Attitudes Toward Suicide Among Chinese People in Hong Kong

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574 Attitudes Toward Suicide in Hong Kong behavior. This tallied with our finding that tudinal complexity of suicide may navigate respondents who were classified under hypo- different forms of prevention efforts to more thetical scenarios as being high risk had more suicidal ideation, made previous suicide at- realistic goals. tempts, and demonstrated a more positive appraisal of suicide than their respective Limitations and Future Research comparison groups. The present study has several limitations that suggest the need for further re- Implications for Suicide Prevention search. First, the findings from a convenience sample clearly cannot be generalized to the Phillips, Liu, and Zhang (1999) sug- general population in Hong Kong or other gested five interacting factors that collec- Chinese communities. The low variance extively determined suicide rates in a commuplained by the identified factors could, for exnity. These included cultural attitudes toward ample, be due to sampling bias toward pro- suicide in addition to the prevalence of social ductive members of society (namely, employees and mental health problems, convenience of and students). Future studies should encommethods of suicide, and comprehensiveness pass a general population sample that in- of suicide prevention services. While intu- cludes socially disadvantaged people who itively plausible, these five factors are not eas- may be more prone to endorse suicide. Secily modifiable, especially by clinicians. In the ond, attitudes do not necessarily translate case of Hong Kong, there is little popula- into behavior in accordance with the multition-based public health policy that addresses factor model of suicide (Manstead, 1996). At- the treatment gap of mental disorders, not to titudes must interact among themselves and speak of their prevention. Widely believed to with non-attitudinal factors in their ultimate be gatekeepers, primary care practitioners are impact on behavior. As such, our findings inadequately trained to manage common should be interpreted cautiously. Third, the mental disorders (Lee, Tsang, & Kwok, CASQ-HK was lengthy and, because of our 2007). The most common methods of suicide failure to secure consent from the partici- in Hong Kong—jumping from height and pants for a second round of distribution, its charcoal burning (Centre for Suicide test-retest reliability was not established. Research and Prevention, 2005)—are hardly Shortening it will allow larger samples of controllable. Moreover, suicide prevention people to be examined and a more stringent efforts are not only limited in quantity but assessment of its psychometric properties. Fi- also have adopted methods (e.g., hotline nally, we believe that attitudinal surveys fail counseling by volunteers and advice to jour- to uncover the layers of privacy and equivonalists on appropriate ways of reporting sui- cality that typically envelop suicide. They cide) that are of questionable usefulness. In should be complemented by ethnographic regards to the findings of the present study, research that elucidates the complex interac- we are still uncertain about how attitudes and tions of attitudes and behaviors in specific contextual factors act in concert to evoke sui- contexts and how large-scale socioeconomic cide, and how attitudinal data can be inte- transformations in Chinese society shape the grated into health interventions to reduce inter-subjective meanings of suicide (Lee & suicide. Nonetheless, acknowledging the atti- Kleinman, 2005). REFERENCES Census and Statistics Department of HKSAR. (2004). Women and men in Hong Kong— vention. (2005). Research findings into suicide and its prevention. Hong Kong: University of Hong Key statistics. Hong Kong: Author. Kong. Centre for Suicide Research and Pre- Goldsmith, S. K., Pellmar, T. C., Klein- 500

Lee et al. 575 man, A. M., & Bunney, W. E. (2002). Reducing behaviour. In G. R. Semin & K. Fieldler (Eds.), suicide—A national imperative. Washington, DC: Applied social psychology (pp. 3–29). London: Sage. National Academies Press. Phillips, M. R., Liu, H. Q., & Zhang, Hjelmeland, H., & Knizek, B. L. (2004). Y. P. (1999). Suicide and social change in China. The general public’s views on suicide and suicide Culture, Medicine & Psychiatry, 23, 25–50. prevention, and their perception of participating Phillips, M. R., Li, X. Y., & Zhang,Y. P. in a study on attitudes towards suicide. Archives of (2002). Suicide rates in China, 1995–1999. Lancet, Suicide Research, 38, 345–359. 359, 835–847. Hsieh, A. C., & Spence, J. D. (1981). Sui- Phillips, M. R. (2004, July). Community atcide and the family in pre-modern Chinese socititudes about suicide in mainland China. Paper preety. In A. Kleinman & T. Lin (Eds.), Normal and sented at the workshop of ICHORTA, Beijing. abnormal behavior in Chinese culture (pp. 29–47). Renberg, E. S., & Jacobsson, L. (2003). Boston: D. Reidel. Development of a questionnaire on attitudes to- Judiciary of the HKSAR. (2004). Corowards suicide (ATTS) and its application in a ner’s Report 2003. Retrieved November 8, 2005, Swedish population. Suicide and Life-Threatening from http://www.judiciary.gov.hk/en/publications/ Behavior, 33, 52–64. publications.htm#con_report Shen, Y. C., Zhang, M. Y., Huang, Y. Q., Lee, S., & Kleinman, A. (2005). Suicide as He, Y. L., Liu, Z. R., Cheng, H., et al. (2006). resistance in Chinese society. In E. J. Perry & M. Twelve month prevalence, severity and unmet Selden (Eds.), Chinese society: Change, conflict and re- need for treatment of mental disorders in metrosistance (2nd ed.; pp. 289–311). London: Routledge. politan China. Psychological Medicine, 36, 1–11. Lee, S., Tsang, A., & Kwok, K. (2007). Statistics Norway. (2004). Statistical Twelve-month prevalence, correlates, and treat- yearbook of Norway. Retrieved November, 8, 2005, ment preference of adults with DSM-IV major from http://www.ssb.no/english/ depressive episode in Hong Kong. Journal of Affec- Wolf, M. (1975). Women and suicide in tive Disorders, 98, 129–136. China. In M. Wolf & R. Witke (Eds.), Women in Lin, Y. H. (1990). The weight of mount Tai: Chinese society, (pp. 111–141). Stanford: Stanford Patterns of suicide in traditional Chinese history and culture. Unpublished doctoral dissertation, Uni- University Press. versity of Wisconsin, Madison. Manuscript Received: January 28, 2006 Manstead, A.S.R. (1996). Attitudes and Revision Accepted: November 1, 2006 501

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