Whether reportage of suicide news Whether reportage of suicide news increases suicide incidence in the following increases suicide incidence in the following day ?day ?

Mutual causation? media reporting Mutual causation? media reporting increased suicide rates or increased suicide increased suicide rates or increased suicide rates resulted in higher reporting intensity? rates resulted in higher reporting intensity?

Statistical MethodsStatistical Methods Reporting intensity was estimated by Reporting intensity was estimated by

local polynomial methodlocal polynomial method Poisson regression model (maximum Poisson regression model (maximum

conditional) likelihood method) was conditional) likelihood method) was used to estimate the influence of used to estimate the influence of newspaper reporting of suicide events newspaper reporting of suicide events on suicide rateson suicide rates

Granger’s causation model was used Granger’s causation model was used to assess mutual causation to assess mutual causation

1

0

11 ),(

)()()()()()(ˆ sdNsYsJtsgtsKtAet b

T

Estimated reporting intensity of suicide Estimated reporting intensity of suicide newsnews

Correlation coefficients of suicide news reporting for Correlation coefficients of suicide news reporting for China Times, United Daily and actual number of suicide China Times, United Daily and actual number of suicide counts before and after the arrival of Apple Daily, 2002-counts before and after the arrival of Apple Daily, 2002-

20052005Pre-Apple Daily Period Pre-Apple Daily Period (Jan. 2002~April 2003)(Jan. 2002~April 2003)

Post-Apple Daily Period Post-Apple Daily Period (May 2003~Dec. 2005)(May 2003~Dec. 2005)

United United DailyDaily

China China TimesTimes

Number of Number of suicide suicide

United United DailyDaily

China China TimesTimes

Apple Apple DailyDaily

Number of Number of suicide suicide

United DailyUnited Daily 1.001.00 0.34***0.34*** 0.05 0.05 1.001.00 0.36***0.36*** 0.21***0.21*** 0.12**0.12**

China TimesChina Times 0.34***0.34*** 1.001.00 0.07 0.07 0.36***0.36*** 1.001.00 0.19***0.19*** 0.19***0.19***

Apple DailyApple Daily -- -- -- 0.21***0.21*** 0.19***0.19*** 1.001.00 -0.01-0.01

Number of Number of suicidesuicide

0.05 0.05 0.07 0.07 1.001.00 0.12**0.12** 0.19***0.19*** -0.01-0.01 1.001.00

The impact of suicide news reporting on actual The impact of suicide news reporting on actual suicides before and after the arrival of Apple suicides before and after the arrival of Apple

Daily, 2002-2005Daily, 2002-2005 Pre-Apple Daily Period Pre-Apple Daily Period (Jan. 2002~April 2003)(Jan. 2002~April 2003)

Post-Apple Daily Period Post-Apple Daily Period (May 2003~Dec. 2005)(May 2003~Dec. 2005)

Crude estimate Crude estimate (s.e.)(s.e.)&&

Adjusted estimateAdjusted estimate (s.e.)(s.e.)##

Crude estimate Crude estimate (s.e.)(s.e.) & &

Adjusted estimateAdjusted estimate (s.e.) (s.e.) ##

United DailyUnited Daily 0.016 (0.014)0.016 (0.014) 0.009 (0.015)0.009 (0.015) 0.013(0.006)*0.013(0.006)* 0.020 (0.007)**0.020 (0.007)**

China TimesChina Times 0.010 (0.014)0.010 (0.014) 0.014 (0.015)0.014 (0.015) 0.015(0.007)*0.015(0.007)* -0.000(0.007)-0.000(0.007)

Apple DailyApple Daily -- -- 0.001(0.009)0.001(0.009) 0.006 (0.010)0.006 (0.010)

Number of suicide Number of suicide (one day prior)(one day prior)

0.009 (0.005) +0.009 (0.005) + 0.001 (0.006)0.001 (0.006) 0.017(0.003)***0.017(0.003)*** 0.005 (0.003)0.005 (0.003)

