Content warning: This article discusses suicide and suicidal feelings, which some readers may find distressing. If you are struggling or worried about someone else, support is available in Macao at the Caritas Hope for Life Hotline.
Every suicide is a personal tragedy. A life is prematurely cut short, leaving the victim’s family, friends and loved ones struggling with grief, pain, anger and an array of other complex emotions.
In Macao, suicide has become a public health problem, as evidenced by the persistently high number of cases in recent years. According to official data, the annual number of deaths by suicide grew by 44 percent between 2015 and 2023, from 61 to 88 cases. Similarly, the number of attempted suicides rose by 146 percent over the same period, from 101 to 249 cases.
Meanwhile, 2024 saw the SAR set a new local record for suicides, with 91 cases registered, an increase of 3 percent year-on-year. When calculated per capita, this is equivalent to roughly 13.6 suicides per 100,000 people, a figure that exceeds the World Health Organisation’s (WHO) latest global average of 9.2 suicides per 100,000 individuals in 2021.
Macao’s high suicide rate has not been lost on local representatives, with then-lawmaker Ron Lam and his counterpart Si Ka Lon both drawing attention to the issue earlier this year.
[See more: Better mental health screenings could lower Macao’s suicide rate, says lawmaker]
“The youth [suicide] situation is especially worth paying attention to,” Lam said in an address to the Legislative Assembly in May. “Last year, there were 4 suicide cases involving people aged 14 or under, making it the first time in the past 10 years that the number of such cases has exceeded 1. For the 15 to 24-year-old category, there were 9 cases – the highest figure in the last decade.”
While the data certainly points to the severity of the problem, Henry Lao, the director-general of the Macau Society of Registered Psychotherapists (MSRP), tells Macao News that “statistics alone cannot capture the true significance” of the challenge.
“Current research indicates that each suicide death directly affects an average of 135 individuals, with 6 to 10 people experiencing severe psychological impact,” Lao says. “In our tightly-knit community – particularly among our youth – these effects are magnified due to the deeper social bonds that define our society.”
What are the challenges of suicide prevention in Macao?
Addressing the problem of suicide in Macao is far from straightforward. For starters, suicide never stems from a singular cause, but is rather brought about by a confluence of risk factors, says Ella Ng Lai Ieng, the head of the Life Hope Hotline – an emotional support telephone service run by local Catholic charity Caritas Macau.
Lao agrees, describing suicides in Macao as a reflection of “both universal human struggles and unique regional challenges.” The MSRP director-general points out that depression and mood disorders continue to be one of the leading factors behind suicide deaths, with a presence in roughly 90 percent of cases. Other major contributors include economic and relationship issues, the negative impact of which can be exacerbated by the fast pace of modern society.
Macao’s all-pervasive casino industry has also contributed to the problem by giving rise to gambling addiction, which Lao notes “can amplify existing vulnerabilities.”
He says that “Problem gamblers face suicide risk fifteen higher than the general population,” adding that, in his line of work, the frequency with which he has met patients who have suicidal thoughts as a result of gambling addiction has been “concerning.”
Another major hurdle in Macao’s fight against suicide stems from the biases and stigmas that locals have regarding mental health problems. Ng notes that residents are generally not inclined to seek out help or share their feelings with another person, as they perceive such actions to be that of a “weakling.”
In fact, Ng mentions that the taboo and stigma surrounding mental illness in Macao are such that some troubled individuals will brush aside the severity of their condition out of fear that they will be judged as “crazy” if they seek out assistance.
[See more: Macao’s worrying mental health trends spark calls for a 24-hour counselling hotline]
Lao also recognises this obstacle, pointing out that cultural attitudes…sometimes create barriers to help-seeking in Macao.” He notes that the misguided view that suicide is “a personal weakeness or selfishness” can result in the public ignoring the very real psychological conditions of those with suicidal tendencies.
“We wouldn’t expect someone to overcome cancer through willpower alone – yet we sometimes expect people to simply ‘overcome’ severe mental health crises without support,” the expert explains.
The psychotherapist also highlights another major misunderstanding in the SAR – the belief that discussing suicide somehow “plants the idea” in someone’s mind.
While studies have shown that prominent media reporting on suicide (especially method, location, or romanticised motives) can be associated with increases in suicidal behaviour in vulnerable people, its discussion in an interpersonal or clinical setting directly does not “plant the idea” or increase the risk. In fact, several reviews of studies in adolescents and adults find no rise in suicidal ideation after being asked, and in some cases a small reduction in distress or suicidal thinking.
Lao points to the fear that raising the topic with a loved one can increase the risk as something that “can prevent life-saving conversations.”
Which people in Macao are most at risk?
According to Lao, young people – especially those in the under-24 bracket – are particularly vulnerable, with this demographic making up over 30 percent of attempted suicides in recent years.
“These young people navigate intense academic pressures, competitive employment landscapes, and rapidly evolving family dynamics,” the MSRP director-general notes.
While the stressors impacting young people are by no means new, Lao points out that their impact has reached new levels of severity due to factors such as the Covid-19 pandemic, which “affected the social fabric that young people depend on for emotional stability.”
