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1. Introduction
Worldwide trends indicated that suicide rates increased with advancing age from adolescence to adulthood [1,2,3]. This trend was often attributed to the usage of more lethal methods by older suicide attempters [4]. Further analysis of age trends revealed considerable cross-national variability and interesting differences between Western and Asian countries [5]. One example is that suicide rates in Australia and the United States were typified by upward-sloping graphs, whereas in Japan, the pattern was bimodal, and recently became trimodal, with a middle-age peak. The bimodal trend was evident in early studies done in Singapore [6], but recently gradually dissipated [7]. In Asian countries, e.g., Hong Kong and Singapore, adolescent suicide rates were lower than adult rates in the recent years, which might be attributed to improvements in economic conditions [8]. However, a recent Singaporean study found a marked increase in suicide attempts in Asian youths as compared to other age groups [9]. These findings highlighted the importance of a more in-depth analysis of age trends in suicides to facilitate better understanding of such trends.
Age plays an important role in determining suicide precipitants, which are the problems encountered shortly before suicide [10]. In Asia, precipitants for youth suicides included interpersonal conflicts, stress over military service [11,12,13,14], family problems [11,15,16], and academic stress [17]. Use of substance and alcohol could also increase existing suicide risk in vulnerable youths [18,19], although this phenomenon was less prevalent for Asian youths [9], as compared with their Western counterparts [18]. By middle age, the societal and cultural expectations in Asian societies were that individuals had established themselves in their careers, with a stable family and financial security, those who had achieved little in these milestones might face disappointment and frustration [10]. Major reasons for suicides included financial and marital problems in middle adulthood, and physical illnesses in the elderly. Elderly suicides had been more prevalent in the lower socioeconomic strata [20], and associated with physical illness [10], financial problems, and social isolation.
Suicide attempters often react impulsively to a stressor [21], and their suicide notes are charged with negative emotions [13]. When examined closely, a myriad of factors precipitate people to suicide across the age groups. However, explanations of the mechanisms precipitating suicide across the lifespan remain inadequate, as...