Suicide Attempts by Jumping from Height

ABSTRACT Background: The issue of suicide attempts by jumping from height is a serious problem in Hong Kong. This study explores the characteristics of survived suicidal jumpers and the suicide attempts. Methods: This is a retrospective data collection study, reviewing the psychiatric consultation notes of 79 jumpers who survived their attempts at suicide. Results: The jumpers attempting suicide were mostly Chinese men aged 21 to 50 years who were sober and drug-free at the time of the incident. More than three quarters of them were living with relatives or friends. Approximately half were employed full time or were housewives, but more than one quarter were unemployed. Three quarters of attempts occurred at their residences or familiar places. The jumpers did not usually leave suicide hints or notes, and nearly 50% of suicidal acts were done under impulse. One quarter of them were suffering from functional psychoses and one quarter from major depressive illness. Half of the attempts were triggered by psychosocial life events. Conclusion: Although half of the jumpers attempting suicide were suffering from either psychotic illness or major depressive disorder, mental illness itself could not account for all suicide attempts by jumping from height. A cognitive-behavioural model is postulated to account for the suicidal behaviour. Key words: Jumping From Height; Impulsiveness; Suicide Attempts INTRODUCTION Hong Kong has had a slight increase in suicide rates from 1981 to 1994, with jumping from height taking over from hanging as the commonest suicide method since 1985. (1) The years of potential life lost, which measures the extent of premature mortality, was estimated to be 322 years per 100,000 population in 1994--higher than that in Taiwan and Beijing during the same year. In 1994, jumping from height accounted for 59% of suicides in Hong Kong, while hanging accounted for 28%. Singapore had the similar phenomenon that 60% of suicides were accounted for by jumping. (2) However, this method is rarely used in Taiwan, which is also a cosmopolitan Chinese community. Jumping from height is usually considered to be a violent method of suicide. The persons who choose the method are usually regarded as having strong self-destructive motivation, and survivors are considered to have failed suicide. People using violent suicide methods should be distinguished from those using methods carrying minimal risk to life or those with multiple self harm behaviour. (3-5) Copeland studied 82 cases of successful suicide by jumping from buildings in Metropolitan Dade County in Miami, USA. (6) These accounted for 96.5% of cases of suicidal jumpers and 5.1% of all suicide cases in the county during 1982 to 1986. The suicidal jumpers were mostly white men, older than 60 years and sober and drug-free at the time of the incident. Two-thirds of the incidents occurred at the victim's residence, which was frequently an apartment or condominium-type of dwelling, seven floors or higher from the ground. The victims had often experienced depression prior to the incidents and did not usually leave a suicide note. However, the author commented that the study only included fatal jumpers and not survivors. He suggested that interviews with survived jumpers might give further information into the reasons behind the act, and might help to design preventive intervention. The study presented here attempts to supplement this information by reviewing psychiatric consultation case notes of survived jumpers. METHODS The Consultation-Liaison (C-L) Team at Kwai Chung Hospital KCH) provides a C-L psychiatric service to three general hospitals in Hong Kong with more than 2500 beds. A database has been established for the C-L service since July 1994, and this was used for the present study to identify patients who had been admitted to a general hospital for suicidal behaviour of jumping from height and had been attended by the liaison psychiatrists between 1 July 1994 and 31 December 1996. …