Evaluating the impact of actual suicide and Evaluating the impact of actual suicide and suicide news reporting of other newspapers on suicide news reporting of other newspapers on the reportage of suicide news of United Daily, the reportage of suicide news of United Daily, China Times, Apple Daily respectively in the China Times, Apple Daily respectively in the

following day, 2002-2005following day, 2002-2005 Dependent Dependent

Explanatory variableExplanatory variablevariablesvariables

United DailyUnited Daily China TimesChina Times Apple DailyApple Daily

Number of suicides Number of suicides (one day prior)(one day prior)

0.044(0.006)***0.044(0.006)*** 0.035(0.006)***0.035(0.006)*** 0.037(0.009)***0.037(0.009)***

Suicide news reportingSuicide news reporting

United DailyUnited Daily 0.022(0.014)0.022(0.014)++ -0.010(0.015)-0.010(0.015) -0.016(0.021)-0.016(0.021)

China TimesChina Times 0.006(0.017)0.006(0.017) 0.033(0.015)*0.033(0.015)* -0.030(0.020)-0.030(0.020)

Apple DailyApple Daily 0.017(0.021)0.017(0.021) 0.090(0.022)***0.090(0.022)*** 0.065(0.028)*0.065(0.028)*

Granger causations among number of suicide Granger causations among number of suicide and suicide news reporting for the three and suicide news reporting for the three

leading newspapersleading newspapers

ConclusionsConclusions The presence of Apple Daily has The presence of Apple Daily has

fueled competitive reporting of fueled competitive reporting of suicide news among Taiwan’s suicide news among Taiwan’s traditional newspapers. traditional newspapers.

The increased suicide news reporting The increased suicide news reporting among Taiwan’s traditional among Taiwan’s traditional newspapers, particularly United newspapers, particularly United Daily, has consequently increased the Daily, has consequently increased the actual number of suicides.actual number of suicides.

Outline of the SpeechOutline of the Speech Media and SuicideMedia and Suicide Opportunity theory and suicide – the Opportunity theory and suicide – the

case of jumping suicide in Taipei case of jumping suicide in Taipei CityCity

Economic fluctuations and suicideEconomic fluctuations and suicide

Opportunity theory Opportunity theory and suicideand suicide

Restricting method of suicide in Restricting method of suicide in suicide preventionsuicide prevention

Chen YYChen YY*, Yip PSF: Suicide sex ratios after the inception of charcoa*, Yip PSF: Suicide sex ratios after the inception of charcoal-burning suicide in Taiwan and Hong Kong. l-burning suicide in Taiwan and Hong Kong. Journal of Clinical PsycJournal of Clinical Psychiatryhiatry. 2011;72(4):566-567 (. 2011;72(4):566-567 (SCI/SSCISCI/SSCI)) Tsai CW, Gunnell D, Chou YH, Kuo CJ, Lee MB, Tsai CW, Gunnell D, Chou YH, Kuo CJ, Lee MB, Chen YYChen YY*: Why do *: Why do people choose charcoal burning as a method of suicide? An interviepeople choose charcoal burning as a method of suicide? An interview based study of survivors in Taiwan. w based study of survivors in Taiwan. Journal of Affective DisordersJournal of Affective Disorders.. 2011:131(1-3):402-407 ( 2011:131(1-3):402-407 (SCI/SSCISCI/SSCI)) Chen YYChen YY, Lee MB, Chang CM, Liao SC: Methods of suicide in differe, Lee MB, Chang CM, Liao SC: Methods of suicide in different psychiatric diagnostic groups. nt psychiatric diagnostic groups. Journal of Affective DisordersJournal of Affective Disorders. 200. 2009;118(1-3):196-200. 9;118(1-3):196-200. (SCI/SSCI)(SCI/SSCI) Chen YYChen YY, Chiang CM, Liao SC, Lee MB: Suicide sex ratio: the interac, Chiang CM, Liao SC, Lee MB: Suicide sex ratio: the interaction between mental illness and suicide methods. tion between mental illness and suicide methods. Journal of Clinical Journal of Clinical PsychiatryPsychiatry. 2009;70(2):294-5. . 2009;70(2):294-5. (SCI/SSCI)(SCI/SSCI) Chen YYChen YY, Gunnell D, Lu TH: Descriptive epidemiological study of sit, Gunnell D, Lu TH: Descriptive epidemiological study of sites of suicide jumps in Taipei, Taiwan. es of suicide jumps in Taipei, Taiwan. Injury PreventionInjury Prevention. 2009;15(1):. 2009;15(1):41-4. 41-4. (SSCI)(SSCI) Chen YYChen YY, Park NS, Lu TH: Suicide methods used by women in Kore, Park NS, Lu TH: Suicide methods used by women in Korea, Sweden, Taiwan and the United states. a, Sweden, Taiwan and the United states. Journal of the Formosan Journal of the Formosan Medical AssociationMedical Association. 2009;108(6):452-9. . 2009;108(6):452-9. (SCI)(SCI) Chen YYChen YY, Gunnell D, Lu TH: Descriptive epidemiological study of , Gunnell D, Lu TH: Descriptive epidemiological study of sites of suicide jumps in Taipei, Taiwan. sites of suicide jumps in Taipei, Taiwan. Injury PreventionInjury Prevention. 2009;. 2009;15(1):41-4. (SSCI) 15(1):41-4. (SSCI)

