Research report Suicidal ideation and suicidal attempts in a population-based study of Chinese people: Risk attributable to hopelessness, depression, and social factors Yin Bun Cheung a , C.K. Law b , Brandford Chan b , Ka Yuet Liu b , Paul S.F. Yip b,c, * a MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, UK b The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR, PR China c Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong SAR, PR China Received 5 October 2005; received in revised form 26 November 2005; accepted 28 November 2005 Available online 6 January 2006 Abstract Background: The population attributable fraction of hopelessness, depression and other risk factors for suicidal ideation and suicidal attempts in Asian population is unknown. Social support is often said to be a buffer against the effect of hopelessness and depression. Methods: Suicidal ideation, suicidal attempts as well as demographic and psychometric data were delineated in a random and representative population sample of 2219 Chinese people in Hong Kong. The population attributable fraction was used to determine the contribution of hopelessness, depression and other risk factors to suicidal ideation and attempts. Results: Multivariate modelling shows that about 40% of suicidal ideation and attempts was attributable to depression and about 20% was attributable to hopelessness. Drug abuse and marital dissolution were also significant contributors to suicidality. The impact of hopelessness and depression was not affected by social support. Limitations: Suicidality was self-reported. Conclusions: Suicidal ideation and suicidal attempts were to a large extent attributable to depression and hopelessness, and, to a lesser extent, drug abuse and marital dissolution. Social support appeared to play little role as a buffer. D 2005 Elsevier B.V. All rights reserved. Keywords: Depression; Hopelessness; Population attributable risk; Suicidal ideation; Suicidal attempt 1. Introduction Suicide is closely associated depression (Blair-West et al., 1997; Lonnqvist, 2000). Hopelessness is a system of negative expectations concerning oneself and one’s future life (Scotland, 1969) and is a strong predictor of suicide in patients with psychiatric or affective disorders (Beck et al., 1990; Keller and Wolfersdorf, 1993). Though hopelessness is associat- ed with depression, it is oriented to the future as opposed to the present state (Beck and Weissman, 1974). It has an effect independent of depression (Kuo et al., 2004; Menon et al., 2000). Previous studies have shown that both depression and hope- lessness were strongly associated with suicide and suicide ideation in psychiatric patients (Beck et al., 0165-0327/$ - see front matter D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2005.11.018 * Corresponding author. The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong SAR, PR China. Tel.: +852 2241 5013; fax: +852 2459 7161. E-mail address: sfpyip@hku.hk (P.S.F. Yip). Journal of Affective Disorders 90 (2006) 193 – 199 www.elsevier.com/locate/jad