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自殺與社會環境因素之探討

自殺與社會環境因素之探討. 陳映燁 台北市立聯合醫院松德院區主治醫師 國立陽明大學副教授. 學歷與經歷. 現職 台北市立聯合醫院松德院區主治醫師（ 94 年 1 月至今） 陽明大學兼任副教授 （ 99 年 2 月至今） 經歷 台大醫院精神部住院醫師 （ 83 年 6 月 - 87 年 6 月） 台大醫院精神部主治醫師 （ 87 年 7 月 - 89 年 7 月） 陽明大學兼任助理教授 （ 94 年 8 月 -99 年 1 月） 學歷 中山醫學系醫學士 （ 76 年 10 月～ 83 年 6 月） 哈佛大學社會與健康行為學碩士 / 博士

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自殺與社會環境因素之探討

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  1. 自殺與社會環境因素之探討 陳映燁 台北市立聯合醫院松德院區主治醫師 國立陽明大學副教授

  2. 學歷與經歷 現職 • 台北市立聯合醫院松德院區主治醫師（94年1月至今） • 陽明大學兼任副教授 （99年2月至今） 經歷 • 台大醫院精神部住院醫師 （83年6月- 87年6月） • 台大醫院精神部主治醫師 （87年7月- 89年7月） • 陽明大學兼任助理教授 （94年8月-99年1月） 學歷 • 中山醫學系醫學士 （76年10月～83年6月） • 哈佛大學社會與健康行為學碩士/博士 Department of Health and Social Behavior, Harvard University, USA （89年9月- 92年11月）

  3. 社會環境因子與自殺 社會環境因素造成個人比較難以繼續生活，而視自殺為一種選擇，可能是直接的影響（例如金融海嘯後失業、欠債走投無路），或是比較間接的方式（例如促使人們認同自殺是一種問題解決模式）

  4. Common socio-environmental determinants of suicide • Social integration: marital status, religious integration, deviancy (Durkheim) • Cultural perspective: gender, race, national culture, media and suicide • Economic factors: unemployment, labor market conditions, income • Urban/rural differences and suicide • Opportunity theory (methods accessibility)

  5. Outline of the Speech • Media and Suicide • Opportunity theory and suicide – the case of jumping suicide in Taipei City • Economic fluctuations and suicide

  6. Media and suicide

  7. Media and Suicide • Media reporting of suicide events could induce suicide imitation • The copycat effect is particularly significant in celebrity suicide • Imitation effect is more prominent when the event is reported in the front page and when the report is extensive and prolonged • Copycat effect is more significant in true suicide stories than fictional stories • Vulnerable groups: younger age groups, suicide attempters and patients of depressive disorders

  8. Media Environment in Taiwan The “invasion” of Hong Kong based “Next Media” Group – tabloid/paparazzi journalism were introduced • 2001 Next Magazine • 2003 Apple Daily • 2009 Web-based animated news

  9. Sex-specific suicide rates in Taiwan, 1986-2010

  10. Method-specific Suicide Rates in Taiwan, 1986-2010

  11. Celebrity suicides and non-celebrity suicides • First generation papers explored a variety of suicide stories (not restricted to celebrities) on the risk of suicides (e.g. Phillips 1974; Kessler 1980) • Recent papers were by and large focused on celebrity suicides, particularly entertainment celebrities (e.g. Cheng/Fu/Yip, review see Stack 2005)

  12. Celebrity Suicide • Effect of media reporting of the suicide of a singer in Taiwan: the case of Ivy Li.– by Chen YY et al (Social Psychiatry and Psychiatric Epidemiology. 2010;45:363-369) • The impact of media reporting of the suicide of a singer on suicide rates in Taiwan – by Chen YY et al (Social Psychiatry and Psychiatric Epidemiology. 2010 DOI: 10.1007/s00127-010-0331-y) • Non-celebrity suicide • The Impact of Media Reporting of Suicide on Actual Suicides in Taiwan, 2002-2005 – by Chen YY et al (Journal of Epidemiology and Community Health. 2010;65(10):934-940) • Media representation of gender patterns of suicide in Taiwan.– by Chen YY et al (The Journal of Crisis Intervention and Suicide Prevention. 2011, accepted)

  13. Celebrity Suicides • Several prior studies have demonstrated the influence of entertainment celebrity suicides on suicide rates in Taiwan, for example the case of Nee MJ in 2005

  14. Celebrity Suicide – the case of Ivy Li • Ivy Li: a young (age 24) rising singing star who completed suicide by burning charcoal in her own car in Nov. 2008. • The reporting was sensational. Love frustration was depicted as the single reason of suicide. • Research Question – charcoal burning was relatively fewer among young females, did Ivy Li’s suicide induce age*method*gender modeling?

  15. Media and Suicide Biweekly number of charcoal-burning suicides among young age group (<30 y/o) Aug~ Dec, 2008

  16. Adjusted relative risk for factors associated with the risk of suicide after media reporting of the suicide of a celebrity during November 2008 in Taiwan, by subgroups of age, gender and methods of suicide -1

  17. Adjusted relative risk for factors associated with the risk of suicide after media reporting of the suicide of a celebrity during November 2008 in Taiwan, by subgroups of age, gender and methods of suicide -2

  18. Adjusted relative risk for factors associated with the risk of suicide after media reporting of the suicide of a celebrity during November 2008 in Taiwan, by subgroups of age, gender and methods of suicide -4

  19. Non-celebrity Suicide The Impact of Media Reporting of Suicide on Actual Suicides in Taiwan, 2002-2005 (Chen YY et al, Journal of Epidemiology and Community Health. 2010;65(10):934-940)

  20. Research Questions • Did the “invasion” of Apple Daily change the reporting style of traditional newspapers (i.e. China Times and United Daily) in Taiwan ? • Whether reportage of suicide news increases suicide incidence in the following day ? • Mutual causation? media reporting increased suicide rates or increased suicide rates resulted in higher reporting intensity?

