Exploring root causes of suicide in Hong Kong through a network analysis

School-related issues, financial difficulties and physical illness are the primary reasons for suicide in Hong Kong citizens aged <20 years, 20–59 years, and ≥60 years, respectively, and physical illness will become the most common reason due to the rapidly ageing population, according to a network analysis.

“Suicide is a complex and multifaceted issue, which is often driven by multiple interacting factors. It has been challenging to identify reasons for suicide using existing scientific methodologies,” wrote the researchers from the University of Hong Kong. “[Our] study aims to identify critical reasons for suicide and suicidal behaviours through a novel network analysis.”

In the territory-wide study using Hong Kong Coroner’s Court reports from 2002–2019, the researchers identified 13,001 suicide cases (mean age at suicide, 50.9 years; male, 62.8 percent) as a concurrence network and calculated eigencentrality of each reason for suicide to determine its relative importance. [Lancet Reg Health West Pac 2023;36:100752]

“Of all suicide cases, there were twice as many males as females [62.8 percent vs 37.2 percent],” reported the researchers. “The youngest and oldest cases were 8 years and 105 years of age, respectively.” Overall, 40 percent of suicide cases were triggered by multiple factors.

School and family issues (eigencentrality, 0.43 and 0.26, respectively) were the primary precipitating factors for suicide among children and adolescents aged <20 years. “Within Hong Kong’s contexts, the psychosocial development phase of teenagers may often be in conflict with parent-imposed emphasis on academic performance, thereby increasing teenagers’ suicide risk,” noted the researchers.

Financial difficulty was the main reason for suicide in adults of working age (eigencentrality, 0.34 for the age group of 20–39 years and 0.39 for the age group of 40–59 years), but its importance differed between males and females (eigencentrality, 0.51 vs 0.14). “This may point towards broader East Asian cultural and sex-age norms, which require men to be the primary breadwinners in the family,” commented the researchers.

Physical illness was the major reason for suicide in older adults aged >60 years (eigencentrality, 0.80). Notably, as Hong Kong’s population has been rapidly ageing, reasons for suicide in the overall population have shifted from financial difficulties in the early 2000s to physical illnesses since 2011. A simulation study by the researchers indicated that most suicide cases will be attributed to physical illness by 2050 due to the changing population structure.Approximately 64 percent of older adults in Hong Kong have ≥1 chronic disease. “Since older adults in Hong Kong typically embody traditional Chinese culture and rely heavily on their families for financial support, they may perceive themselves as a burden if they have a chronic disease or require additional support. In such cases, suicide may be viewed as a way of escape,” explained the researchers.

According to the researchers, the network analysis provides data-driven information, based upon which effective and proactive suicide prevention strategies can be developed for different age and gender groups. “[Importantly,] our findings serve as a reminder for policymakers in East-Asian countries with similarly ageing populations [eg, Singapore, Japan] to take early precautionary steps to prevent a similar situation,” highlighted the researchers.