The suicide rate in Hong Kong has been increasing since 1997, and the suicide rate among the 30-49-year-olds has increased from 294 in 1996, to 484 in 2003, surging about 65% since 1996. Despite the fact that an increasing trend had been observed, the characteristics of suicides among this age group were not known because no empirical research had been conducted among this age group in Hong Kong. The present study is the first psychological autopsy study conducted on the 30-49 age group in a Chinese society. The aims of this study were to identify and examine the magnitude of the risk factors of middle-aged suicide among the Hong Kong citizens, to determine the similarities and applicability of Western findings into local situation, and to recommend culturally specific evidence-based preventive and intervention strategies. These findings suggest that there are more commonalities than differences in risk factors for suicide found in other psychological autopsy studies; however, the magnitude of some of these identified risk factors were inconsistent with suicide research conducted in other countries. Given the multi-faceted and distinctive nature of middle-age suicide in Hong Kong, a public health approach of suicide prevention strategy, which targets both individuals and the population, is considered to be appropriate than the clinical approach in order to reduce larger population developing greater suicidal risk.