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Article: Depressive symptoms and suicide in 56,000 older Chinese: a Hong Kong cohort study

TitleDepressive symptoms and suicide in 56,000 older Chinese: a Hong Kong cohort study
Authors
Sun, WJXu, LChan, WMLam, THSchooling, CM
KeywordsDepressive symptoms
Geriatric Depression Scale
Suicide
Issue Date2011
PublisherSpringer Medizin. The Journal's web site is located at http://www.springer.com/steinkopff/psychiatrie/journal/127
Citation
Social Psychiatry And Psychiatric Epidemiology, 2011, p. 1-10 How to Cite?
DOI: http://dx.doi.org/10.1007/s00127-011-0362-z
AbstractObjective: To examine dose-response associations between depressive symptoms and suicide and modification effects of sex, age and health status in older Chinese. Methods: We used the Chinese version of the 15-item Geriatric Depression Scale (GDS) to measure depressive symptoms (GDS score ≥ 8) and Cox regression to examine association with suicide mortality in a population-based cohort of 55,946 individuals, aged 65 years or above, enrolled from July 1998 to December 2000 at one of 18 Elderly Health Centres of Hong Kong Department of Health. The cohort was followed up for suicide mortality till 31 March 2009 (mean follow-up 8.7 years). Results: Depressive symptoms were associated with suicide in men [hazard ratio (HR) 2.03, 95% confidence interval (CI) 0.96-4.29] and women (HR = 2.36, 95% CI 1.31-4.24) after adjusting for age, education, monthly expenditure, smoking, alcohol drinking, physical activity, body mass index, health status, and self-rated health. There was no threshold for GDS score and suicide in either sex. Age, sex and health status did not modify the association. Conclusions: Depressive symptoms predict higher suicide risk in older Chinese in a dose-response pattern. These associations were not attenuated by adjustment for health status, suggesting that depressive symptoms in older people are likely to be an independent causal factor for suicide. The GDS score showed no threshold in predicting suicide risk, suggesting that older people with low GDS scores deserve further attention and those with very high scores need urgent intervention. © 2011 The Author(s).
Persistent Identifierhttp://hdl.handle.net/10722/145985
ISSN
0933-7954
2023 Impact Factor: 3.6
2023 SCImago Journal Rankings: 1.780
PubMed Central ID
PMC3304054
ISI Accession Number ID
WOS:000301786400001
Funding AgencyGrant Number
Health Care & Promotion Fund Committee, Hong KongS111016
Funding Information:

This project was funded by grant S111016 from the Health Care & Promotion Fund Committee, Hong Kong. We declare that we have no conflict of interest in the present study.

References

Kasckow J, Liu N, Haas GL, Phillips MR (2010) Case-control study of the relationship of depressive symptoms to suicide in a community-based sample of individuals with schizophrenia in China. Schizophr Res 122(1–3):226–231 doi: 10.1016/j.schres.2010.02.1056

Maris RW (2002) Suicide. Lancet 360(9329):319–326 doi: 10.1016/S0140-6736(02)09556-9

Chan SS, Chiu HF, Chen EY et al (2009) Population-attributable risk of suicide conferred by axis I psychiatric diagnoses in a Hong Kong Chinese population. Psychiatr Serv 60(8):1135–1138 doi: 10.1176/appi.ps.60.8.1135

Cheng ST, Yu EC, Lee SY et al (2010) The geriatric depression scale as a screening tool for depression and suicide ideation: a replication and extention. Am J Geriatr Psychiatry 18(3):256–265 doi: 10.1097/JGP.0b013e3181bf9edd

Sokero TP, Melartin TK, Rytsala HJ (2003) Suicidal ideation and attempts among psychiatric patients with major depressive disorder. J Clin Psychiatry 64(9):1094–1100 doi: 10.4088/JCP.v64n0916

Vannoy SD, Duberstein P, Cukrowicz K (2007) The relationship between suicide ideation and late-life depression. Am J Geriatr Psychiatry 15(12):1024–1033 doi: 10.1097/JGP.0b013e3180cc2bf1

Norlev J, Davidsen M, Kjoller M (2006) Six year follow-up of health status changes in Danish adults with suicide tendency in 1994. Suicide Life Threat Behav 36(1):103–112 doi: 10.1521/suli.2006.36.1.103

Conwell Y, Duberstein PR, Hirsch JK (2010) Health status and suicide in the second half of life. Int J Geriatr Psychiatry 25(4):371–379 doi: 10.1002/gps.2348

Li ZB, Ho SY, Chan WM (2004) Obesity and depressive symptoms in Chinese elderly. Int J Geriatr Psychiatry 19(1):68–74 doi: 10.1002/gps.1040