Jumping suicide ── Jumping suicide ── HotspotsHotspots

Jumping hotspotsJumping hotspots 1 1 ）） popularity 2popularity 2 ）） medimedia attention 3a attention 3 ）） accessibilityaccessibility ExampleExample ：： Golden Gate BridgeGolden Gate Bridge: Around 30 jumping suicide de: Around 30 jumping suicide deaths per year. Around 50% of residents from Oaklaaths per year. Around 50% of residents from Oakland area of San Francisco who committed suicide by nd area of San Francisco who committed suicide by jumping from bridges drove across the Oakland Bajumping from bridges drove across the Oakland Bay Bridge on their way to commit suicide from the Gy Bridge on their way to commit suicide from the Golden Gateolden Gate(Seiden and Spence, 1983 Omega)(Seiden and Spence, 1983 Omega)

Oakland Bay Bridge

Golden Gate Bridge

Research gap in Jumping Research gap in Jumping suicidesuicide

Focus on one single site. Lack of Focus on one single site. Lack of detailed analysis of the detailed analysis of the characteristics of the sites (Bridges? characteristics of the sites (Bridges? Hospitals? Shopping malls?) Hospitals? Shopping malls?)

Fail to identify the types of sites with Fail to identify the types of sites with the highest incidence rates. Thus, the highest incidence rates. Thus, prior studies could not provide a prior studies could not provide a definitive basis for prioritizing definitive basis for prioritizing preventative measures.preventative measures.

A descriptive epidemiological A descriptive epidemiological study of sites of suicide jumps study of sites of suicide jumps

in Taipei, Taiwanin Taipei, Taiwan Research QuestionsResearch Questions

Where did jumping suicide occur in Where did jumping suicide occur in Taipei City?Taipei City? Are there jumping Are there jumping hotspotshotspots in the ca in the case of building jumping?se of building jumping? What were the sociodemographic chWhat were the sociodemographic characteristics of individuals who jumaracteristics of individuals who jumped from different type of sites?ped from different type of sites?

MethodsMethods All suicide deaths by jumping from a height All suicide deaths by jumping from a height

(ICD-9 code E957) in Taipei from 2002 (ICD-9 code E957) in Taipei from 2002 through 2005 were included in this study. through 2005 were included in this study.

Information source: death certificate, Information source: death certificate, ambulance records, medical records, media ambulance records, medical records, media reportsreports

The total numbers of various kinds of The total numbers of various kinds of potential jumping sites were estimated potential jumping sites were estimated from the Statistical Abstract of Taipei City, from the Statistical Abstract of Taipei City, 2000 Population and Housing Census2000 Population and Housing Census

MethodsMethodsClassification of sitesClassification of sites home private residential buildings, home private residential buildings, not-home private residential buildingnot-home private residential buildingss non-residential buildingsnon-residential buildings

business office buildings, hospitals, shopbusiness office buildings, hospitals, shopping malls (including department stores),ping malls (including department stores), hotels, bridges and others. hotels, bridges and others.

