published_or_final_version / Social Work / Master / Master of Social Work

Background: Substantial attention has been given to studying suicides among those who had been in contact with healthcare providers. However, effective suicide prevention must target both users (contact) and non-users of healthcare services (non-contact). The non-contact group has been under-researched and prevention programs are often designed based on studies that over-rely on samples of the contact group. Using both quantitative and qualitative methods, this thesis aims to retrospectively explore and explain the profiles and service-use patterns of the non-contact group alongside service utilization models. The quantitative studies, which aimed to identify factors associated with the non-contact groups, were conducted based on the samples drawn from the psychological autopsy study of suicides (aged 15-59) in Hong Kong (2003-2005). Study 1: Portfolio analysis of the non-contact group with psychiatric illnesses Considering psychiatric illness as the basic “evaluated need” for psychiatric service-use, it was controlled for in the comparison between the contact (n=52; 43.7%) and non-contact group (n=67; 56.3%). The non-contact group was associated with having relatively stable employment, a higher level of problem solving ability, unmanageable debts, and non-psychotic disorders. They were evidently different from the contact group, while accounting for a larger proportion of the suicide population. Study 2: Study of suicides without psychiatric illnesses Twenty-nine suicide cases without any psychiatric diagnoses were compared to live controls without diagnoses (n=135), and live controls (n=15) and deceased (n=86) with non-psychotic diagnoses. They were not significantly different to the groups with psychiatric illness on the level of impact from various life events, either acute or chronic, including relationship, family, legal, physical, and job insecurity. However, with fewer signs of detectable abnormalities such as previous suicide attempts, they were not given timely attention from healthcare or psychosocial services. Alternative preventive measures are suggested to address the service needs arising from their negative life events. Study 3: Study of suicides with distress from job insecurity Suicides who were employed at time of death tended to make no contact with healthcare services. They were single, lived alone, earned less income, and suffered from depression. Chronic job insecurity, which was partially mediated by psychiatric illness, was found to influence their non-contact pattern. This could be due to fear of job loss or being stigmatized at work if they decided to receive treatment. Strengthening mental health programs and financial management in workplaces is suggested. Study 4: Study of perceptions towards pathway to care among patients survived from near-lethal suicide attempts The personal accounts of patients that survived from near-lethal suicide attempts revealed that the higher their suicide intent, the lower their perceived needs and the greater their resistance to receiving healthcare services. Themes associated with their non-contact pattern were irrelevancy, non-usefulness and self-reliance. Their views were detouring or against the pathway to care. Conclusion: The non-contact pattern of suicides cannot be explained by conventional service-use models. They showed a distinctive profile from the contact group, and it is suggested that they be helped through proactive prevention programs and / or population-based preventive measures, e.g. restriction of suicide means. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Sociology / Master / Master of Social Sciences

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Social Work / Master / Master of Social Work

Introduction Suicidality and excessive alcohol use are both important public health issues. Various risk factors including alcoholism have been studied and identified to be associated with suicidality. Increasing evidence has shown that excessive alcohol use is associated with a wide range of physical and mental health issues. There is a lack of local study to study the association between alcohol consumption and suicidality in details including the association of different patterns of alcohol use with suicidal thoughts and behaviors. The aim of this study is to study the association between alcohol use and suicidality, taking into account of possible differences between different pattern of alcohol use and various possible confounding factors. Methods This study was based on analysis of data collected in Population Health Survey (PHS) conducted in 2003/04, which was conducted by the Department of Health (HKSAR) and the Department of Community Medicine (HKU). A total of 5600 respondents between the age of 18 to 64 were included in this study. The primary outcome was current suicidal ideation. Association between history of suicidal attempt with the other variables was also studied. The primary predictors variables included alcohol-related variables (presence of drinking, age of first drink, type of drink, amount of drinking, presence of binge drinking), history of mental illness (self-reported known history of depression, anxiety disorder and schizophrenia), level of depression and anxiety (STAI and CES-D scores), quality of life (WHOQOL-BREF score), exercises, stress management and various demographic variables including age, sex, place of birth, marital status, education level and income level. Logistic regression was used to analyze the association between suicidality and alcohol use. Results The prevalence of lifetime history of suicidal attempts is 5.1% in this population. 17.3% has lifetime history of suicidal ideations, 1.3% has a suicidal attempt in the past 1 year and 11.9% have suicidal ideations in the past one week. Being divorced or separated, being female, being a smoker, considering themselves having need for emotional support, having more severe depressive symptoms, having chronic diseases, depression and anxiety disorder were associated with presence of a history of suicidal attempt. The presence of current suicidal ideations was found to be associated with more severe depressive symptoms, poorer quality of life as reflected by a lower physical domain score of WHOQOL-BREF, being single, having history of binge drinking, having recent suicidal thoughts and lifetime history f suicidal thought. The presence of alcohol drinking and larger amount of alcohol intake were not shown to be significantly associated with presence of suicidal ideations and behaviors in the binary logistic regression models. Only the association between presence of current suicidal ideation and binge drinking was shown to be statistically significant. Conclusion This study did not find a strong association between alcohol consumption and suicidality. Among the alcohol-related variables, only binge drinking was found to be statistically significantly associated with current suicidal ideations. Further study to further explore association between alcohol and suicidality should be considered. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences