High Rates of Elderly Suicide in Hong Kong


Hong Kong has one of the highest elderly suicide rates in the world. Each year a disproportionate number of suicides are committed by elderly people. Most of the existing suicide prevention programs have very little effect on the elderly, who rarely utilise these programs. In 1996 when the last By-census was conducted in Hong Kong, more than 14 % of the total population were found to be aged 60 year and over. It is projected that, by the year 2000, more than 15 % of the population in Hong Kong will be aged 60 and over, and the actual number would be over one million. Life expectancy in Hong Kong is still rising and stood at 76.3 years for males and 81.8 years for females in 1996.

The 1996 By-Census findings revealed that nearly 28% of the elderly population were widowed, while about 4% had never married and very few had actually been divorced or separated. Economically, the elderly in Hong Kong are probably among the poorest in the population. Since most of them are not receiving any retirement pension, their only way to maintain a living is to rely on their own savings or the support of their children.

The relatively inferior economic position of the elderly has produced an adverse effect in eroding the traditionally prestigious social status held by the elderly. The major source of support for the elderly is provided by their families. However, it has also been well documented that the family system in Hong Kong underwent tremendous changes in the last two decades. These changes included the decreasing size of households and an increasing trend for married children to live away from their parents. Nuclear families have become the dominant family type in Hong Kong since the 1970s. In Hong Kong, suicide ranks seventh in the ten leading causes of death for all ages in Hong Kong.

The crude Hong Kong suicide rate increased by 27% from 9.6 to 12.2 per 100,000 between 1981 and 1994.

However, on an age standardised basis, the increase over the 14 years 1981 to 1994 was only 12.6% from 9.5 to 10.7, indicating that a change in age composition explains more than 50% of the upward trend since the proportion of individuals aged 60 or above increased from 11% in 1981 to 14% in 1994 and the elderly suicide was four or five times above the average. Each year a disproportionate number of suicides are committed by elderly people. For example, in 1994 over 30% of the suicide deaths occurring in Hong Kong were elderly persons aged 60 or above. In the same year, the elderly constituted only 14% of the total population.

The suicide rate in the general population was 12.2 per 100,000 whereas 53.0 suicides per 100,000 were found among the elderly aged 75 or above. Single males aged 60 or above had the highest suicide rate at 80 per 100,000 in 1994. Hong Kong has a relatively low youth suicide rate but one of the highest elderly suicide rates in the world.

For some western countries like Canada, the United States, Australia and the United Kingdom, the elderly suicide rates were not much higher than the average, whereas elderly suicide rates in some European countries (e.g. Germany, Hungary, and Austria) were 2 to 3 times higher than average. The elderly suicide rate in Hong Kong was much higher than the rates in these countries.

Suicide is a very complex problem. It is caused by a variety of reasons, including social, psychological, emotional and situational factors. Prolonged illnesses, death of loved ones, family troubles, frustrations, despair and hopelessness are some of the reasons often cited in cases of attempts of suicide by the elderly. Research studies of suicide notes have indicated that elderly people are much more likely than other age groups to see suicide as a means of escaping from life or a means of alleviating pain. Their motive is simply to end their life. The suicide rates increases with age, with a drastic increase for the groups aged 70-74, and 75 or above.

The male suicide rate is higher than the female one, with a gender ratio of 1.4:1. Unmarried elderly persons tend to have a higher suicide rate, especially the never married and divorced elderly men. On the contrary, the married females have a relatively high suicide rate compared to their male counterparts. Proportionally, more elderly suicide males live in poor living environments, such as: public housing, caged homes, and elderly homes. These elderly men tend to have less family support as compared to elderly males in general.

More elderly suicide cases living in public housing come from relatively older housing schemes in Kwun Tong, Wong Tai Sin, and Kwai Tsing; while those cases living in private housing come mostly from crowded areas, such as Eastern Hong Kong, Mong Kok and Sham Shui Po. No specific distribution pattern can be found between the working status and living districts. About 85% of the deaths occur at home or nearby, and 60% of them are alone just before their deaths. Most of the cases take place during the daytime, between 9 a.m. and 12 p.m. There is no obvious difference in month and day-of-the-week distributions. Research studies confirm that elderly suicide is far more serious than in any other age groups in Hong Kong. In terms of demographic profile, the older elderly person, aged 75 years or above, is more likely to commit suicide. Elderly males and the unmarried elderly are a high-risk group. This might be related to their poor health and limited social support. When elderly persons move into advanced age, many of them are facing significant health problems and some are gradually losing their ability to care for themselves. This multiple loss in later life affects their emotional state. In general, unmarried elderly males have less social support than their female counterparts. Social support is an important aid to elderly persons under psychological stress.

Therefore, providers of care to the elderly should pay more attention to the mental health needs of older elderly people and those who tend to have limited social support. Regarding the socio-economic status, it has been found that the ratio of suicides of economically inactive elderly persons and active ones is 10 to 1. For the elderly a job sometimes means much more than earning a living. It also provides them with an active life style, which is very important to their psychological well-being, especially in this age cohort which has a strong work ethic. Jobs, volunteer work, and social activities can help the elderly maintain an active life style. If the working status and type of accommodation are taken into consideration, there seems to be a relationship between financial hardship and elderly suicides. It is suspected that a better and supportive home environment and an active life style would be effective in helping the elderly to cope with crisis situations. The Hong Kong Government, thus, has promised to provide better accommodation to these "cage home" elderly in public housing estates in the coming years. As to which districts having more elderly suicides, it is clear that the more crowded districts with less facilities tended to have higher suicide rates.

The crowded living environment has long been documented as being a contributing factor to mental health problems. On the other hand, the newly developed suburban areas in Hong Kong, for example, New Territories North, do not have community support services and inadequate medical care due to poor urban planning. Many elderly persons were displaced from their old neighbourhoods to new developments, resulting in a breakdown of neighbourhood support networks. The same problems were faced by those living in rural communities in the New Territories that experienced urbanization. The loss of neighbourhood links can lead to depression, which then leads to suicidal tendencies.

Community support services for the elderly play a pivotal role in integrating old people into new communities and could help prevent suicides. Therefore, it is important that the Government keeps its promise to provide sufficient community support services for the elderly. Because government funding for such services is inevitably limited, districts with the highest suicide rates should be given priority. With an aging population, high suicide rate among the elderly is likely to remain high if the needs of the elderly were not adequately addressed. It is estimated that about 20% of Hong Kong population will be sixty or above by the year 2030.

It is a great pity that our senior citizens after making so much contribution to the community choose to end their lives by committing suicide. Suicide is one of the most disturbing of all kinds of death, especially the disastrous and lasting effects on the survivors. The government and the individuals should by all means to provide the assistance to the elderly.

by Iris Chi (The Hong Kong University).