Centre for Suicide Research and Prevention The University of Hong Kong

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Centre for Suicide Research and Prevention

The University of Hong Kong 香港大學香港賽馬會

防止自殺研究中心 Professor Paul Yip

April 8, 2016


Number of Suicides and Suicide rates in Hong Kong (1997-2014)

Registered death date up to 31 July 2015 (n=845)

Estimation of suicide death in 2014 (n=893) by adjustment with year 2013


Profile of youth suicide in HK

 HK has a different pattern of youth suicide as compared to Western countries

(Yip et al., 2004; Ho, Lee, Tang, & Hung, 1998)

― Suicide rate in the 15-24-year age group is relatively lower than other Western countries such as Australia, NZ, US etc.

― Lower gender ratio among teenagers

― Less depressive disturbance

― Less antisocial disturbance

― Less substance abuse or drug use


Risk factors in youth suicide in HK

• Academic pressure

• Mental illness

• Interpersonal relations (peer, friends)

• Break up in a relationship

• Conflict with family members

T. P. Ho, S. F. Hung, C. C. Lee, K. F. Chung and S. Y. Chung (2000). Characteristics of youth suicide in Hong Kong . Social Psychiatry and Psychiatric Epidemiology

Volume 30, Number 3, 107-112,





BGCA (2009)

 About 4.2% P.1 – P.6 students at critical range for anxiety and depression

Among 2,586 youth aged 15-24 (Yip et al., 2004),

The prevalence rates of suicidal ideation and behavior:

 17.8% considered

 5.4% planning

 8.4% attempt once or above

 1.2% required medical care

Among 2,220 respondents aged 15-29 (Cheung et al, 2004),

 Depressive symptoms: 9%(CES-D) (M:7.3% ; F:10.5%)

 Suicidal ideation: 6.2%

 Suicidal attempt: 2.0% (CSRP, 2005)

Mental health and suicidality in Hong Kong


Lifetime Prevalence of Risky Behaviours in HK Youth

CSRP research:

Telephone survey was conducted in 2013, with a total of 1010

respondents aged 12-29
















0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00%

STD Abortion Unintended pregnancy Drug/ Substance abuse Compensated dating Legal offences Debt problems Unsafe sex Bully others

>5 cigarettes per day Injure self intentionally Bullied by others Consider suicide Drink > 5 drinks in one occasion



At-risk youths with distress in past 4 weeks N=313

Did not seek help N=89 (28%)

Seek informal help (friends / family) N=200 (64%)

Seek formal help (social services) N=24 (7%)

Help-seeking behavior

Expressing distress online


n=64 (72%)


n=165 (83%)


n=18 (75%)

Help-seeking behavior in youth

CSRP research: Telephone survey was conducted in 2013, with a total of 1010 respondents aged 12-29


Contact group - substantial attention

Non-contact group - ranged from 62% to 86% of suicide population (Vassilas and Morgan 1993, 1997; Pirkis and Burgess 1998; Appleby et al. 1999b; Andersen et al. 2000; Miller and Druss 2001; Manchester 2006; Ho, 2003; Hamdi et al, 2008; Law et al, 2010; Phillips, 2009 & 2010) )

The majority of the suicide population had made no contact with psychiatric service before they died

(Law et al., 2010)



With Public Health Approach 從公共健康著手


Suicide Prevention Strategies

~Public Health Approach~

Suicide prevention for high-risk groups would have only modest effect on population suicide rates, even if

effective interventions were developed.

(Lewis, Hawton and Jones, 1997)

Reducing a small risk in a large population is more

effective than for a high risk in a small population

(Rose, 1992)

Lewis, G., Hawton, K., & Jones, P. (1997). Strategies for preventing suicide. British Journal of Psychiatry, 171, 351-354.

Rose, G. (1992) The strategy of preventive medicine. Oxford, England: Oxford University Press.


