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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]

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. [ABSTRACT FROM AUTHOR]

In recent years, various pro-natalist policies have been adopted in Singapore and other high-income Asian countries with low fertility, aiming at raising fertility rates. Previous studies were mainly focused on the impact or outcome of the policies. This paper, however, aims to identify the most influential groups in determining Singapore's total fertility rate (TFR) and evaluate the targeting of pro-natalist measures adopted by the government. We first reveal the changing age-parity-and-marital-status composition of women at childbearing age, and further conduct an elasticity analysis to assess the roles of different subgroups of women in changing the TFR. Our results show that compared to other groups, the 20–29-year-old single women and the married childless women aged 30–34 (‘married’ throughout this paper includes women who are or have been married) are more influential in determining the TFR and should be the potential pro-natalist target groups. However, Singapore's pro-natalist policies are more in favour of third and higher-order births. Such mismatch indicates that, if more efforts are devoted to facilitating marriage and first births in these potential groups, the TFR may be increased effectively. In order to achieve a long-term and significant fertility reversal, it calls for a long-term and integrated policy package. [ABSTRACT FROM PUBLISHER]

Cancer-related fatigue (CRF) is common in women with breast cancer, but little is known of its relationship with perceived stress. We conducted a cross-sectional study to explore the associations of CRF with perceived stress, anxiety, depression, pain and sleep quality in 133 Chinese women (aged 25-68 years) with early stage breast cancer. The majority of women had completed surgery and chemotherapy and were awaiting radiotherapy. Self-administered questionnaires consisting of the Brief Fatigue Inventory, Perceived Stress Scale-10, Hospital Anxiety and Depression Scale, Brief Pain Inventory, and Pittsburgh Sleep Quality Index were used to collect data. Forty-five per cent of the women were severely fatigued. Compared with local healthy women and US breast cancer patients, the group's mean perceived stress score was significantly higher (both p < 0.01). Higher perceived stress (β = 0.18, p = 0.032), higher anxiety (β = 0.30, p < 0.001) and higher pain severity (β = 0.38, p < 0.001) were associated with increased severity of CRF. The association of CRF with perceived stress was partially mediated by anxiety, suggesting a possible pathway from cancer and cancer treatment to CRF via stress appraisals and emotional distress. The findings indicate the importance of monitoring the psychological status of patients during treatment. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Intimate partner violence is a serious social problem and public health issue affecting the well-being of the young adults. However, there is very little epidemiological evidence on the incidence and associated health problems in contemporary Chinese society. Using a representative community sample of 1,223 young adults aged 18 to 27 years conducted by Hong Kong Family Planning Association in 2011, this study aimed to estimate the prevalence, risk factors, and possible health consequences of intimate partner violence among young adults in Hong Kong. It is found that the prevalence of lifetime and preceding 1-year intimate partner violence by former or current partners was 8.6% and 4.9% respectively. Male youths who were older were less likely to experience past-year intimate partner violence (odds ratio [OR] = 0.21, p < .05) and those who had a university degree or were unemployed were more likely to experience past-year intimate partner violence (OR = 8.48, p < .01 and OR = 8.14, p < .05 respectively). Female youths who had a full-time job were less likely to experience the lifetime violence (OR = 0.15, p < .05) and those who were ever pregnant with current partner were more likely to experience both lifetime intimate partner violence (OR = 5.00, p < .05) and past-year violence (OR = 5.63, p < .05). Both female and male victims were more likely to be subjected to mental health problems and only female victims felt fear for the violent partner. [ABSTRACT FROM AUTHOR]

Although mental illness is a major suicide risk factor, some cases of suicide list no symptoms of mental disorder at the time of death. Studying suicides without psychiatric illness has important implications for social work because this group's service needs seem to have been overlooked. The authors of this article conducted a psychological autopsy study of 150 people who committed suicide and 150 age- and gender-matched living controls. Suicides without psychiatric illness showed similar detectable psychopathology as the suicide and living control groups with nonpsychotic psychiatric disorders. Though suicides without psychiatric disorders showed fewer warning signs that could be noticed by their informants, they experienced more negative life events than living controls. The suicide cases without psychiatric illness also seemed to be less protected by enabling factors (such as social support and employment) than living controls with and without psychiatric disorders. Furthermore, they had lower use of services than the control and deceased-with-diagnosis groups. With fewer at-risk signs and poorer enabling resources, they were undetected or unengaged by the existing physical, psychiatric, and psychosocial services. This group should be of concern to social workers, who may develop community-based health education programs and preventive services to meet this vulnerable population's psychosocial needs. [ABSTRACT FROM PUBLISHER]

