Attitudes Toward Suicide Among Chinese People in Hong Kong

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572 Attitudes Toward Suicide in Hong Kong TABLE 4 Endorsement of Suicide Under Difficult Life Scenarios Life Scenarios Mean Score SD Being terminally ill 2.61* 1.10 Having a chronic psychiatric illness 2.53* 1.12 Being severely depressed 2.50* 1.14 Being a burden to others and feeling hopeless about the future 2.36* 1.11 Being heavily indebted because of gambling 2.22* 1.11 Not having anyone to provide financial or emotional support in old age 2.22* 1.08 Having been raped 2.10 1.09 Being addicted to drugs 1.96 1.02 Being sentenced to imprisonment 1.88 0.94 Having a business failure 1.86 0.95 Being criminally charged 1.81 0.95 Frequently abused or beaten up by spouse 1.75 0.94 Note. Each of the 12 items was measured on a 5-point Likert scale as follows: 5 = definitely consider, 4 = very likely to consider, 3 = probably consider, 2 = probably not consider, and 1 = definitely not consider. *refers to mean score significantly higher than 2 (probably not consider) (p < 0.05) suicide. Filial piety in the Confucian tradi- more sympathetic toward suicidal people tion has often been cited as a Chinese virtue when compared to male respondents. They that protects the elderly from adversities, yet were also more likely to make a distinction the rates of suicide among the elderly are between suicide and attempted suicide. This consistently very high among Chinese com- combination of attitudes appears to protect munities in Hong Kong, China, Taiwan, and them against suicide but, in the presence of Singapore (Lee & Kleinman, 2005). Such a impulsivity, may also make them more likely paradox indicates the need to take a multi- to attempt suicide under circumstances of attitudinal approach to understanding the el- perceived hopelessness (Goldsmith, Pellmar, derly vulnerability to suicide. The present Kleinman, & Bunney, 2002). Conversely, by study provides at least two clues to this vul- making a smaller distinction between suicide nerability. First, terminal and chronic dis- and attempted suicide and demonstrating less eases were the most commonly endorsed ra- sympathy toward suicidal people, male retionales for suicide out of the twelve difficult spondents might be less likely to expect res- scenarios presented to our respondents (Ta- cue or seek help, and more likely to make a ble 4). Second, older respondents were more lethal attempt. This may help explain the fatalistic toward suicide and more likely to higher ratio of suicide/attempted suicide consider suicide under the hypothesized sce- among male than female individuals in both narios. This indicates a clinical need for help- Chinese and Western communities (Lee & ing professionals to be especially sensitive to Kleinman, 2005). The clinical implication of the vulnerability to suicide of Chinese elderly this finding may be that proactive approaches with chronic diseases. are required for helping suicidal males. Pop- Attitudinal variability may stem from ular measures such as hotline counseling may the fact that a given person holds a contradic- not be effective. tory mixture of attitudes that interact among themselves under particular scenarios. In the Cross-Cultural Comparison present study, female respondents exhibited a Different methodologies employed premore negative appraisal of suicide and were clude a valid comparison between the find- 498
Lee et al. 573 ings of our study and those reported in the ceived limited public and policy attention in West. Nonetheless, it is instructive to draw Hong Kong. This echoed our focus group comparisons on certain items of general in- findings, which showed that the professional terest. Thus, we compared five items of the viewpoint of suicide being due to treatable CASQ-HK about the myths and prevention mental disorders such as depression or hav- of suicide with comparable items drawn from ing biological causes was conspicuous by its a Norwegian survey (Table 5; Hjelmeland & absence (except in the group consisting of Knizek, 2004). The results suggest that both healthcare professionals). It was also shown Chinese and Norwegian respondents were by the finding that only 23.9% of responneutral about the statement “People who talk dents endorsed the item “People who at- about suicide do not commit suicide,” but tempted or committed suicide very often had Norwegians showed a stronger agreement to mental illnesses.” How this difference may “There is a risk to evoke suicidal thoughts relate to lower rates of suicide in Norway in a person’s mind if you ask about it.” Our (11.1/100,000 in 2003) than in Hong Kong respondents also demonstrated more agree- (18.6/100,000 in 2003) is worth examining in ment to “Suicide happens without previous the future (Census and Statistics Department warning” and less agreement with “Suicide of HKSAR, 2004; Judiciary of HKSAR, 2004; can be prevented.” Both Chinese and Nor- Statistics Norway, 2004). wegian respondents somewhat disagreed with A study in Sweden examined public at- “Once someone has decided to commit suititudes toward suicide in 1986 and 1996 in cide, it is difficult to change his/her mind.” the context of a multifactor model (Renberg Overall speaking, our respondents exhibited & Jacobsson, 2003). This suggested that at an a more pessimistic attitude than Norwegians individual level, a permissive attitude toward toward the prevention of suicide. This is not suicide was associated with affirmative re- surprising because suicide prevention has re- sponses to questions about one’s own suicidal TABLE 5 Comparison of Response Distribution About the Myths and Prevention of Suicide with the Study by Hjelmeland and Knizek (2004) Strongly In doubt/ Strongly agree Agree Middle Disagree Disagree Nw Hk Nw Hk Nw Hk Nw Hk Nw Hk (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) People who talk about suicide do not commit suicide There is a risk to evoke suicidal thoughts in a person’s mind if one 1.9 3.2 27.4 33.6 52.9 34.3 12.8 26.5 5.1 2.4 asks about it. Suicide happens without previous 1.9 1.5 7.4 7.8 44.1 19.6 34.3 55.3 12.3 15.5 warning. Once a person has made up his/her mind about suicide, nobody can 3.9 4.9 25.3 30.4 32.7 14.7 32.3 41.2 5.8 7.7 stop him/her. 3.9 1.7 15.0 15.3 29.3 21.3 38.1 52.1 13.6 8.4 Suicide can be prevented 36.7 5.3 45.8 32.1 16.3 16.8 0.7 38.8 0.5 6.4 Hk (Hong Kong): findings from this study Nw (Norway): findings shown in the study by Hjelmeland and Knizek (2004) 499
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Attitudes Toward Suicide Among Chinese People in Hong Kong

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