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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]

Suicide is a global public health concern. The Stigma of Suicide Scale–Short Form (SOSS-SF) is a brief measure on the stigma toward suicide. This study aimed to examine the psychometric properties of the SOSS-SF in a sample of 1,946 adolescents and early adults (M age = 23.3, 69% females) in Hong Kong. The participants completed the SOSS-SF, measures on suicidal ideation and perceived distress, and binary items on lifetime risk behaviors online. Exploratory structural equation modeling evaluated the factor structure and reliability of the SOSS-SF in split samples and its measurement invariance, convergent validity, and discriminant validity in the overall sample. Contrary to a poor fit for the three-factor structure in the original 16-item SOSS-SF, the four-factor model showed a good fit in the revised 12-item version in both subsamples. The four factors (Glorification, Isolation, Disgrace, and Selfishness) loaded significantly on three items each (λ =.52-.93) and had adequate reliability (ω =.78-.88). The SOSS-SF displayed scalar invariance across age group, gender, and suicidal ideation and significant associations with validating variables. These results demonstrate a valid and reliable four-factor structure for the SOSS-SF and support its use for assessment of multifaceted stigma toward suicide. [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]

AbstractObjectiveMethodsResultsConclusion\nHIGHLIGHTSFemale labor-force participation (FLFP) has been theorized as contributing to higher suicide rates, including among women. Evidence on this relationship, however, has been mixed. This study explored the association between FLFP and suicide in an understudied context, Taiwan, and across 40-years.Annual national labor-participation rates for women ages 25–64, and female and male suicide-rates, for 1980–2020, were obtained from Taiwan’s Department of Statistics. The associations between FLFP rates and sex/age-stratified suicide-rates, and between FLFP rates and male-to-female suicide-rates ratios were assessed via time-series regression-analyses, accounting for autoregressive effects.Higher FLFP rates were associated with lower female suicide-rates (ß = −0.06, 95% CI (Credibility Interval) = [−0.19, −0.01]) in the adjusted model. This association held in the age-stratified analyses. Associations for FLFP and lower male suicide-rates were observed in the ≥45 age-groups. FLFP rates were significantly and positively associated with widening male-to-female suicide-rates ratios in the adjusted model (ß = 0.24, 95% CI = [0.03, 0.59]).This study’s findings suggest that FLFP protects women from suicide, and point to the potential value of FLFP as a way of preventing suicide. In Taiwan, employed women carry a double-load of paid and family unpaid care-work. Child care-work is still done by mothers, often with grandmothers’ support. Therefore, this study’s findings contribute to evidence that doing both paid work and unpaid family care-work has more benefits than costs, including in terms of suicide-protection. Men’s disengagement from family care-work may contribute to their high suicide rates, despite their substantial labor-force participation.Female labor-force participation (FLFP) has been theorized to increase suicide.Over time higher FLFP was associated with lower suicide, particularly in women.Higher FLFP was associated with widening male-to-female suicide-rate ratios. [ABSTRACT FROM AUTHOR]

In contrast to the economic approach that dominates poverty research, a subjective approach that asks respondents to evaluate their own poverty status offers an insider's perspective on poverty. However, most studies investigating the factors associated with subjective poverty in high-income societies have failed to disentangle those factors' effects on subjective poverty from their effects on economic poverty, and most were conducted in Europe. Using data from the two-wave (2015–2017) Hong Kong Panel Survey for Poverty Alleviation (N = 840), this study examined the extent to which the effects on subjective poverty of eight socio-demographic factors (e.g. gender, age, residence status, marital status, educational attainment, employment status, housing status, and self-rated health) are mediated through the dynamics of economic poverty using logistic regression and mediation analysis. The results of logistic regression showed educational attainment, housing status, and self-rated health to be significantly associated with subjective poverty. Mediation analysis revealed that the effects of secondary education and living in public or private rental housing on subjective poverty are not mediated through the dynamics of economic poverty and that only 20.40% of self-rated poor health's effect is mediated. Our findings thus suggest that solving economic poverty alone is insufficient to tackle the issue of subjective poverty in Hong Kong. Several policy initiatives, including improving the career prospects of the secondary-educated, enhancing the mobility outcomes of public rental tenants, and reducing the rent-to-income ratio of private rental tenants, could contribute to alleviating subjective poverty. [ABSTRACT FROM AUTHOR]