Background: Taipei has seen a substantial increase in suicide rates during the past decade, with a significant rise between 2004 and 2006, the time of this study period. Methods: A decompositional analytic method was used to quantify the relative contributions of age, sex and case fatality of methods to attempts and suicides. Results: From 2004 to 2006, the rate of fatal and non-fatal suicide attempts combined for population aged 15 years or above in Taipei increased by 37.3%, while the suicide rate increased by 29.2%. Three factors in these analyses contributed to the increase in suicide rates: (1) an increase in number of attempts, (2) a greater proportion of men among fatal and non-fatal attempts and (3) an increase in the use of a lethal method--burning of charcoal to produce carbon monoxide. The authors estimated that 74.5% and 25.6% among men and women, respectively, of the overall increased suicide mortality were attributable to increased 'charcoal burning suicides.' Conclusions: The rise in suicide rate reflected an increase in attempts and an influx of working-age men joining the pool of people attempting suicide. The much larger size of the attempter pool had the effect of reducing the case fatality even as the suicide rate climbed. The increase in the number of suicide attempts and the rise in the suicide rate were age-, sex-, and method-specific. These results strongly support the concept that reducing the total number of attempts is a central element to curbing suicides. [ABSTRACT FROM AUTHOR]

Background: Media guidelines for suicide reporting are available in many countries. However, to what extent the mass media comply with the guidelines is unknown. Few studies are available that investigate systematically whether the mass media reflect the epidemiological reality of suicide deaths in their articles. Methods: Based on the WHO media guidelines, this study investigated the characteristics of newspaper articles of suicides in three Chinese communities, namely Hong Kong, Taiwan and Guangzhou. Epidemiological comparisons were conducted to identify the age and gender differences between the suicide victims as reported in the newspapers and the official records of suicide deaths in all three places. Results: The results found that one media characteristic complied with the WHO media guidelines (ie, only about 2% of the articles were printed on the front page), but there were a number of instances of non-compliance (ie, only 4--14% provided sources for help-seeking and 27--90% printed with photos). The epidemiological comparisons revealed an over-representation of younger suicides and an under-representation of late-life suicides in the newspapers of all three places. Furthermore, female suicides were found to be under-reported in Taiwan and Guangzhou newspapers, but not in Hong Kong papers. Conclusion: Non-compliant suicide articles are prevalent in the newspapers of these three Chinese settings. The observed media misrepresentations may potentially mislead the public and the policy makers about the actual risk for suicide in some demographic groups. [ABSTRACT FROM AUTHOR]

Objectives: To assess changes in the intensity of suicide news reporting in Taiwan's local newspapers after the arrival of a daily tabloid-type newspaper, Apple Daily (AD), and evaluate the impact of suicide news reporting on actual suicides and possible mutual causation. Methods: A counting process was used to estimate the intensity of daily suicide news items reported in the China Times (CT) and United Daily (UD) before and after the arrival of AD (2002--05). Poisson regression models were used to assess the impact of the intensity of suicide news reporting on the actual number of next day suicides. Granger's causation model was used to assess mutual causation between suicide news reporting and actual suicides. Results: There was a significant increase in reporting intensity of suicide news in the UD soon after the entry of the AD into Taiwan's media market, while a delayed increase of approximately 1 year was observed in the CT. After the arrival of the AD, the reporting intensity in the UD was significantly related to the occurrence of actual suicides (p<0.05), even after controlling for social variables, whereas no significant correlation was previously observed. Mutual causation between suicide news reporting and actual suicides was also observed. Conclusions: The presence of the AD in Taiwan has fuelled competitive reporting of suicide news among traditional newspapers. This increase in the intensity of suicide news reporting has consequently had an impact on the actual number of suicides. This provides further empirical support for improving media reporting as a key element in suicide prevention. [ABSTRACT FROM AUTHOR]

