Centre for Suicide Research and Prevention The University ... · Drug/ Substance abuse Compensated...
Transcript of Centre for Suicide Research and Prevention The University ... · Drug/ Substance abuse Compensated...
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
0.30%
0.70%
1.20%
2.50%
2.70%
2.70%
6.10%
8.40%
9.50%
10.20%
10.4%
14.60%
20.50%
28.10%
28.10%
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
Gambling
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
Yes
n=64 (72%)
Yes
n=165 (83%)
Yes
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)
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 Indicated
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
Projects
Universal
Selective
Bo
ttom
s u
p a
pp
roach
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
Centre for Suicide Research and Prevention website - #WeCare
http://csrp.hku.hk/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 https://www.facebook.com/hkucsrp
Short-term: break or slow down the infection chain
CSRP:
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
EDB:
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
Survivors:
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
sharing
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
Parents:
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
Students:
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
campaigns
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
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
If we don’t win their hearts today,
they will break our hearts tomorrow.
Photo by Centre for Suicide Research and Prevention
RESOURCES AVAILABLE
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