This study is the first attempt to examine poverty transitions and their correlates in Hong Kong, which has a high poverty rate despite being one of the world's wealthiest societies. By classifying the respondents into pre-transfer non-poor, non-transfer poor, post-transfer non-poor and post-transfer poor, factors that were associated with the probability of moving out of (into) poverty due to the receipt (absence) of social welfare transfers were identified. The examination of poverty transitions with consideration for social welfare transfers has important implications on development of effective policies for poverty alleviation. Two types of factors were included: social stratification factors and life-course events. We draw data from the 2015 and 2017 Hong Kong Panel Survey for Poverty Alleviation. Binary and multinomial logistic regressions were used to examine factors associated with poverty transitions. The results showed that employment factors (number of employed household members and increased employment ratio) were the only factors that help people move out of poverty. Demographic factors (number of children in the household and increased dependency ratio) increased the risk of falling into post-transfer poor. Immigrants were more likely to transit from post-transfer poor to non-transfer poor. More policy efforts should be devoted to helping the working poor and single parent households, and to reducing stigma against immigrants receiving welfare benefits. [ABSTRACT FROM AUTHOR]

Purpose: Underreporting of suicide is a worldwide problem. In particular, the national suicide rates published by the Chinese Ministry of Health ("MOH") could be severely underreported. Validity of the assumption of evenly underreported of suicide by place (city/rural), gender, and age in China has been evaluated and some possible adjustments to the underreporting have been suggested. Methods: Mortality rates from the MOH from 2002 to 2016 were extracted. Due to zero undetermined deaths, accidental deaths (weighted by causes of death) were used to evaluate underreported suicides. 53% of drownings, 11% of falls, 11% of poisonings, and 7% of other accidents were assumed as underreported suicides. Negative binomial regressions were used to calculate the rate ratios of the underreported suicides compared to suicides. Negative binomial regressions were also used to calculate the annual percentage changes of different mortality rates. Results: Suicides of rural males could most likely be underreported (49%; 95% CI 39–61%), but suicides of rural females would least likely (30%; 95% CI 24–38%). Suicides of people aged 15–24 years and 75 years and above could more likely to be underreported than other ages. After adding the underreported suicides, declining trends of the national suicide rates had been eased. Conclusions: People who lack social connection could have a high possibility of underreporting suicide. However, when rural females died of unnatural causes, their parents or even the whole village tended to quest for their intents, thus rural females had a lower possibility of underreporting suicide. [ABSTRACT FROM AUTHOR]

The Asian economic crises of 1997 and the 2008 Global Financial Crisis (GFC) had far-reaching impacts on Asian and other global economies. Turmoil in the banking and finance sectors led to downturns in stock markets, resulting in bankruptcies, house repossessions and high unemployment. These crises have been shown to be correlated with a deterioration in mental health and an increase in suicides, and it is important to understand the implication of these impacts and how such recessions affect the health of affected populations. With the benefit of hindsight, did lessons learned from the negative effects of the 1997 Asian economic recession impact the aftermath of the 2008 GFC in Asian countries? Utilising a framework based on a simple strata-bootstrap algorithm using daily data – where available – we investigate the trend in suicide rates over time in three different populations (Hong Kong, Taiwan and South Korea), and examine whether there were any changes in the pattern of suicide rates in each country subsequent to both the 1997 Asian and 2008. We find that each country responded differently to each of the crises and the suicide rates for certain age-gender specific groups in each country were more affected. [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]

Seasonality of suicidal behavior has been widely reported in many epidemiological studies with a well replicated suicide peak in spring followed by a trough in winter season. Research from some regions over the past few decades has shown a diminishing seasonal pattern of suicides and this introduced a new perspective on the suicide study. Data on all suicide deaths from the period 1991 to 2015 was extracted from the South Korean National Death Registration data set which was made available by Statistics Korea. Our findings confirmed a strong seasonal effect of suicides in South Korea throughout the study period and a marked diminishing pattern was observed since the period of 2006–2010. The rhythm of suicides kept changing across the time intervals with a spring peak followed by a second peak in late summer/autumn. The seasonality varied across age groups and the seasonal effect among the Korean elderly suicides was still found to be significant though a diminishing pattern was observed recently. [ABSTRACT FROM AUTHOR]