Schooling CM, Lam TH, Li ZB et al (2006) Obesity, physical activity, and mortality in a prospective chinese elderly cohort. Arch Intern Med 166(14):1498–1504 doi: 10.1001/archinte.166.14.1498

Cheng ST, Chan AC (2005) Comparative performance of long and short forms of the Geriatric Depression Scale in mildly demented Chinese. Int J Geriatr Psychiatry 20(12):1131–1137 doi: 10.1002/gps.1405

Chan AC (1996) Clinical validation of the Geriatric Depression Scale (GDS): Chinese version. J Aging Health 8(2):238–253 doi: 10.1177/089826439600800205

Lam TH, Ho SY, Hedley AJ et al (2001) Mortality and smoking in Hong Kong: case-control study of all adult deaths in 1998. BMJ 323(7309):361 doi: 10.1136/bmj.323.7309.361

Satagopan JM, Ben-Porat L, Berwick M et al (2004) A note on competing risks in survival data analysis. Br J Cancer 91(7):1229–1235 doi: 10.1038/sj.bjc.6602102

Andersen PK, Abildstrom SZ, Rosthoj S (2002) Competing risks as a multi-state model. Stat Methods Med Res 11(2):203–215 doi: 10.1191/0962280202sm281ra

Miller G (2006) Mental health in developing countries. China: healing the metaphorical heart. Science 311(5760):462–463 doi: 10.1126/science.311.5760.462

Wong PW, Yeung AW, Chan WS et al (2009) Suicide notes in Hong Kong in 2000. Death Stud 33(4):372–381 doi: 10.1080/07481180802705791

Martinsen EW (2008) Physical activity in the prevention and treatment of anxiety and depression. Nord J Psychiatry 62(Suppl 47):25–29 doi: 10.1080/08039480802315640

Lee S, Tsang A, Li XY et al (2007) Attitudes toward suicide among Chinese people in Hong Kong. Suicide Life Threat Behav 37(5):565–575 doi: 10.1521/suli.2007.37.5.565

Phillips MR, Shen Q, Liu X et al (2007) Assessing depressive symptoms in persons who die of suicide in mainland China. J Affect Disord 98(1–2):73–82 doi: 10.1016/j.jad.2006.07.020

Bradvik L, Mattisson C, Bogren M et al (2008) Long-term suicide risk of depression in the Lundby cohort 1947–1997–severity and gender. Acta Psychiatr Scand 117(3):185–191 doi: 10.1111/j.1600-0447.2007.01136.x

Murphy E, Smith R, Lindesay J et al (1988) Increased mortality rates in late-life depression. Br J Psychiatry 152:347–353 doi: 10.1192/bjp.152.3.347

Penninx BW, Beekman AT, Honig A et al (2001) Depression and cardiac mortality: results from a community-based longitudinal study. Arch Gen Psychiatry 58(3):221–227 doi: 10.1001/archpsyc.58.3.221

Bolton JM, Belik SL, Enns MW et al (2008) Exploring the correlates of suicide attempts among individuals with major depressive disorder: findings from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 69(7):1139–1149 doi: 10.4088/JCP.v69n0714

Gunnell D, Rasul F, Stansfeld SA et al (2002) Gender differences in self-reported minor mental disorder and its association with suicide. A 20-year follow-up of the Renfrew and Paisley cohort. Soc Psychiatry Psychiatr Epidemiol 37(10):457–459 doi: 10.1007/s00127-002-0579-y

Ryan J, Carriere I, Ritchie K et al (2008) Late-life depression and mortality: influence of gender and antidepressant use. Br J Psychiatry 192(1):12–18 doi: 10.1192/bjp.bp.107.039164

Ran MS, Xiang MZ, Li J et al (2007) Correlates of lifetime suicide attempts among individuals with affective disorders in a Chinese rural community. Arch Suicide Res 11(1):119–127 doi: 10.1080/13811110600993090

Hughes D, Kleespies P (2001) Suicide in the medically ill. Suicide Life Threat Behav 31(Suppl):48–59 doi: 10.1521/suli.31.1.5.48.24226

Hakko H, Manninen J, Karvonen K et al (2008) Association between physical illnesses and depressive symptoms requiring hospitalization in suicide victims. Psychiatry Res 160(3):271–277 doi: 10.1016/j.psychres.2007.07.025

Licht-Strunk E, Van Marwijk HW, Hoekstra T et al (2009) Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up. BMJ 338:a3079 doi: 10.1136/bmj.a3079

Hantouche E, Angst J, Azorin JM (2010) Explained factors of suicide attempts in major depression. J Affect Disord 127(1–3):305–308 doi: 10.1016/j.jad.2010.04.032

