Suicide in Asia

The purpose of this post is to highlight the differences in epidemiologic characteristics and the risk factors between Asia and Western suicides.  A study by Chen, Wu, Yousuf & Yip (2011) reported that the overall suicide rate in Asia is approximately 19.3 per 100,000, about 30% higher than the global rate of 16.0 per 100,000. (p.129).  During a 12-year period (from 1995-2009), the top three suicide rates countries are Japan (24 per 100,000), South Korea (31.0) and Sri Lanka (23.0).  Hong Kong and China stood at 13.8 and 6.6, respectively. 

Unlike the Western countries, where suicide rates for males are about 3-4 times higher than those for females, in several Asian countries like Hong Kong, the gap between male and female suicide rates is smaller.  Whilst Hong Kong and Australia have similar suicide rates, the gender ratio (male-to-female) are about 4 and 2, respectively.  The gender ratio for the US was 3.8 in 2009.  This implies that the suicide rates for Hong Kong females is higher than that of the Australian and US females, while a lower suicide rate for males in Hong Kong is observed compared to the Western counterparts.

Although the risk factors for suicide such as mental disorders, alcohol-related disorders, previous history of suicide attempt, and stressful life event appear to be universal (as reported in the earlier blog post), there are differences with respect to mental disorders and stressful life events.  As mentioned in an earlier blog post, Tondo and Baldessarini (2011) that 90% of suicides in the US occur in persons with a clinically diagnosable psychiatric disorder, particularly patients with bipolar depression disorder.  However, it was reported that in China 40% of suicides suffered from depression and that the overall rate of mental disorders in suicide completers is 63%.  In Hong Kong, depression was found in 51% and 53% of middle-aged and old adult suicides, respectively. 

An underlying cause that explains the differences of the nature in stressful life events between Asian and the West is the Confucian notion of hierarchy and familial relationships.  This in turn can also help explain the narrower gender ratio gaps in Asia.  Family dispute is a critical factor for suicide among women in many Asian countries.  The low social status of women has been suggested as a potential link to the high suicide rates for Asian women involved in abusive family relationships.  Abusive marriage relationship is a common cause for women suicides reported in Hong Kong.  Moreover, under a family-centered culture where the male is the head of a family, unemployment or job-related stress is a more common reason of suicide among Asian men than their Western counterparts.

 

An important implication of these differences in risk factors between Asian and the West is a need to develop cultural-specific intervention strategies.  Social support is likely to be a critical protective factor for preventing suicidal behavior in Asia.  In addition, community-based suicide intervention programs are an effective tool in light of the strong family and community ties in Asia.

In the coming posts, I will focus on the topic of this blog - suicide of youths and young adults in Hong Kong.  Besides sharing on research article reviews, I will also provide some personal views of how to prevent youth suicide.  Stay-tune!

References

Chen, Y. Y., Wu, K.C.C., Yousuf, S. & Yip, P.S.F. (2011). Suicide in Asia: opportunities and challenges.  Epidemiologic Reviews, 34, 13, 129-144. Doi: 10.1093/epirev/mxr025