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Background: Research suggests that a whole-school approach to mental health promotion can be more effective than a compartmentalized approach. In particular, student-led initiatives have demonstrated a positive impact on students' mental health, though not without systemic and individual barriers. Factors that lead to successful implementation and sustaining of student-led initiatives are currently not well understood. Methods: A case study is presented to demonstrate how a student-led intervention came about, inspired changes in the school organization and members, and transformed the school's approach to mental health promotion. Analysis of in-depth interviews with student leaders and adult advisors was informed by theories of innovation diffusion and human motivation. Results: Key factors and mechanisms of change were identified for the initiation, transformation, and institutionalization stages of the student-led initiative. Changes in students' identity and adult advisors' mindset were found to be integral to the successful conversion to a whole-school approach in mental health promotion. Conclusions: This study confirms the value of mobilizing the student body as an active resource in promoting mental health in school and the importance of input from school management, advisors, and intervention expert. Recommendations on how to implement a student-led initiative and sustain the positive changes are given.

Objectives Due to statistical challenges in disentangling the mobility effect (i.e. intergenerational educational mobility) from the position effect (i.e. parental and person's own education), the impact of intergenerational educational mobility on cognitive function remains unclear. We employed a novel approach to identify the mobility effect and investigate the net impact of intergenerational educational mobility on heterogeneous patterns of cognition among middle-aged and older adults in China. Methods Participants aged 45 and older were recruited from the China Health and Retirement Longitudinal Study, a population-based prospective cohort study between 2011 and 2018. We identified cognitive trajectories using the growth mixture model (GMM) and subsequently employed the mobility contrast model (MCM) to examine the effects of intergenerational educational mobility on cognitive patterns stratified by gender. Results Almost two thirds of respondents experienced intergenerational educational mobility, and 55% experienced upward mobility. Men had a higher rate of upward mobility than women. Three population-based cognitive patterns were identified: the low cognitive function with decline group (28%), the moderate cognitive function group (47%), and the high cognitive function group (26%). MCM analysis revealed that both upward and downward intergenerational educational mobility negatively affected cognitive trajectory patterns, extending beyond the influence of individuals' current and parental education. Discussion In future research, the impact of mobility can be studied in longitudinal data sets by combining the GMM and MCM approaches. The net negative effect of intergenerational educational mobility on cognitive trajectory patterns indicates that it should be recognized as an independent predictor of cognitive decline. [ABSTRACT FROM AUTHOR]

Research to date has rarely addressed the association between peer victimization in childhood and social networking addiction in adulthood, much less the internal mechanism underlying that association. By integrating the relational self-system processes model and the cognitive–behavioral model of pathological internet use, our study marked an initial effort to explore whether social anxiety and perceived loneliness independently and/or sequentially mediate the impact of peer victimization on social networking addiction. Using school-based random cluster sampling, we recruited 1,136 students at various colleges in eastern, central, and western China (mean age = 21.98 years, 56.2% women) to complete an online survey. The results confirmed social anxiety’s single mediation effect, perceived loneliness’s single mediation effect, and the serial mediation effect of social anxiety and perceived loneliness between peer victimization and social networking addiction. The findings suggest that certain psychopathological and cognitive factors mediate the effect of peer victimization in childhood on individuals’ symptoms of social networking addiction in adulthood both independently and sequentially. Our research contributes to clarifying how interpersonal stressors lead to psychopathological symptoms, maladaptive cognitions, and, in turn, addictive behavior, which has important implications for theory, interventions, and future research. [ABSTRACT FROM AUTHOR]

Introduction: From 2010 to 2021, suicide rates in 15–24 age group in Taiwan increased by 70%, with jumping being the most common method in 2021. We examined the link between the rise in youth suicides and the increase in high‐rise buildings during this period. Methods: Spearman's correlation coefficients and negative binomial mixed‐effects models were employed to assess the association between the increase in high‐rise buildings and jumping suicides over time. Results: Spearman's correlation coefficients of high‐rise buildings and jumping suicide rates in youth decreased from 0.692 (p < 0.001) in 2010 to 0.354 (p = 0.11) in 2021. Negative binomial mixed‐effects models showed that although jumping suicide rates in youths increased over time, the increase in numbers of high‐rise buildings was not related to rates of youth suicide by jumping. Conversely, in older age groups, the correlations were still prominent. Conclusion: Despite the rising trend in youth suicides by jumping over the past 11 years, our study refutes the intuitive notion that the increase in high‐rise buildings contributes to this trend. It is imperative to identify and address other potential factors, such as academic stress and/or family disruptions, for effective prevention of youth suicide. [ABSTRACT FROM AUTHOR]

