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Objective: With its anonymity and accessibility, text-based online counseling has shown great potential in reaching people with mental health needs. One strategy adopted to meet the service gap is concurrent counseling, that is, each counselor attending to more than one client at a time. To date, there is no reported evidence supporting its rationality and effectiveness. This study investigated the potential opportunities, effectiveness, and caveats in concurrent service delivery and identified the optimal cutoff number of concurrent sessions while maintaining the quality of service at or above a set threshold. Method: We analyzed the transcript of 54,716 online counseling sessions from Open Up, a free, 24/7 text-based counseling service, to develop an attention score that measures the attention allocation of counselors and examined the impact of the counselor's attention allocation on client satisfaction and service outcomes. Results: On average, compared to nonconcurrent sessions, concurrent sessions were longer, more likely to end prematurely, and had lower client satisfaction. We also identified an optimal attention score of approximately 0.4 (out of 1.0, which denotes full attention), which translates to two to three concurrent sessions. Conclusions: This study provides empirical evidence for the feasibility of conducting multiple text-based sessions concurrently without compromising service quality and client experience. Our method of measuring the counselor attention allocation offers a way to systematically assess and evaluate concurrent sessions. What is the public health significance of this article?: The rapid increase in the availability of online counseling services continues to be outpaced by the growth in their demand. This study is the first to provide evidence for the possibility and effectiveness of concurrent counseling, that is, treating more than one client at a time. It highlights the feasibility of reaching more people with psychological distress without substantially sacrificing the service quality. The resulting attention score calculation is potentially relevant to a wide range of contexts. [ABSTRACT FROM AUTHOR]

The Chinese Health Questionnaire (CHQ) is a 12-item assessment tool of psychological distress. The present study systematically evaluated the psychometric properties of the CHQ in a large sample of 1968 young people in Hong Kong. The participants completed the CHQ online in 2018 and 869 of them completed a follow-up survey on the CHQ, suicidal ideation, hikikomori, and help-seeking in 2019. Dimensionality of the CHQ was assessed via confirmatory factor analysis using the robust weighted least square estimator in 2018 and 2019. Measurement invariance was investigated across gender, age groups, and time between 2018 and 2019. Convergent validity of the CHQ factors were evaluated with respect to the mental health outcomes in the multiple indicators and multiple causes (MIMIC) approach. Confirmatory factor analyses shortened the CHQ into 10 items and revealed a superior fit for the bifactor model with a general factor and two specific factors on somatic and depressive symptoms in both 2018 and 2019. The general factor demonstrated substantial factor loadings (λ = 0.58–0.91), good reliability (ΩH = 0.85), and temporal stability (r = 0.62), and scalar measurement invariance across gender, age groups, and time. The general factor was significantly and positively associated with suicidal ideation, hikikomori, and help-seeking. The two specific factors displayed lower factor loadings, reliability, temporal stability, and weaker associations with the mental health outcomes. The present findings lend support to a valid and stable bifactor structure with a strong general factor for the CHQ-10 among young people in Hong Kong. Public Significance Statement: The 10-item Chinese Health Questionnaire (CHQ) showed a bifactor structure with a strong general factor and 2 weak specific factors in young people in Hong Kong. The CHQ-10 demonstrates satisfactory reliability, measurement stability across gender, age groups, and time across 2018 and 2019, and good convergent validity with suicidal ideation, hikikomori, and help-seeking. [ABSTRACT FROM AUTHOR]

The success of screening for individuals at suicidal risk among the general population relies heavily on the availability of a reliable and validated instrument. However, there remains a lack of a well-validated screening tool for suicidal risk in Chinese, despite the fact that about a quarter of the world's suicides takes place in China. In view of the severity of the suicide problem among the Chinese population, there is a crucial need to develop robust screening tools locally. This study investigates the psychometric properties related to the Chinese version of the Adult Suicidal Ideation Questionnaire (ASIQ) with a 2-wave, population-based panel study in the Hong Kong Special Administrative Region, People's Republic of China. Two-thousand sixteen Chinese people were interviewed for their suicidality, psychological well-being, and ASIQ scores. The Chinese ASIQ was shown to have strong internal reliability, convergent validity, and factorial validity. This study also demonstrated its predictive validity by examining sensitivity and specificity in identifying subsequent suicidality. A 4-item short version of ASIQ was also developed. [ABSTRACT FROM AUTHOR]

The success of screening for individuals at suicidal risk among the general population relies heavily on the availability of a reliable and validated instrument. However, there remains a lack of a well-validated screening tool for suicidal risk in Chinese, despite the fact that about a quarter of the world's suicides takes place in China. In view of the severity of the suicide problem among the Chinese population, there is a crucial need to develop robust screening tools locally. This study investigates the psychometric properties related to the Chinese version of the Adult Suicidal Ideation Questionnaire (ASIQ) with a 2-wave, population-based panel study in the Hong Kong Special Administrative Region, People's Republic of China. Two-thousand sixteen Chinese people were interviewed for their suicidality, psychological well-being, and ASIQ scores. The Chinese ASIQ was shown to have strong internal reliability, convergent validity, and factorial validity. This study also demonstrated its predictive validity by examining sensitivity and specificity in identifying subsequent suicidality. A 4-item short version of ASIQ was also developed.