ResultsResults

Total number of jumping suicide: 276Total number of jumping suicide: 276 Not jumping in Taipei city: 40 casesNot jumping in Taipei city: 40 cases Address error: 26 casesAddress error: 26 cases Final sample size: 210 (male NFinal sample size: 210 (male N ＝＝ 107107 female Nfemale N ＝＝ 103)103) Average age: 49Average age: 49 （（ SDSD ＝＝ 20.120.1 ），）， femfemales ales （（ 46y/o46y/o ）） were younger than mwere younger than malesales （（ 52y/o52y/o ））

ResultsResults Number of jumping suicides from a particular type of site, proportion Number of jumping suicides from a particular type of site, proportion

(%) of total suicides from that type of site, and the number of jumping (%) of total suicides from that type of site, and the number of jumping suicides from the site per 1000 such sites in Taipei, 2002-2005suicides from the site per 1000 such sites in Taipei, 2002-2005

Number of suicidal jumps

(1)

Estimated number

of sites (2)

Estimated number of jumping deaths per 1,000 sites

(%)(%) Rate (1)/(2) (95% CI)

Residential buildings 140 (67) 67,680 2.1 (1.7, 2.4)

Non-residential buildings

Business office buildings 28 (13) 47,000 0.6 (0.4, 0.8)

Hospitals 16 (8) 52 307.7 (182.2, 433.1)

Shopping malls 11 (5) 40 275.0 (136.6, 413.4)

Hotels 4 (2) 320 12.5 (0.3, 24.7)

Bridges 3 (1) 330 9.1 (-1.1, 19.3)

Others 5 (2) - - -

ResultsResultsHigh risk groups of jumping from High risk groups of jumping from

homehome

ConclusionConclusion Jumping hotspots in Taipei: Jumping hotspots in Taipei:

Hospital and Shopping mallsHospital and Shopping malls Females and the elderly were Females and the elderly were

more likely to jump from more likely to jump from home residential buildingshome residential buildings

Outline of the SpeechOutline of the Speech Media and SuicideMedia and Suicide Opportunity theory and suicide – the Opportunity theory and suicide – the

case of jumping suicide in Taipei case of jumping suicide in Taipei CityCity

Economic fluctuations and suicideEconomic fluctuations and suicide

Economic Economic fluctuations and fluctuations and

suicidesuicide

Economic factors and Economic factors and suicidesuicide

Law CK, Yip PSF, Law CK, Yip PSF, Chen YYChen YY*: The *: The economic and potential years of life lost economic and potential years of life lost of suicide in Taiwan, 1997-2007. of suicide in Taiwan, 1997-2007. The The Journal of Crisis Intervention and Journal of Crisis Intervention and Suicide PreventionSuicide Prevention. 2011;32:153-159 . 2011;32:153-159 ((SSCISSCI))

Chen YYChen YY*, Yip PSF, Lee CKM, Fan HF, *, Yip PSF, Lee CKM, Fan HF, Fu KW: Economic fluctuations and Fu KW: Economic fluctuations and suicide: a comparison of Taiwan and suicide: a comparison of Taiwan and Hong Kong. Hong Kong. Social Science & MedicineSocial Science & Medicine. . 2010;71:2083-2090 (SSCI)2010;71:2083-2090 (SSCI)

IntroductionIntroduction Existing evidence indicate a positive Existing evidence indicate a positive

correlation between economic correlation between economic recession and increase in suicide rate recession and increase in suicide rate

The association between economic The association between economic recessions and increase in suicide recessions and increase in suicide rates were particularly prominent rates were particularly prominent among males at their working age among males at their working age

The association of unemployment and The association of unemployment and suicide rate in Asian countries was suicide rate in Asian countries was stronger than western countriesstronger than western countries

Charcoal burning suicide Charcoal burning suicide and unemployment rateand unemployment rate

Both Taiwan and Hong Kong experienceBoth Taiwan and Hong Kong experienced marked increase in suicide rate in the d marked increase in suicide rate in the early twentieth centuryearly twentieth century Surge in charcoal burning suicide is one Surge in charcoal burning suicide is one important contributing factor important contributing factor The marked increases in suicide rates -- The marked increases in suicide rates -- a complex amalgation of financial disrua complex amalgation of financial disruptions and rapid rise in the use of charcoptions and rapid rise in the use of charcoal burning suicide.al burning suicide.

