File Download
  Links for fulltext
     (May Require Subscription)
Supplementary

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
2021 Impact Factor: 4.519
2020 SCImago Journal Rankings: 1.863
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
dc.relation.referencesKasckow 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):226–231en_US
dc.relation.referencesdoi: 10.1016/j.schres.2010.02.1056en_US
dc.relation.referencesMaris RW (2002) Suicide. Lancet 360(9329):319–326en_US
dc.relation.referencesdoi: 10.1016/S0140-6736(02)09556-9en_US
dc.relation.referencesChan 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):1135–1138en_US
dc.relation.referencesdoi: 10.1176/appi.ps.60.8.1135en_US
dc.relation.referencesGallo JJ, Anthony JC, Muthen BO (1994) Age differences in the symptoms of depression: a latent trait analysis. J Gerontol 49(6):P251–P264en_US
dc.relation.referencesYang GH, Phillips MR, Zhou MG et al (2005) Understanding the unique characteristics of suicide in China: National Psychological Autopsy Study. Biomed Environ Sci 18(6):379–389en_US
dc.relation.referencesGaynes BN, West SL, Ford CA et al (2004) Screening for suicide risk in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 140(10):822–835en_US
dc.relation.referencesCheng 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):256–265en_US
dc.relation.referencesdoi: 10.1097/JGP.0b013e3181bf9edden_US
dc.relation.referencesSokero TP, Melartin TK, Rytsala HJ (2003) Suicidal ideation and attempts among psychiatric patients with major depressive disorder. J Clin Psychiatry 64(9):1094–1100en_US
dc.relation.referencesdoi: 10.4088/JCP.v64n0916en_US
dc.relation.referencesVannoy SD, Duberstein P, Cukrowicz K (2007) The relationship between suicide ideation and late-life depression. Am J Geriatr Psychiatry 15(12):1024–1033en_US
dc.relation.referencesdoi: 10.1097/JGP.0b013e3180cc2bf1en_US
dc.relation.referencesNorlev 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):103–112en_US
dc.relation.referencesdoi: 10.1521/suli.2006.36.1.103en_US
dc.relation.referencesConwell Y, Duberstein PR, Hirsch JK (2010) Health status and suicide in the second half of life. Int J Geriatr Psychiatry 25(4):371–379en_US
dc.relation.referencesdoi: 10.1002/gps.2348en_US
dc.relation.referencesLi ZB, Ho SY, Chan WM (2004) Obesity and depressive symptoms in Chinese elderly. Int J Geriatr Psychiatry 19(1):68–74en_US
dc.relation.referencesdoi: 10.1002/gps.1040en_US
dc.relation.referencesSchooling CM, Lam TH, Li ZB et al (2006) Obesity, physical activity, and mortality in a prospective chinese elderly cohort. Arch Intern Med 166(14):1498–1504en_US
dc.relation.referencesdoi: 10.1001/archinte.166.14.1498en_US
dc.relation.referencesCheng 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):1131–1137en_US
dc.relation.referencesdoi: 10.1002/gps.1405en_US
dc.relation.referencesChan AC (1996) Clinical validation of the Geriatric Depression Scale (GDS): Chinese version. J Aging Health 8(2):238–253en_US
dc.relation.referencesdoi: 10.1177/089826439600800205en_US
dc.relation.referencesLam 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):361en_US
dc.relation.referencesdoi: 10.1136/bmj.323.7309.361en_US
dc.relation.referencesSatagopan JM, Ben-Porat L, Berwick M et al (2004) A note on competing risks in survival data analysis. Br J Cancer 91(7):1229–1235en_US
dc.relation.referencesdoi: 10.1038/sj.bjc.6602102en_US
dc.relation.referencesAndersen PK, Abildstrom SZ, Rosthoj S (2002) Competing risks as a multi-state model. Stat Methods Med Res 11(2):203–215en_US
dc.relation.referencesdoi: 10.1191/0962280202sm281raen_US
dc.relation.referencesMiller G (2006) Mental health in developing countries. China: healing the metaphorical heart. Science 311(5760):462–463en_US
dc.relation.referencesdoi: 10.1126/science.311.5760.462en_US
dc.relation.referencesWong PW, Yeung AW, Chan WS et al (2009) Suicide notes in Hong Kong in 2000. Death Stud 33(4):372–381en_US
