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
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/185516 |
| Date | January 2012 |
| Creators | Law, Yik-wa., 羅亦華. |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Source | http://hub.hku.hk/bib/B48079662 |
| Rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works., Creative Commons: Attribution 3.0 Hong Kong License |
| Relation | HKU Theses Online (HKUTO) |
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