  21. Statistical Methods • Reporting intensity was estimated by local polynomial method • Poisson regression model (maximum conditional) likelihood method) was used to estimate the influence of newspaper reporting of suicide events on suicide rates • Granger’s causation model was used to assess mutual causation

  22. Estimated reporting intensity of suicide news

  23. Correlation coefficients of suicide news reporting for China Times, United Daily and actual number of suicide counts before and after the arrival of Apple Daily, 2002-2005

  24. The impact of suicide news reporting on actual suicides before and after the arrival of Apple Daily, 2002-2005

  25. Evaluating the impact of actual suicide and suicide news reporting of other newspapers on the reportage of suicide news of United Daily, China Times, Apple Daily respectively in the following day, 2002-2005

  26. Granger causations among number of suicide and suicide news reporting for the three leading newspapers

  27. Conclusions • The presence of Apple Daily has fueled competitive reporting of suicide news among Taiwan’s traditional newspapers. • The increased suicide news reporting among Taiwan’s traditional newspapers, particularly United Daily, has consequently increased the actual number of suicides.

  28. Outline of the Speech • Media and Suicide • Opportunity theory and suicide – the case of jumping suicide in Taipei City • Economic fluctuations and suicide

  29. Opportunity theory and suicide

  30. Restricting method of suicide in suicide prevention • Chen YY*, Yip PSF: Suicide sex ratios after the inception of charcoal-burning suicide in Taiwan and Hong Kong. Journal of Clinical Psychiatry. 2011;72(4):566-567 (SCI/SSCI) • Tsai CW, Gunnell D, Chou YH, Kuo CJ, Lee MB, Chen YY*: Why do people choose charcoal burning as a method of suicide? An interview based study of survivors in Taiwan. Journal of Affective Disorders. 2011:131(1-3):402-407 (SCI/SSCI) • Chen YY, Lee MB, Chang CM, Liao SC: Methods of suicide in different psychiatric diagnostic groups. Journal of Affective Disorders. 2009;118(1-3):196-200. (SCI/SSCI) • Chen YY, Chiang CM, Liao SC, Lee MB: Suicide sex ratio: the interaction between mental illness and suicide methods. Journal of Clinical Psychiatry. 2009;70(2):294-5. (SCI/SSCI) • Chen YY, Gunnell D, Lu TH: Descriptive epidemiological study of sites of suicide jumps in Taipei, Taiwan. Injury Prevention. 2009;15(1):41-4. (SSCI) • Chen YY, Park NS, Lu TH: Suicide methods used by women in Korea, Sweden, Taiwan and the United states. Journal of the Formosan Medical Association. 2009;108(6):452-9. (SCI) • Chen YY, Gunnell D, Lu TH: Descriptive epidemiological study of sites of suicide jumps in Taipei, Taiwan. Injury Prevention. 2009;15(1):41-4. (SSCI)

  31. Jumping suicide ── Hotspots Jumping hotspots 1）popularity 2）media attention 3）accessibility Example： Golden Gate Bridge: Around 30 jumping suicide deaths per year. Around 50% of residents from Oakland area of San Francisco who committed suicide by jumping from bridges drove across the Oakland Bay Bridge on their way to commit suicide from the Golden Gate (Seiden and Spence, 1983 Omega)

  32. Oakland Bay Bridge Golden Gate Bridge

  33. Research gap in Jumping suicide Focus on one single site. Lack of detailed analysis of the characteristics of the sites (Bridges? Hospitals? Shopping malls?) Fail to identify the types of sites with the highest incidence rates. Thus, prior studies could not provide a definitive basis for prioritizing preventative measures.

  34. A descriptive epidemiological study of sites of suicide jumps in Taipei, Taiwan • Research Questions • Where did jumping suicide occur in Taipei City? • Are there jumping hotspots in the case of building jumping? • What were the sociodemographic characteristics of individuals who jumped from different type of sites?

  35. Methods • All suicide deaths by jumping from a height (ICD-9 code E957) in Taipei from 2002 through 2005 were included in this study. • Information source: death certificate, ambulance records, medical records, media reports • The total numbers of various kinds of potential jumping sites were estimated from the Statistical Abstract of Taipei City, 2000 Population and Housing Census

  36. Methods Classification of sites • home private residential buildings, • not-home private residential buildings • non-residential buildings business office buildings, hospitals, shopping malls (including department stores), hotels, bridges and others.

  37. Results Total number of jumping suicide: 276 Not jumping in Taipei city: 40 cases Address error: 26 cases Final sample size: 210 (male N＝107 female N＝103) Average age: 49（SD＝20.1），females （46y/o）were younger than males（52y/o）

  38. Results • Number of jumping suicides from a particular type of site, proportion (%) of total suicides from that type of site, and the number of jumping suicides from the site per 1000 such sites in Taipei, 2002-2005

  39. ResultsHigh risk groups of jumping from home

  40. Conclusion • Jumping hotspots in Taipei: Hospital and Shopping malls • Females and the elderly were more likely to jump from home residential buildings

  41. Outline of the Speech • Media and Suicide • Opportunity theory and suicide – the case of jumping suicide in Taipei City • Economic fluctuations and suicide

  42. Economic fluctuations and suicide

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