Grants
A prospective study of major risk factors and mortality in the clients of the Hong Kong elderly health services

 

DC FieldValueLanguage
dc.contributor.authorSun, WJen_HK
dc.contributor.authorXu, Len_HK
dc.contributor.authorChan, WMen_HK
dc.contributor.authorLam, THen_HK
dc.contributor.authorSchooling, CMen_HK
dc.date.accessioned2012-03-27T09:04:43Z-
dc.date.available2012-03-27T09:04:43Z-
dc.date.issued2011en_HK
dc.identifier.citationSocial Psychiatry And Psychiatric Epidemiology, 2011, p. 1-10en_HK
dc.identifier.issn0933-7954en_HK
dc.identifier.urihttp://hdl.handle.net/10722/145985-
dc.description.abstractObjective: To examine dose-response associations between depressive symptoms and suicide and modification effects of sex, age and health status in older Chinese. Methods: We used the Chinese version of the 15-item Geriatric Depression Scale (GDS) to measure depressive symptoms (GDS score ≥ 8) and Cox regression to examine association with suicide mortality in a population-based cohort of 55,946 individuals, aged 65 years or above, enrolled from July 1998 to December 2000 at one of 18 Elderly Health Centres of Hong Kong Department of Health. The cohort was followed up for suicide mortality till 31 March 2009 (mean follow-up 8.7 years). Results: Depressive symptoms were associated with suicide in men [hazard ratio (HR) 2.03, 95% confidence interval (CI) 0.96-4.29] and women (HR = 2.36, 95% CI 1.31-4.24) after adjusting for age, education, monthly expenditure, smoking, alcohol drinking, physical activity, body mass index, health status, and self-rated health. There was no threshold for GDS score and suicide in either sex. Age, sex and health status did not modify the association. Conclusions: Depressive symptoms predict higher suicide risk in older Chinese in a dose-response pattern. These associations were not attenuated by adjustment for health status, suggesting that depressive symptoms in older people are likely to be an independent causal factor for suicide. The GDS score showed no threshold in predicting suicide risk, suggesting that older people with low GDS scores deserve further attention and those with very high scores need urgent intervention. © 2011 The Author(s).en_HK
dc.languageengen_US
dc.publisherSpringer Medizin. The Journal's web site is located at http://www.springer.com/steinkopff/psychiatrie/journal/127en_HK
dc.relation.ispartofSocial Psychiatry and Psychiatric Epidemiologyen_HK
dc.rightsThe Author(s)en_US
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.en_US
dc.subjectDepressive symptomsen_HK
dc.subjectGeriatric Depression Scaleen_HK
dc.subjectSuicideen_HK
dc.titleDepressive symptoms and suicide in 56,000 older Chinese: a Hong Kong cohort studyen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4551/resserv?sid=springerlink&genre=article&atitle=Depressive symptoms and suicide in 56,000 older Chinese: a Hong Kong cohort study&title=Social Psychiatry and Psychiatric Epidemiology&issn=09337954&date=2011-03-07& spage=1&authors=Wen Jie Sun, Lin Xu, Wai Man Chan, <i>et al.</i>en_US
dc.identifier.emailLam, TH:hrmrlth@hkucc.hku.hken_HK
dc.identifier.emailSchooling, CM:cms1@hkucc.hku.hken_HK
dc.identifier.authorityLam, TH=rp00326en_HK
dc.identifier.authoritySchooling, CM=rp00504en_HK
dc.description.naturepublished_or_final_versionen_US
dc.identifier.doi10.1007/s00127-011-0362-zen_HK
dc.identifier.pmid21384121-
dc.identifier.pmcidPMC3304054-
dc.identifier.scopuseid_2-s2.0-84863725847en_HK
dc.identifier.hkuros199112en_US
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dc.identifier.volume47en_US
dc.identifier.issue4en_US
dc.identifier.spage1en_HK
dc.identifier.epage10en_HK
dc.identifier.eissn1433-9285en_US
dc.identifier.isiWOS:000301786400001-
dc.publisher.placeGermanyen_HK
dc.description.otherSpringer Open Choice, 21 Feb 2012en_US
dc.relation.projectA prospective study of major risk factors and mortality in the clients of the Hong Kong elderly health services-
dc.identifier.scopusauthoridSun, WJ=18635452400en_HK
dc.identifier.scopusauthoridXu, L=37005014800en_HK
dc.identifier.scopusauthoridChan, WM=7403914485en_HK
dc.identifier.scopusauthoridLam, TH=7202522876en_HK
dc.identifier.scopusauthoridSchooling, CM=12808565000en_HK
dc.identifier.citeulike8996499-
dc.identifier.issnl0933-7954-

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