Attitudes Toward Suicide Among Chinese People in Hong Kong

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566 Attitudes Toward Suicide in Hong Kong China [HKSAR], 2004; Census and Statistics Chinese subjects (Phillips, 2004). This ver- Department of HKSAR, 2004). sion of the CASQ was then adapted for the Published research on suicide and at- present study after another round of nine fotempted suicide in Hong Kong has focused cus groups conducted among Chinese sub- on the analysis of trends, methods of suicide, jects in Hong Kong. risk factors, and its association with mental With written informed consent, nine disorders (Centre for Suicide Research and focus groups with a total of 82 participants Prevention, 2005). The findings of these stud- (41 males and 41 females) were conducted in ies are usually derived from a quantitative Hong Kong in a quiet group room of a analysis of clinical or population data and university department from April 13 to June provide an informative epidemiological pro- 7, 2002. Six of the groups consisted of people file of suicide. Nonetheless, they have limited of different age categories (namely, 15–19, explanatory power with regard to the cultural 20–26, 27–38, 39–50, 51–65 and 66 years or meanings of suicide among Chinese people above, respectively). The other three groups (Hsieh & Spence, 1981; Lee & Kleinman, were composed of suicide attempters, health- 2005; Wolf, 1975). care professionals, and policy-related per- Cultural meanings are linked to social sonnel. attitudes. Since individuals draw upon cul- During the focus groups, we used tural representations of suicide when they open-ended questions to probe participants’ contemplate, attempt, or commit suicide, perception of such issues as what suicide was, studying public attitudes toward suicide may why it happened, how common it was, what help us elucidate the causes and patterns of kind of people it affected, how it influenced suicide in a community (Lee & Kleinman, others, and what could be done to prevent it. 2005). Attitudinal research may also shed We then presented 13 scenarios of fatal and light on theories of suicide in general. To nonfatal suicides to the participants. The sce- date, no systematic study of Chinese attitudes narios were about problems arising from love toward suicide has been carried out in Hong relationships, chronic psychiatric illness, in- Kong or mainland China. Thus, the authors law oppression, domestic violence, haunting (from Hong Kong, Beijing, and Boston, MA, by ghosts, nonfilial children, repeated failures respectively) carried out a collaborative proj- in a college entry examination, parental disect that combined qualitative and quantita- approval of marriage, business failure, alcotive methods to assess attitudes toward suihol/gambling, unexplained depression, tercide in several communities in China minal cancer, and impulsive wrist-slashing including Hong Kong. The present paper re- related to loss of face. Each focus group ports the findings from Hong Kong. lasted 2 hours. The sessions were taperecorded, transcribed, and analyzed using the QSR Nvivo text analysis software. From the main themes the investigators derived by listening METHOD to the tapes, the text analysis created nine Instrument primary nodes for content organization. These included a general impression about suicide in society, personal attitudes toward The Chinese Attitude Toward Suicide suicide, methods used, reasons for suicide, Questionnaire (CASQ) was generated on the perception of impulsivity, acceptance of sui- basis of text analysis (using QSR Nvivo softcide, and the consequence and prevention of ware) of 101 focus groups and 18 in-depth suicide. Subbranches of the content were ininterviews conducted by the mainland aucluded in each node and the number of octhors (LX, MP). It was revised after two sub- currences was counted for each subbranch. sequent pilot tests of the preliminary scales Additional questions were derived from each in approximately 2,000 randomly selected subbranch that occurred frequently. 492
Lee et al. 567 The revised version of the Chinese At- nese University of Hong Kong to their titude Toward Suicide Questionnaire–Hong friends and relatives. Informed consent was Kong (CASQ–HK, available upon request) obtained from the participants and confiden- consists of 98 items. It was pilot-tested with tiality and anonymity were assured. A total of 96 individuals of varied sociodemographic 746 and 480 questionnaires were collected, background in August 2004. Further revi- respectively. The overall response rate was sions were then made so that the items would 81.7%. Statistical analysis was carried out convey their intended meanings effectively. The final version of the CASQ-HK consists of three parts. Part A is composed of 73 with SPSS 13.0 for Windows. statements about attitudes toward suicide on a 5-point Likert scale (1-greatly agree, 2- RESULTS agree, 3-neutral, 4-disagree, 5-greatly disagree). Part B includes 12 statements about Sociodemographic Characteristics 12 difficult scenarios. Respondents were The demographic distribution of re- asked on a 5-point Likert scale (5–definitely spondents is shown in Table 1. The mean age consider, 4–very likely to consider, 3–probably of males was 36.3 years (SD = 15.2) and for consider, 2–probably not consider, and 1–definitely females, 31.8 years (SD = 13.9). There were not consider) their likelihood of considering more males than females and most respon- suicide in those scenarios. Part C was composed of 13 items about sociodemographics dents reported no religious affiliation. and the presence of serious suicidal ideation, previous suicidal attempt, and having known Reliability and Factor Analysis someone who attempted or committed sui- The Cronbach’s alpha of the CASQcide previously. Approval for the study was HK is 0.852. Part A of the CASQ-HK was obtained from the research ethics committee factor analyzed using the principal axis facof The Chinese University of Hong Kong. toring method with varimax rotation. A nine- Owing to the sensitivity of the topic, several factor model, which together explained 36.1% hotlines for help-seeking were provided at of the total variance, emerged as the most in- the end of the questionnaire. terpretable and could be considered an ade- Although we renamed the CASQ-HK quate representation of the data provided by as an instrument that examined attitudes to- the sample of respondents. In Table 2 the ward life and death, our attempts to approach items with loadings of more than 0.35 on any several organizations for data collection, such of the factors are displayed. The nine factors as schools, corporations, and old age homes, pertained to negative appraisal, stigma, sui- were uniformly refused. According to the ad- cidal spectrum, fatalism, social change, sup- ministrators of those institutions, they were port, contagiousness, sympathy, and function. concerned that their study could evoke sui- Sixteen items (available from the authors cidal ideas among their students, staff, or inmates that they did not know how to handle. Survey Participants upon request) did not load on any factors. Variation of Attitudes Toward Suicide Items on each of the nine factors were We eventually recruited a convenience scored from 1 to 5, with a higher score indisample that was composed of Chinese people cating stronger disagreement. Items with op- born and living in Hong Kong. One thouposite meanings were reversely scored. These sand questionnaires were distributed to staff scores were tested using two-tailed t tests and members of a medium-sized trading com- ANOVA at the significance level of 0.05 to pany. Another 500 questionnaires were dis- compare differences across demographic sub- tributed by nine student helpers of The Chi- groups (Table 3). Although males showed a 493
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Attitudes Toward Suicide Among Chinese People in Hong Kong

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