Social media has played a role as well, with the expert pointing out that it has “introduced entirely new dimensions of psychological risk.”
“These platforms amplify existing vulnerabilities like depression and social isolation, creating new forms of comparison that magnify feelings of inadequacy,” he points out. “Cyberbullying and exposure to problematic content can create concerning effects within peer groups.”
[See more: Cannabis often exacerbates existing mental health struggles, studies find]
Middle-aged residents in the 35 to 64 age bracket also have a higher risk of suicide, as official data shows that around 52 percent of suicides in 2024 were committed by those in this demographic.
On the reasons for these high figures, Lao says that middle-aged individuals in this “sandwich generation” face a wide range of pressures. These include having to simultaneously look after their elderly parents and young children, striking a balance between their work and family commitments, and dealing with housing market and employment uncertainties.
In particular, the suicide rate among middle-aged men in their thirties and fifties is especially high and more than double that of their female counterparts last year.
“For middle-aged men especially, traditional expectations around providing for family can intersect with cultural attitudes toward help-seeking, creating barriers,” says Lao.
What is currently being done to address suicide in Macao?
Currently, the Macao government and local organisations provide a range of services to support individuals who are at risk of suicide. These include 24-hour suicide prevention and mental health telephone services such as the Life Hope Hotline and the Heartening Student Hotline, which Lao says can serve as “critical first-contact points for individuals who may not yet feel ready for face-to-face assistance.”
As the head of the Life Hope Hotline, Ng says that her telephone service currently receives an average of around 1,400 calls per month, with roughly 95 percent originating from local residents.
“Our main priority is to first listen respectfully to the caller and to give them a chance to share what has been happening to them,” Ng explains. “By design, hotlines are not really for us to help resolve the caller’s problem. Rather, it is to figure out how we can respectfully listen to the caller’s inner state.”
Still, the hotline director says her staff will respond to each case according to the exact situation. In some situations, the caller may have simply wanted space to share their emotions without additional support.
[See more: The jury is still out on teens, social media and mental health]
Meanwhile, other individuals are open to further help, although they are unaware of the specific services in place, in which case the hotline attendant will provide the necessary details.
In situations where the caller is reluctant to seek medical help, Ng says the attendant will request contact details to follow up on their situation and to provide them with the encouragement and confidence needed to take the next step. This would include specialised services such as psychiatric and psychological interventions that are being offered by public hospitals and health care centres.
As well, community organisations such as the Women’s General Association of Macau and the General Union of Neighbourhood Association of Macau provide assistance in the form of support groups, accessible psychotherapy and education outreach, which Lao says contributes to the normalisation of help-seeking behaviour.
Within schools, students also have access to counselling services, ensuring that they too can receive the necessary mental health services in an educational setting.
What else can be done about suicide in Macao?
One area that Ng would like to see a greater amount of focus on is the collection of suicide data collection, a task that is made all the more difficult due to the lack of organisations wholly dedicated to researching suicide prevention in Macao.
Lao concurs, pointing out that the SAR can build on its present research foundation “by developing more comprehensive, long-term structured systems for suicide data collection and analysis.”
“Enhanced academic research examining local trends and culturally-specific factors could provide crucial insights for developing more effective interventions,” the psychotherapist explains.
To this end, he calls for the SAR government, medical professionals and local tertiary institutions to work together to conduct comprehensive studies and to develop suicide intervention strategies that are aligned with the situation in Macao.
At the same time, Lao believes a more balanced approach is needed when it comes to funding for treatment and prevention. While not discounting the importance of treatment services, the expert argues that additional funding for prevention could help to save further lives by addressing the problem before it takes root.
[See more: Mental health issues are affecting younger children, data shows]
In dealing with youth suicide, the MSRP director-general suggests making mental health education a key part of school curricula, as this will “normalise” discussions about emotional well-being and equip students with “consistent skills.”
Meanwhile, the ability of the education sector to engage in suicide prevention could be significantly bolstered by increasing the number of mental health professionals in the school counselling system. Lao says that this would relieve teachers from having to deal with students’ mental health issues by themselves, and would instead allow them to better serve as the “first line of observation and support.”
This role, of course, extends far beyond the classroom setting, with Ng pointing out that the task of suicide prevention falls on each individual, who must take the initiative to spot the warning signs in themselves and others, and ensure that these issues are addressed through discussion and professional help.
In short, the onus of suicide prevention shouldn’t be on any one person or stakeholder. As Lao points out, “effective suicide prevention demands seamless partnership across entire systems: families, schools, community organisations, medical services, all working together in creating a comprehensive safety net.”
If you or someone you know is having thoughts about suicide, call the Caritas Hope for Life Hotline. The English and Portuguese language service can be reached on 2852 5777 and operates from 2 pm to 11 pm Sunday to Tuesday and from 9 am to 6 pm Thursday to Saturday. It is closed on Wednesdays and Public Holidays. The Chinese language service operates 24/7 on 2852 5222. In an emergency, call 999, 110 or 112.