Public Health Approach

Mercy and Rosenberg 2000, Powell, and Kachur 1995, Potter, Rosenberg, and Hammond 1998, US Department of Health and Human Services 2001

Towards Evidence-based Suicide Prevention Programmes, WHO 2010

Evaluation 評價 What works?

Prevention/ Intervention 預防/介入 How do we do it?

Risk (Protective) Factor Identification 風險因素識別 What’s the cause?

Surveillance 監測 What’s the problem?

Problem 問題 Response 應對


Public Health Approach: Interventions

Source: WHO. (2010)

Tip of the iceberg


The entire population

• Community-based suicide prevention programs

• School-based mental health enhancement programs

• Limiting charcoal access

• Suicide reporting recommendations

Subgroups with risk factors

• Care for suicide survivor project

• Gatekeeper training program

• Consulting for NGOs

High-risk individuals

Volunteer mentorship: help young adults with DSH behaviour


Universal Selective

Bottoms up approach



Intervention in Public Health Approach


Universal Approach

Awareness and Education

Improve recognition of suicide risk and understanding of suicidal behavior and mental illness

Promote help seeking behavior

Reduce stigma of mental illness and suicide

Enhance mental well-being through school-based programs

Little Prince is Depressed, Professor Gooley & The Flame of Mind, The Adventures of DoReMiFa

www.depression.edu.hk www.mindmap.hk


Conceptual framework of the school-based program

 Cognitive-behavioral approach

 Positive psychology intervention

Content of the program

 Emotional competence

 CBT Model & ABC Theory

 Problem-solving skills

 Social & communication skills

 Empathy

 Gratitude

 Hope

 Self-esteem & strengths

 Goal setting

Universal Approach


Social Media Engagement


Centre for Suicide Research and Prevention website - #WeCare


此專頁旨在為關注學生自殺的各界人士提供幫助。我們整理了青少年自殺風 險因素、預警訊號、社區可以提供幫助的資源、如何與青少年傾談的技巧等

,亦針對不同的人士(例如傳媒、網民、家長、學生、校長、老師等)提供 具體的跟進建議。


Centre for Suicide Research and Prevention - Facebook




Intervention in Public Health Approach


Action plan in response to

current situation


Short-term: break or slow down the infection chain


 A hub website to guide different users to relevant resources and information (#WeCare)

 Through psychological autopsy studies to identify potential risk factors in youth and suicide cluster

Social media:

 Stop sharing or reposting sensational suicide news. The message can be delivered by a hashtag campaign

 Facebook users: if they see anyone possibly at suicide risk,

they can @ those NGOs with online services



 Contact the deceased's family and close friends to remind them NOT to set up online memorial for the deceased for now.

 Provide professional training for teachers on early identification and crisis management

 Teachers or school social workers should directly ask or spot students with potential suicidal risk or affected by the recent suicide news

 Active monitoring on Facebook secrets pages and try to contact those showing suicide risk

 Revise the Guideline on Student Suicide and provide training on utilization of the guideline

Short-term: break or slow down the infection chain


CSRP Facebook Promotion strategy:

Re-package webpage information into bite- sized pieces, multi-media illustration.

Share through social networks

@ mass media and online media’s FB accounts

# hashtag campaigns for different initiatives

Collect feedback for webpage updates

http://csrp.hku.hk/wecare Main page:

general information of youth suicide problems (e.g. risk factors, protective factors, warning signs, statistics, intervention suggestions, etc.)

Interaction with readers via email and phone call

Entrance to categorized pages

Mass media, online media, public:

1. Media reporting and online information dissemination guidelines

2. Contact information of experts in

relevant fields 3. Contact information

of social services, including online services

4. Training opportunities 5. Research evidence 6. Examples of good

and poor practices 7. News articles/video

clips relating to this topic

8. Reader’s sharing


1. Self-help manual 2. Contact

information of NGOs that provide services for survivors 3. News

articles/video clips relating to this topic 4. Reader’s


School principals and teachers:

1. Crisis management guidelines

2. Training opportunities 3. Tips for mental

health promotion 4. Educational

psychology resources

5. Contact information of NGOs that provide services for school issues.

6. News articles/video clips relating to this topic

7. Reader’s sharing


1. Suggestions on communication skills

2. Training opportunities 3. Tips for mental

health promotion 4. Contact

information of NGOs that provide services for parental issues, family issues, etc.