Background Existing studies have described a strong correlation between unemployment rates and suicide rates, but the exact mechanisms through which they may interact with one another remain unknown. Method This study examined the complex relationships between suicide rates and both regional unemployment rates and individual employment status during times of economic recession (2000-3) and recovery (2003-6) in Hong Kong. Results Despite the strong correlation (0.86) between the unemployment rates and suicide rates for 2000e6, the rates of suicides within the employed and unemployed groups moved in the opposite direction from the overall population trend. That is, the suicide rate among the unemployed decreased during economic recession and increased during recovery. Conclusion It is important to be able to distinguish precisely between population-level concepts, such as rates, and individual-level characteristics, such as employment status, when considering the development of evidence-based suicide prevention strategies. [ABSTRACT FROM AUTHOR]

Background: The decreasing suicide rate in China has been regarded as a major contributor to the decline of global suicide rate in the past decade. However, previous estimations on China's suicide rates might not be accurate, since often they were based on the data from the Ministry of Health's Vital Registration ("MOH-VR") System, which is biased towards the better-off population. This study aims to compare suicide data extracted from the MOH-VR System with a more representative mortality surveillance system, namely the Center for Disease Control and Prevention's Disease Surveillance Points ("CDC-DSP") System, and update China's national and subnational suicide rates in the period of 2004-2014.Methods: The CDC-DSP data are obtained from the National Cause-of-Death Surveillance Dataset (2004-2014) and the MOH-VR data are from the Chinese Health Statistics Yearbooks (2005-2012) and the China Health and Family Planning Statistics Yearbooks (2013-2015). First, a negative binomial regression model was used to test the associations between the source of data (CDC-DSP/MOH-VR) and suicide rates in 2004-2014. Joinpoint regression analyses and Kitagawa's decomposition method are then applied to analyze the trends of the crude suicide rates.Results: Both systems indicated China's suicide rates decreased over the study period. However, before the two systems merged in 2013, the CDC-DSP System reported significantly higher national suicide rates (IRR = 1.18, 95% Confidence Interval [CI]: 1.13-1.24) and rural suicide rates (IRR = 1.29, 95% CI: 1.21-1.38) than the MOH-VR System. The CDC-DSP System also showed significant reversing points in 2011 (95% CI: 2006-2012) and 2006 (95% CI: 2006-2008) on the rural and urban suicide trends. Moreover, the suicide rates in the east and central urban regions were reversed in 2011 and 2008.Conclusions: The biased MOH-VR System underestimated China's national and rural suicide rates. Although not widely appreciated in the field of suicide research, the CDC-DSP System provides more accurate estimations on China's suicide rates and is recommended for future studies to monitor the reversing trends of suicide rates in China's more developed areas. [ABSTRACT FROM AUTHOR]

Background: Older adults worldwide are at a greater risk of suicide than other age groups. There is a scarcity of prospective studies exploring risk factors for suicide in older people and their discriminative ability to identify future suicide.Methods: We examined a prospective cohort of senior Taipei City residents between 2005 and 2009 (N=101,764). Cox proportional hazards regression analysis was used to determine significant risk factors and to construct a predictive score. The accuracy of the derived score in the prediction was tested by Receiver Operating Characteristic analysis.Results: Male sex (Hazard Ratio [HR]=3.41, p<0.001), lower education (HR=3.31, p<0.001) and lower income (HR=2.52, p=0.01) were associated with an increased risk of suicide, as well as depressed mood (HR=1.44, p=0.02; per unit increase in a 4-point scale) and insomnia (HR=1.30, p=0.03; per unit increase in a 4-point scale). The derived prediction score yielded a sensitivity of 0.63 a specificity of 0.73 and an area under curve of 0.73. Removing depressed mood from the prediction model did not significantly alter suicide predictability (P=0.11).Limitations: The dataset examined did not contain information regarding to important risk factors such as substance misuse and prescribed medications and the measures of mental health were relatively limited.Conclusion: Prediction of suicide based on factors recorded in a routine health screen of elderly people was unsatisfactory; the strongest predictors were factors that cannot be easily altered. Further understanding of how the socioeconomic condition of seniors contributes to suicide may provide valuable insights for intervention targeting this growing population-at-risk. [ABSTRACT FROM AUTHOR]