powerpoint簡報-香港醫(yī)學(xué)會

1、Elderly Suicide in Hong Kong香港長者的自殺狀況研究,Prof. Helen Chiu 趙鳳琴教授Head, Department of Psychiatry 精神科學(xué)系主任Faculty of Medicine 醫(yī)學(xué)院 The Chinese University of Hong Kong 香港中文大學(xué),Trend in Suicide Rates (by Age Groups) from

2、 1990-2005自殺率趨勢 (按年齡組別 ) 1990-2005,Census and Statistics Dept of HKSAR 香港政府統(tǒng)計處,Latest official suicide statistics (2005)最新官方公布的自殺率 (2005),Suicide in Elderly長者的自殺狀況,Elderly suicide rates 2 to 3 times rates in youn

3、ger adults in Hong Kong 香港長者的自殺率比青少年的高2至3倍Elderly suicide rates tend to be high in Asian countries despite traditional veneration of the elderly亞洲國家的自殺率屬偏高, 儘管有著尊敬長者的傳統(tǒng) Few studies on elderly suicide in Hong

4、Kong and Asia 在亞洲及香港罕有關(guān)於長者自殺情況的研究,Suicide Rates (per 100,000) by Gender, Age and Place自殺率 (每 10萬人口) 按性別，年齡和地方組別,來源︰WHO，2002,Suicide Rates (per 100,000) by Gender, Age and Place自殺率 (每 10萬人口) 按性別，年齡和地方組別,來源︰WHO，2

5、002,Attempted Suicide in the elderly (Chiu et al, 1996) 長者的自殺未遂,55 subjects ? 65 yearsMale :Female 1:1.6 40% of cases occurred after 75Self-poisoning accounted for over 90% of cases of attempted suicide in

6、 western studiesBut only 27.3% in our studySelf-injury --- 72.7%,55 位長者 (年齡65及以上)男女比例為 1:1.640% 發(fā)生於75歲以後在西方的研究中，服毒自殺的案例佔超過90%在我們研究中只佔27.3%自殘 – 72.2%,49.1% had depression 49.1% 有抑郁癥 lower than most p

7、ublished data (70-90%) 比大部分發(fā)表的文獻數(shù)據(jù)為低 (70-90%)36% no psychiatric diagnosis 36% 沒有確診為精神病,FU for 2 to 4 years --- 2 至 4年跟進計劃Repetition rate of 3.6% is low compared with previous studies in western count

8、ries (around 8 to 20%) 與西方國家的研究(大約8到20%) 作比較，有3.6%較低的重複率Rate of completed suicide --- 5.5% 自殺死亡率 --- 5.5%Rates of 2-8% in studies in western countries 西方國家的自殺死亡率為2-8%,Psychological Autopsy Study

9、心理剖析研究,retrospective study of elderly suicide by interviewing informants 通過對家屬或親友進行回顧性研究case control study 病例對照研究法 identify risk factors 鑑定危險因素,,Psychological Autopsy Study (Chiu et al, 2004)

10、心理剖析研究,70 suicide cases100 community control elderlyage ? 60Results:87% of suicide cases had a mental disorder compared to 9% of controls, in particular depressive illness60% of suicide subjects had expressed sui

11、cidal intention before suicide,70 位自殺病例100位社區(qū)對照長者年齡 ? 60結(jié)果︰87%的自殺病例與9%的對照病例有精神紊亂，尤其抑郁癥 60%的自殺長者在自殺之前曾經(jīng)表示自殺的意念,Psychological Autopsy Study心理剖析研究,Results: 75% of suicide subjects had consulted a doctor within 1 m

12、onth of death compared with 39% of control 與39%的對照病例相比較，75%的自殺長者在的1個月內(nèi)曾經(jīng)看過醫(yī)生Suicide cases -- ?negative life events, ?no. of physical illness, ?cancer, ?pain, ?past hx of attempted suicide 自殺長者 – 有較多的;

13、 負(fù)面生活事件，普通科疾病， 癌癥，痛癥，自殺未遂史,Suicidal attempts in the elderly (Tsoh et al, 2005)長者自殺未遂,66 suicide attempters 66位有自殺未遂的長者91 subjects from community 91位來自社區(qū)的對照組68.2% of suicide attempters had majo

14、r depression 68.2% 位有自殺未遂的病例患有重型抑郁癥Major depression associated with 60-fold increased risk for attempted suicide 患有重型抑郁癥會有自殺未遂的風(fēng)險比其他高出60倍Past suicidal attempts, poor ADL, arthritis, low conscientiousn

15、ess ? risk 有自殺史，自理能力較差，有關(guān)節(jié)炎癥，低自覺性有較高風(fēng)險Co-residence with children ? risk 與子女同住者風(fēng)險較低,Clues to suicide prevention in HK(Chiu et al, 1996; 2004; Tsoh et al, 2005)香港預(yù)防自殺的線索,Psychiatric illness, esp. depre

16、ssion is an important risk factor of suicide 精神病 ，尤其是抑郁癥是一個重要的自殺危險因素Attention should be paid to those with past suicidal attempt and those expressing suicidal ideas 需要密切關(guān)注有自殺未遂史和曾經(jīng)表示有企圖自殺的人Poor health an

17、d pain ? suicide risk 身體差和有病痛均會增加自殺風(fēng)險Primary care doctors may be gate keepers to detect suicidal elderly 社區(qū)前線醫(yī)生可為偵查長者自殺把關(guān),SARS and Elderly Suicide in Hong Kong非典型肺炎和香港的長者自殺,(Chan et al, 2006),Surveillance

18、 data on rate of completed suicide自殺死亡率的監(jiān)測數(shù)據(jù),SARS and Elderly Suicide (Chan et al, 2006) 非典型肺炎和長者自殺,There is an apparent increase insuicide rates in older persons in 2003, which may be related to SARS outbreak Ol

19、der people may be more vulnerable :disruption of health caredisruption of social network and supportproneness to exaggerated pessimism because of high mortality of SARS in older persons,在2003年，香港長者的自殺率有明顯的增加，這可能與非