5. News

articles/video clips relating to this topic

6. Reader’s sharing


1. Guidelines for student-initiated programs 2. Suggestions on

peer support skills 3. Tips for mental

health promotion 4. Training

opportunities on peer support

5. Contact information of NGOs or school services that provide mental health support.

6. News articles/video clips relating to this topic

7. Reader’s sharing

Figure 1. Architecture of #WeCare Project


Mid-term: vaccine and better care

 Request all of the schools to include mental health programs into regular curriculum

 More mental health training for teachers and parents

 Provide training to all teachers and school staff on suicide prevention

 More mental health awareness training for the public

 Increase the capacity of school psychologists and social workers

 Support NGOs to develop services that meet youth's needs

 Facilitate those self-initiated helping programs or mental health



Long-term: change the context/culture

 Reform education system to ensure students' well-being

 Change family dynamics to more open and supportive communications between family members

 Legislate to protect youth's mental health, including that the media should not report any personal information of under-aged person, even if the person is dead.

 Change help-seeking culture to "it's ok to seek help.“

 Through psychological autopsy studies and other related research

studies, to identify effective strategies for suicide prevention


What else can we do to

prevent student suicide?


Preparing students for new transition

 The purpose of preparation class is to lessen students’ burden

 But does teaching English, Chinese or maths really help lessen their stress or burden?

 Or how shall we prepare them?

Preparatory classes introduce concepts taught in P1, build basic skills and clear misconceptions

(Sources: The Straits Times, 28 Dec 2015)

Over the last six months, XX, who will start at XXX Primary School next month, attended weekly preparatory lessons in

Primary 1 subjects – English, Chinese and maths – on top of her regular kindergarten classes.


Preparing students for new transition

Goal: to reduce students’ anxiety and build social network

Orientation program for primary school students

― Ice breaking games

― Group activities (teachers are welcomed to join)

― Introduction of one’s character strengths (positive psychology)

― School tour

• Buddy system (pair up new students with older students)

• Introduction of the school environment and facilities

• Introduction of teachers and other staff

• Be familiar with the new schedule

• Activities for enhancing mental health awareness


Preparing students for new transition

Goal: to enhance one’s problem-solving skills and build social network

Orientation program for secondary school students

Ice breaking games

Welcoming lunch

School tour

Introduction of the teachers, social workers and other staff

Introduction of the activities/clubs that are available for students

Be familiar with the new schedule

Former students to share their school lives, such as:

How to build one’s own social network

How to ask and seek help

How to deal with academic stress

How to establish good habits

Open discussion about the changes student will experience

Activities for enhancing mental health awareness


Community plays Important Roles in

Suicide Prevention Work


If we don’t win their hearts today,

they will break our hearts tomorrow.

Photo by Centre for Suicide Research and Prevention



Suicide Prevention Services

Suicide Prevention Services (24-hour) 2382 0000 The Samaritan Befrienders Hong Kong (24-hour) 2389 2222 The Samaritans (24-hour Multi-lingual suicide

prevention services)

2896 0000

Social & Legal Services Information and Telephone

Caritas Family Crisis Support Centre (24-hr) 18288 Social Welfare Department Hotline Service

Monday to Saturday (9am – 10pm)

2343 2255

Legal Aid Department (24-hr) 2537 7677 Domestic Violence Hotline for women 2375 5322 Victim of abused women – Harmony Family

Services (24-hr)

2522 0434

Harmony Family Services (for men) 2295 1386





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