Silent suicides: studies on the non-contact group of suicide

Abstract

Background: Substantial attention has been given to studying suicides

among those who had been in contact with healthcare providers. However,

effective suicide prevention must target both users (contact) and non-users of

healthcare services (non-contact). The non-contact group has been

under-researched and prevention programs are often designed based on studies

that over-rely on samples of the contact group. Using both quantitative and

qualitative methods, this thesis aims to retrospectively explore and explain the

profiles and service-use patterns of the non-contact group alongside service

utilization models. The quantitative studies, which aimed to identify factors

associated with the non-contact groups, were conducted based on the samples

drawn from the psychological autopsy study of suicides (aged 15-59) in Hong

Kong (2003-2005).

Study 1: Portfolio analysis of the non-contact group with psychiatric illnesses

Considering psychiatric illness as the basic “evaluated need” for psychiatric

service-use, it was controlled for in the comparison between the contact (n=52;

43.7%) and non-contact group (n=67; 56.3%). The non-contact group was

associated with having relatively stable employment, a higher level of problem

solving ability, unmanageable debts, and non-psychotic disorders. They were

evidently different from the contact group, while accounting for a larger

proportion of the suicide population.

Study 2: Study of suicides without psychiatric illnesses

Twenty-nine suicide cases without any psychiatric diagnoses were compared

to live controls without diagnoses (n=135), and live controls (n=15) and deceased

(n=86) with non-psychotic diagnoses. They were not significantly different to the

groups with psychiatric illness on the level of impact from various life events,

either acute or chronic, including relationship, family, legal, physical, and job

insecurity. However, with fewer signs of detectable abnormalities such as previous

suicide attempts, they were not given timely attention from healthcare or

psychosocial services. Alternative preventive measures are suggested to address

the service needs arising from their negative life events.

Study 3: Study of suicides with distress from job insecurity

Suicides who were employed at time of death tended to make no contact

with healthcare services. They were single, lived alone, earned less income, and

suffered from depression. Chronic job insecurity, which was partially mediated by

psychiatric illness, was found to influence their non-contact pattern. This could be

due to fear of job loss or being stigmatized at work if they decided to receive

treatment. Strengthening mental health programs and financial management in

workplaces is suggested.

Study 4: Study of perceptions towards pathway to care among patients survived

from near-lethal suicide attempts

The personal accounts of patients that survived from near-lethal suicide

attempts revealed that the higher their suicide intent, the lower their perceived

needs and the greater their resistance to receiving healthcare services. Themes

associated with their non-contact pattern were irrelevancy, non-usefulness and

self-reliance. Their views were detouring or against the pathway to care.

Conclusion: The non-contact pattern of suicides cannot be explained by

conventional service-use models. They showed a distinctive profile from the

contact group, and it is suggested that they be helped through proactive prevention

programs and / or population-based preventive measures, e.g. restriction of suicide

means.