Snowdon John, Phillips Julie, Zhong Baoliang, Yamauchi Takashi, Chiu Helen F K, Conwell Yeates
Discipline of Psychiatry, Sydney Medical School, Sydney, Australia.
Department of Sociology, Institute for Health, Health Care Research and Aging Research, Rutgers University, USA.
J Affect Disord. 2017 Mar 15;211:12-19. doi: 10.1016/j.jad.2017.01.007. Epub 2017 Jan 4.
The patterns of association between age and suicide rate vary by country, subpopulation and gender, and over time. To shed light on factors associated with these differences, we analysed suicide data from four populations, two 'Western' (Australia, the United States [US]) and two Asian (Japan and Hong Kong). We computed suicide rates in five-year age-groups (between 10 and 14 years and 85+ years) for men and women separately, and present graphical representations of the age patterns during selected five-year periods. Rates and age patterns differed markedly, as did gender patterns except in Hong Kong. In 1964-8, male suicide rates in Australia and US were represented by upward-sloping graphs, whereas in Japan the pattern was bimodal. By 1979-83, male patterns in Australia and US were bimodal, but Japan's was trimodal, including a middle-age peak reached in 1994-98. In contrast, female age patterns in the Western countries were shallowly convex or uniform, while in Hong Kong and Japan the upward-sloping graphs became, over time, less steep; by 2009-13, the pattern in Japan was uniform (flat). In recent decades, suicide rates of older men in Australia, US and Japan, and older women in Japan and Hong Kong, have fallen considerably. Suicide rates of men aged 45-64 in Australia and US also fell, though by 2009-13 the US rate had risen again. The suicide rate of Australian men in their twenties halved between 1994-98 and 2009-13, while rates for younger men and women in Japan have risen since 1994-98. In Hong Kong, suicide rates of young men have increased. Age patterns of suicide likely reflect period and cohort effects shaped by socioeconomic stressors, availability of health and welfare services, access to lethal methods of suicide, and other factors. Greater understanding of their impact on age patterns of suicide can result in potential preventive solutions.
年龄与自杀率之间的关联模式因国家、亚人群、性别以及时间的不同而有所差异。为了阐明与这些差异相关的因素，我们分析了来自四个人口群体的自杀数据，其中两个是“西方”群体（澳大利亚、美国），另外两个是亚洲群体（日本和中国香港）。我们分别计算了男性和女性在5岁年龄组（10至14岁以及85岁以上）的自杀率，并呈现了选定五年期内年龄模式的图表。自杀率和年龄模式存在显著差异，性别模式也是如此，不过中国香港除外。1964 - 1968年期间，澳大利亚和美国男性自杀率呈上升趋势，而日本的模式则是双峰型。到1979 - 1983年，澳大利亚和美国男性自杀模式变为双峰型，但日本的模式变为三峰型，其中包括在1994 - 1998年达到峰值的中年人群。相比之下，西方国家女性的年龄模式呈浅凸型或较为平稳；而在中国香港和日本地区，随着时间推移，上升趋势逐渐变缓；到2009 - 2013年，日本的模式变为平稳（持平）状态。近几十年来，澳大利亚、美国和日本老年男性以及日本和中国香港老年女性自杀率大幅下降。澳大利亚和美国45至64岁男性自杀率也有所下降，不过到2009 - 2013年美国的这一比率又有所上升。1994 - 1998年至2009 - 2013年期间，澳大利亚20多岁男性自杀率减半，而自1994 - 1998年以来，日本年轻男性和女性自杀率呈上升趋势。在中国香港，年轻男性自杀率有所上升。自杀的年龄模式可能反映了由社会经济压力源、健康和福利服务的可及性、自杀致死方法的可获得性以及其他因素所塑造的时期和队列效应。深入了解这些因素对自杀年龄模式的影响有助于找到潜在的预防措施。
