Patterns in suicide by marital status in Hong Kong, 2002–2020: Is marriage still a protective factor against suicide?

Purpose: Marriage has long been considered protective against suicide, but shifting social norms since 2000 in Hong Kong raise doubts regarding whether this is still the case. This study investigates the changing association between suicide and marital status in Hong Kong between 2002 and 2020. Methods: Suicide death case reports issued between January 1, 2002 and December 31, 2020 were obtained from the Hong Kong Coroner’s Court. Suicide rates were calculated for each year in the study period by gender, age group, and marital status (married, never-married, widowed, divorced/separated). Suicide risk ratios for each marital status cohort by gender and age group, as well as interactions between year and marital status, were estimated using Poisson regression models. Results: Suicide risk decreased significantly over time for men and women of all ages. People who were never-married, or divorced/separated, had significantly higher suicide risks than their married counterparts. Increasing suicide risks over time were observed for never-married men aged between 20 and 49 years, never-married women aged 35–49 years, and divorced/separated men aged 20–34 years. Widowed men and women of any age had higher suicide risks compared with previous studies in Hong Kong. Conclusion: Despite rapidly changing social contexts in Hong Kong during the study period, marriage remains a strong protective factor against suicide for men and women of all ages. The protective effect is particularly evident for younger people. Increasing suicide rates for divorced/separated, never-married, or widowed people suggest that they may require more psychosocial support.