dc.relation.referencesdoi: 10.1080/07481180802705791en_US
dc.relation.referencesChi I, Yip PS, Yu GK et al (1998) A study of elderly suicides in Hong Kong. Crisis 19(1):35–46en_US
dc.relation.referencesMartinsen EW (2008) Physical activity in the prevention and treatment of anxiety and depression. Nord J Psychiatry 62(Suppl 47):25–29en_US
dc.relation.referencesdoi: 10.1080/08039480802315640en_US
dc.relation.referencesLee S, Tsang A, Li XY et al (2007) Attitudes toward suicide among Chinese people in Hong Kong. Suicide Life Threat Behav 37(5):565–575en_US
dc.relation.referencesdoi: 10.1521/suli.2007.37.5.565en_US
dc.relation.referencesPhillips 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):73–82en_US
dc.relation.referencesdoi: 10.1016/j.jad.2006.07.020en_US
dc.relation.referencesBradvik 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):185–191en_US
dc.relation.referencesdoi: 10.1111/j.1600-0447.2007.01136.xen_US
dc.relation.referencesMurphy E, Smith R, Lindesay J et al (1988) Increased mortality rates in late-life depression. Br J Psychiatry 152:347–353en_US
dc.relation.referencesdoi: 10.1192/bjp.152.3.347en_US
dc.relation.referencesPenninx BW, Beekman AT, Honig A et al (2001) Depression and cardiac mortality: results from a community-based longitudinal study. Arch Gen Psychiatry 58(3):221–227en_US
dc.relation.referencesdoi: 10.1001/archpsyc.58.3.221en_US
dc.relation.referencesBolton 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):1139–1149en_US
dc.relation.referencesdoi: 10.4088/JCP.v69n0714en_US
dc.relation.referencesGunnell 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):457–459en_US
dc.relation.referencesdoi: 10.1007/s00127-002-0579-yen_US
dc.relation.referencesSimon GE, VonKorff M (1998) Suicide mortality among patients treated for depression in an insured population. Am J Epidemiol 147(2):155–160en_US
dc.relation.referencesRyan J, Carriere I, Ritchie K et al (2008) Late-life depression and mortality: influence of gender and antidepressant use. Br J Psychiatry 192(1):12–18en_US
dc.relation.referencesdoi: 10.1192/bjp.bp.107.039164en_US
dc.relation.referencesRan 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):119–127en_US
dc.relation.referencesdoi: 10.1080/13811110600993090en_US
dc.relation.referencesHughes D, Kleespies P (2001) Suicide in the medically ill. Suicide Life Threat Behav 31(Suppl):48–59en_US
dc.relation.referencesdoi: 10.1521/suli.31.1.5.48.24226en_US
dc.relation.referencesHakko H, Manninen J, Karvonen K et al (2008) Association between physical illnesses and depressive symptoms requiring hospitalization in suicide victims. Psychiatry Res 160(3):271–277en_US
dc.relation.referencesdoi: 10.1016/j.psychres.2007.07.025en_US
dc.relation.referencesDepartment of Health (2010) Age-standardised death rates by leading causes of death, 2001–2009. http://www.dh.gov.hk/english/pub_rec/pub_rec.htmlen_US
dc.relation.referencesLicht-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:a3079en_US
dc.relation.referencesdoi: 10.1136/bmj.a3079en_US
dc.relation.referencesKuzuya M, Masuda Y, Hirakawa Y et al (2006) High prevalence rate of depression among community-dwelling frail elderly Japanese. Nippon Ronen Igakkai Zasshi 43(4):512–517en_US
dc.relation.referencesHantouche E, Angst J, Azorin JM (2010) Explained factors of suicide attempts in major depression. J Affect Disord 127(1–3):305–308en_US
dc.relation.referencesdoi: 10.1016/j.jad.2010.04.032en_US
dc.relation.referencesIARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Volume 44 Alcohol Drinking: Summary of Data Reported and Evaluationen_US
dc.relation.referencesLee H, HFK C, Kwok W (1993) Chinese elderly and the GDS short form. Clin Gerontol 14:37–42en_US
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-

Export via OAI-PMH Interface in XML Formats

OR

Export to Other Non-XML Formats