INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2006; 21: 113–118. Published online 16 January 2006 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.1432 Elderly suicide and the 2003 SARS epidemic in Hong Kong Sau Man Sandra Chan 1 *, Fung Kum Helen Chiu 1 , Chiu Wah Linda Lam 1 , Pui Yiu Vivian Leung 2 and Yeates Conwell 3 1 Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong 2 Department of Psychiatry, ShatinHospital, New Territories East Cluster, Hong Kong 3 Centre for Suicide Researchand Prevention, University of Rochester, Rochester, NY, USA SUMMARY Background Hong Kong was struck by the community outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003. In the same year, the elderly suicide rate in Hong Kong showed a sharp upturn from a previous downward trend. Methods Secondary analyses using Poisson Regression Models on the suicide statistics from the Census and Statistics Department of the Hong Kong Government were performed. Results In a Poisson Regression Model on the annual suicide rates in elders aged 65 and over in years 1986–2003, 2002 served as the reference year. Suicide rates in 1986–1997 were significantly higher than the reference year, with an Incident Rate Ratio (IRR) of 1.34 to 1.61. However, rates in 1998–2001 did not differ from the reference year significantly, repre- senting stabilization of suicide rates for 4 years after 1997. The elderly suicide rate increased to 37.46/100,000 in 2003, with an IRR of 1.32 (p ¼ 0.0019) relative to 2002. Such trend is preserved when female elderly suicide rates in 1993–2003 were analyzed, while suicide rates in elderly men and younger age groups did not follow this pattern. Discussions Mechanistic factors such as breakdown of social network and limited access to health care might account for the findings. These factors could have potentiated biopsychosocial risk factors for suicide at individual levels, particularly in elderly. Female elders, by way of their previous readiness to utilize social and health services instituted in the past decade, are thus more susceptible to the effects of temporary suspension of these services during the SARS epidemic. Conclusions The SARS epidemic was associated with increased risk of completed suicide in female elders, but not in male elders or the population under 65 years of age. Copyright # 2006 John Wiley & Sons, Ltd. key words — SARS; epidemic; disaster; elderly suicide; suicide prevention INTRODUCTION As part of the global trend, Hong Kong has experi- enced rapid growth in population aged 65 years and over during the last few decades. Over that same time frame, seniors in Hong Kong have experienced a con- tinuous decline in mortality (Department of Health, HKSAR 2004). Against this background, the rate of suicide among older adults in Hong Kong has been relatively high compared to other countries (Chiu et al., 2004). Parallel with the development of social and health policies for elders, such as the staged development of seven psychogeriatric teams for territory-wide service in Hong Kong in 1991–1996, implementation of government policy on elderly wel- fare in 1998, establishment of territory-wide Elderly Suicide Prevention Programs (Chiu et al., 2003) offer- ing highly accessible and expedited multidisciplinary services in collaboration with community partners since 2000, the suicide rate of the elderly population has been apparently decreasing steadily. For instance, the elderly suicide rate was roughly 40 per 100,000 in 1986–1992 and there was a downward trend through 1993–1998, eventually reaching 29–31/100,000 in 1999 to 2002 (Figure 1). Hong Kong was struck by the epidemic of Severe Acute Respiratory Syndromes (SARS) in 2003, affecting 1755 individuals, including 300 deaths from Received 2 June 2005 Copyright # 2006 John Wiley & Sons, Ltd. Accepted 11 July 2005 *Correspondence to: Prof. S. M. S. Chan, Department of Psychiatry, Ground Floor, Multicentre, Tai Po Hospital, 9 Chuen On Road, Tai Po, New Territories, Hong Kong Special Adminis- trative Region. Tel: (852)-26076025. Fax: (852)-26671255. E-mail: schan@cuhk.edu.hk