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]

School-based programs are recommended by the World Health Organization (WHO) to promote mental health for young people. However the effectiveness of such programs varies, and there are multi-level challenges to embedding mental health education in schools. Further, critical scholarship has focused on the ways in which such programs can contribute to neoliberal goals, rather than empowering students meaningfully. Our research used focus group interviews to capture the perspectives and experiences of teachers and children participating in a school-based program in Hong Kong. We applied Bernstein's theory of pedagogic practices to analyze the interview data, in particular the concepts of boundaries and framing. We identified rigid boundaries between classrooms, the wider school, and home. Boundaries between academic and wider learning, and between school leaders and teachers, hindered cultural change towards mental wellbeing in schools. The program in this study reduced boundaries between students, and between students and teachers. This enhanced students' communication, and bonding with peers and teachers. School culture about mental health education was found to have weak framing, with students having more influence on the learning process in this program than they currently do in other subjects. We argue that understanding boundaries and framing underpins development of better pedagogic practices in mental health education. When rooted in careful analysis of power relationships with school cultures, mental health promotion is not necessarily aligned with dominant values in society that privilege academic success over wellbeing. School-based programs can provide co-learning spaces for teachers and students, that encourage learning about mental health. [ABSTRACT FROM AUTHOR]

This study examines the typologies of adult son–parent and daughter–parent relations in Hong Kong, a place where East meets West. The data were drawn from a survey of 834 adult children (381 sons and 453 daughters) aged between 18 and 59 with at least one living parent. Latent class analysis identified four types of relations for both son-parent and daughter-parent relations: tight-knit, distant ascending ties, obligatory, and detached. Sons were more likely to engage in obligatory and tight-knit relations with parents, whereas daughters were more likely to engage in distant ascending ties relations. Multinomial logistic regression found that adult children who were young, single, or co-residing with their child aged above 18 were more likely to have tight-knit relations with their elderly parents. Our findings suggest that although the male-dominated norm remains influential in Hong Kong, daughters are increasingly maintaining close interactions with their parents. [ABSTRACT FROM AUTHOR]

Background: Continuous exposure to stressors can lead to vulnerability and, in some cases, resilience. This study examined the variation in its psychological impact across the first four waves of COVID-19 in Hong Kong. Methods: Transcripts from Open Up, an online text-based counseling service, between January 2019 and January 2021 were analyzed (N = 60 775). We identified COVID-19 mentioned sessions using keywords and further categorized them into those that also mentioned symptoms of common mental disorders (CMDs) and those that did not. Autoregressive integrated moving average models were used to analyze the associations between the severity of the outbreak and the mention of COVID-19 and CMDs. Results: Results revealed that the pandemic led to increased psychological distress. Compared to prior to its advent, more people sought help in the initial months of the outbreak. Furthermore, associations were found between the severity of the outbreak and the number of help-seeker mentioning the pandemic, as well as between the outbreak severity and the number of help-seekers disclosing psychological distress. However, these relationships were not uniform across the four waves of outbreaks; a dissociation between outbreak severity and help-seekers' concern was found in the fourth wave. Conclusion: As the pandemic waxes and wanes, people may become habituated to its psychological toll. This may be interpreted as a form of resilience. Instead of worsening with time, the psychological impact of COVID-19 may reduce with repeated exposure. [ABSTRACT FROM AUTHOR]

