Stigma is one of the important features. Depression and mental health is not well understood in Asia, due to stigma and the insufficient resources allocated for the purpose of helping those with mental health problems. 

But stigma and resources allocation are also related. Stigma and prejudice against mental illness affects the funding and also the ability to raise funds from the community.

No, in Asia, the gender ratio is much lower; it is about 1 to 2 men to 1 woman. However, the overall rate is similar - suicide rates are 13.5 and 11.0 for Hong Kong and Australia, respectively. What it translates to is that we have a relatively lower rate among men compared to Australia, whereas a higher rate of women was found in Hong Kong or Asia.

The reasons for the higher rate among women are complicated and multifactorial. We have seen a higher rate among older adult women in Asia. Most of the older adults have a higher proportion of suffering from more than one disease, sometimes not terminal but painful. The insufficiency of medical and health service could be one of the causes, and the mismatch of expectation between older generation and younger generation.

Also, the method used among the women in Asia is very different from the west. They tend to use more lethal methods, including pesticides.

The suicide rate in South Korea in 2010 was 31.2 per 100,000 people, the highest amongst OECD countries and amongst the highest in the world. However, it was only 10 per 100,000 in 1990. The increase over the last two decades was substantial. 

The causes of the surge in suicide in South Korea may be complex. Some research indicated that the Asian economic crisis in 1997 and rise in unemployment rates might account for some of the increases in suicide in South Korea; however suicide rates continued to rise after its economy recovered few years later. 

The rise in suicide was most prominent in the elderly; this may be related to the disintegration of support networks in rural areas when young people moved to the cities. 

South Koreans living in rural areas have easy access to highly toxic pesticides, and pesticide poisoning accounted for over 20% of total suicides in South Korea, compared to less than 1% in Australia.

Recent studies also indicated the impact of extensive media coverage of celebrity suicide on trends in suicide in South Korea; increases in suicide rates following celebrity suicides could last for one to two months. 

The aforementioned factors, including economic recession, rise in unemployment, easy access to highly toxic pesticides, and the media, were also found to influence suicide rates in other Asian countries such as Taiwan, demonstrating that findings from one country may have implications for suicide prevention in other countries. The South Korean government has taken some actions aimed to prevent suicide, e.g. to establish the Korea Suicide Prevention Center and ban the sales of paraquat, one of the most lethal pesticides which accounted for more than 1000 suicides per year in South Korea.   

There are more working people than unemployed people who die from suicide. According to the Rose Theorem (‘a large number of people at small risk may give rise to more cases of disease than a small number who are at high risk’), it may be more effective to target the working population (a large number at a lower risk) than the unemployed (a small number at a higher risk). 

It is important to cultivate a “mental wellbeing-friendly” working environment. In this aspect, Australia has been doing much better than other countries.  Long working hours and lower wages in Hong Kong and other Asian countries have proved to be conducive to generating a high GDP growth with a higher profit margin for businesses. However, it is the mental wellbeing of the employee that is paying a high cost, which has not been factored into our cost-benefit analysis.

The important thing is to make sure the employee can benefit from the economic growth and additional business activities. Engaging the employee in a meaningful way and rewarding them in a tangible manner are very important not only for maintaining good employer and employee relationships, but also for the employees’ wellbeing as well.

Australia is known to be culturally sensitive. Embracing diversity and accommodating difference in the work place is certainly the way to go to make workplaces more conducive to enhancing wellbeing.

Removing the stigma among health professionals that may arise from ignorance, lack of knowledge, prejudice and bias, and even discriminatory attitudes against certain groups.

For example, self-harm patients, especially the young and multiple attempters, being admitted to the emergency department – sometimes the health care professionals don’t pay sufficient attention and support to them. There could also be barriers for the non-English speaking patients to receive the appropriate care and support.

Raising awareness and knowledge of cultural diversity among health professionals is indeed very important, as they are always the first engagement to seeking help. If the experiences were not pleasant, it will discourage them from seeking help.  Understanding different cultures with empathy and sensitive attitudes would certainly help.