How suicide rates change in the How suicide rates change in the course of economic recovery?course of economic recovery?

Are there differences between Are there differences between Taiwan and Hong Kong?Taiwan and Hong Kong?

Overall and sex-specific suicide rate trends Overall and sex-specific suicide rate trends in relation to economic fluctuations in in relation to economic fluctuations in

Taiwan, 1997-2007Taiwan, 1997-2007

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Suicide de

aths

per 100

,000

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Une

mploy

men

r rate (%

)

Male suicide rate Female suicide rate Overall suicide rate Unemployment rate

Economic Recession Economic Recovery

Overall and sex-specific suicide rate trends Overall and sex-specific suicide rate trends in relation to economic fluctuations in in relation to economic fluctuations in

Hong Kong, 1997-2007Hong Kong, 1997-2007

0.0

0.5

1.0

1.5

2.0

2.5

3.0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Suicide

dea

ths pe

r 100

,000

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Une

mploy

men

t rate (%

)

Male suicide rate Female suicide rate Overall suicide rate Unemployment rate

Economic Recession Economic Recovery

Charcoal burning suicide rates trends in Charcoal burning suicide rates trends in relation to economic conditions in Taiwan relation to economic conditions in Taiwan

and Hong Kong, 1997-2007and Hong Kong, 1997-2007

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Sui

cide

dea

ths

per 1

00,0

00

Charcoal burning suicide(Taiwan) Charcoal burning suicide(Hong Kong)

Economic Recession Economic Recovery

ARMAX regression analyses of the ARMAX regression analyses of the relationships between unemployment rate and relationships between unemployment rate and

suicide rate trend, charcoal burning suicide suicide rate trend, charcoal burning suicide rate trend in Taiwan and Hong Kong, 1997-rate trend in Taiwan and Hong Kong, 1997-

20072007 Taiwan Hong Kong

1997-2007 1997-2003Economic recession

2003-2007Economic recovery

1997-2007 1997-2003Economic recession

2003-2007Economic recovery

crude adjusted crude adjusted crude adjusted crude adjusted crude adjusted crude adjusted

Overall suicide rate

0.01 0.01 0.07*** 0.08*** -0.07& -0.14* 0.06*** 0.07*** 0.05** 0.04& 0.11*** 0.01

CB suicide rate 0.01 0.01 0.02** 0.02* -0.08* -0.10* 0.06*** 0.03** 0.02* 0.02+ 0.02** 0.04

Note:& p<0.1, + p=0.05, * p<.05, **p<.01, ***p<.0001crude: regression analyses with unemployment rate as the single predictor and suicide rate as outcome variableadjusted: regression analyses assessing the relationship between unemployment rate and suicide rate adjusting for GDP, divorce rate and seasonality

ConclusionConclusion The economic slump fueled the emergence oThe economic slump fueled the emergence of charcoal burning suicide in both Taiwan and f charcoal burning suicide in both Taiwan and Hong Kong.Hong Kong. The arrival of an economic recovery between The arrival of an economic recovery between 2003 and 2007 has delivered different suicide 2003 and 2007 has delivered different suicide patterns in Taiwan and Hong Kong.patterns in Taiwan and Hong Kong. A declining trend in overall suicide rate as welA declining trend in overall suicide rate as well as charcoal burning suicide rate was observel as charcoal burning suicide rate was observed in Hong Kong, however; economic recovery d in Hong Kong, however; economic recovery has not brought down suicide rate in Taiwan. has not brought down suicide rate in Taiwan.

Thank you for your attentionThank you for your attention