Many people face problems of emotional distress. Early detection of high-risk individuals is the key to prevent suicidal behavior. There is increasing evidence that the Internet and social media provide clues of people’s emotional distress. In particular, some people leave messages showing emotional distress or even suicide notes on the Internet. Identifying emotionally distressed people and examining their posts on the Internet are important steps for health and social work professionals to provide assistance, but the process is very timeconsuming and ineffective if conducted manually using standard search engines. Following the design science approach, we present the design of a system called KAREN, which identifies individuals who blog about their emotional distress in the Chinese language, using a combination of machine learning classification and rulebased classification with rules obtained from experts. A controlled experiment and a user study were conducted to evaluate system performance in searching and analyzing blogs written by people who might be emotionally distressed. The results show that the proposed system achieved better classification performance than the benchmark methods and that professionals perceived the system to be more useful and effective for identifying bloggers with emotional distress than benchmark approaches [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the factor structure of the Work-Family Balance Scale (WFBS) and examine its reliability and validity in use in the urban Chinese population. The scale was validated using a sample of 605 urban Chinese residents from 7 cities. Exploratory factor analysis identified two factors: work-family conflict and work-family enrichment. The WFBS showed adequate reliability and concurrent validity. The WFBS is a reliable and valid instrument to measure work-family balance for Chinese working parents. However, further examination of the scale is needed. (Contains 4 tables.)

Charcoal burning suicides in Hong Kong between 2002-2004 in the 15 to 59-year-old age group were investigated using the psychological autopsy method. The psychopathological profiles of charcoal burning suicides (N = 53) were compared against "other suicides" (N = 97). The two groups did not differ significantly in the prevalence of "DSM-IV" axis I diagnoses with the exception of schizophrenic spectrum disorder which was less frequently associated with charcoal burning suicides. Score on "neuroticism" in the NEO-five Factor Inventory (NEO-FFI) was significantly higher in victims of charcoal burning suicide. There was also a trend toward higher score on "conscientiousness" in the NEO-FFI among charcoal burners than victims of other suicide.

Suicide notes have been regarded as one of the most informative data sources to understand the reasons why people commit suicide. However, there is a paucity of suicide note studies, leaving researchers with an assumption that this phenomenon remains static over time. This study examines this assumption by comparing the characteristics of note-leavers of the same population at 2 different points in time. The authors investigated the characteristics of 316 note-leavers in 2000 in Hong Kong and compared them to note-leavers in 1992. The proportion of people who left suicide notes increased from 20% to 35% between 1992 and 2000, a change that may be related to changes in suicide methods. Note-leavers in 2000 were characterized as individuals aged 25-59 years old, employed, with no physical illness, no psychiatric illness, and died as a result of charcoal-burning. Present data suggest that reasons for leaving suicide notes may have changed over the 8 years from 1992 to 2000. (Contains 1 table.)

An integrative suicide prevention program was implemented to tackle an outbreak of visitor charcoal burning suicides in Cheung Chau, an island in Hong Kong, in 2002. This study evaluated the effectiveness of the program. The numbers of visitor suicides reduced from 37 deaths in the 51 months prior to program implementation to 6 deaths in the 42 months post-implementation period. The number of visitor suicide pacts decreased from 7 pacts (15 individuals) to 1 pact (2 individuals). No statistically significant differences in the numbers of visitor suicide attempts and resident suicides were observed in the two time periods. No statistically significant changes in visitor suicides during the study period were observed on the comparison islands. The consistency and timing of reduction in visitor suicides correlated with the development and delivery of the integrative program on the intervention island, suggesting a causal association between program delivery and reduction of visitor suicides. The possibility of displacement seems small because there was no increase in visitor suicides on the comparison islands during the study period. This integrative approach in preventing target-specific suicides may serve as an example for other communities to develop suicide prevention programs that make use of the existing local resources.

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.

Classification of suicides is essential for clinicians to better identify self-harm patients with future suicidal risks. This study examined potential subtypes of suicide in a psychological autopsy sample (N = 148) in Hong Kong. Hierarchical cluster analysis extracted two subgroups of subjects in terms of expressed deliberation assessed by the Beck Suicide Intent Scale (SIS). The first group was associated with charcoal burning suicide, no psychiatric illness, indebtedness, better problem-solving ability, chronic stress, and higher overall SIS scores. The second group was associated with jumping from a height, psychotic disorders, psychiatric treatment, acute stress, and lower overall SIS score. The existence of a substantial cluster of subjects with lower expressed intent and preparation has important implications for the performance of the SIS as a predictive tool. Suicide prevention strategy may have to target potential subgroups with specific approaches.