Over the past few decades, the level of divorce, measured by the crude divorce rate (CDR), has increased dramatically in both the East and the West, but has recently appeared to fall or level off in some countries. To investigate whether the recent decline or stabilisation of the CDRs reflects the real trends in divorce risk, a decomposition analysis was conducted on the changes in the CDRs over the past 20 years on two western and three East Asian countries, namely, the UK, Australia, Taiwan, South Korea, and Singapore. The following is observed: the decline in the CDRs of the UK and Australia in the 1990s, and of Taiwan and Korea in the 2000s, was mainly due to shrinkage in the proportion of the married population rather than any reduction in divorce risk; only Australia experienced a genuine reduction in divorce risk between 2001 and 2011; and the continuous increase of Singapore’s divorce level between 1990 and 2010 may be is an unintentional effect of the government’s marriage promotion policies. The shift in the population age structure, and more importantly, the drastic decline in marriage, has seriously distorted the CDRs, making them unreliable indicators for monitoring divorce trends. [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]

Studies in female sexual assertiveness have generally focused on individuals rather than couples, and little research has been conducted in the Chinese context. This study examined perceived and actual female sexual assertiveness at the couple level, and also explored its impact on marital and sexual satisfaction with a representative sample of 770 couples in Hong Kong. The results showed that husbands reported a higher level of acceptance of female sexual assertiveness in both perception and actual behavior; furthermore, couples reported greater congruence in their perception of female sexual initiation than actual behavior. Multiple logistic regressions showed that actual female sexual assertiveness, not the perception of it, affects both spouses' marital and sexual satisfaction. Compared with couples in which neither accepted female sexual initiation in practice, husbands where both spouses accepted this were more likely to be satisfied with the marriage. Husbands who accepted female sexual refusal whilst their wives did not were also more likely to be satisfied with both the marital and sexual relationship. Similarly, wives who did accept female sexual assertiveness but whose husbands did not were more likely to be satisfied with both the marital and sexual relationship. [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: Nurses are especially vulnerable to violent and other forms of aggression in the workplace. Nonetheless, few population-based studies of workplace violence have been undertaken among working-age nurse professionals in Hong Kong in the last decade.Methods: The study estimates the prevalence and examines the socio-economic and psychological correlates of workplace violence (WPV) among professional nurses in Hong Kong. The study uses a cross-sectional survey design. Multivariate logistic regression examines the weighted prevalence rates of WPV and its associated factors for a population of nurses.Results: A total of 850 nurses participated in the study. 44.6% had experienced WPV in the preceding year. Male nurses reported more WPV than their female counterparts. The most common forms of WPV were verbal abuse/bullying (39.2%), then physical assault (22.7%) and sexual harassment (1.1%). The most common perpetrators of WPV were patients (36.6%) and their relatives (17.5%), followed by colleagues (7.7%) and supervisors (6.3%). Clinical position, shift work, job satisfaction, recent disturbances with colleagues, deliberate self-harm (DSH) and symptoms of anxiety were significantly correlated with WPV for nurses.Conclusions: WPV remains a significant concern for healthcare worldwide. Hong Kong's local health authority should put in place a raft of zero-tolerance measures to prevent WPV in healthcare settings. [ABSTRACT FROM AUTHOR]

Background: In response to an unexpected long cold spell in February 1996 which killed more than 100 older adults (mostly living alone) in Hong Kong, the Hong Kong Senior Citizen Home Safety Association established a Personal Emergency Link Service to provide emergency contact to the older adults, which uses a telephone system to render emergency relief and total care service around the clock. To facilitate the dynamic and efficient allocation of service resources, it is crucial to understand the factors linked with use of the services and number of hospital admissions arising from PE link service.Methods: We initially use the Poisson generalized linear model (GLM) with polynomial effect functions of relevant covariates. If the time series of residuals from fitting the Poisson GLM reveals significant serial correlation, a Poisson generalized linear autoregressive moving average (GLARMA) model is refitted to the data to account for the auto-correlation among the time series of daily call numbers. If the data is overdispersed relative to the best fitting Poisson GLARMA model, then the negative binomial GLARMA model is refitted to account for any overdispersion. In all the models, dummy variables for weekdays and months are included to account for any cyclic trends due weekday effect or month of the year effect. The secular time trend is modeled by a polynomial function of calendar time over the study period. Finally any critical temperatures are identified by visually inspecting the graph of the effect function of temperature.Results: The weekday and month effects are both significant with Monday seeing more PE Link calls than Sunday and June seeing less than January. Temperature has significant effect on the PE Link call rate with the effect highly nonlinear. A critical temperature, below which excessive increase in PE link calls that lead to hospital admissions, is identified to be around 15 °C.Conclusion: Identifying a threshold temperature which generates an excessive increase in the expected number of PE Link calls would be useful in service provision planning and support for elderly in need of hospital admission. [ABSTRACT FROM AUTHOR]

Background: Work-related stress appears to be a contributing factor in the lives of employed people who kill themselves, particularly during economic downturns. However, few studies have compared them with working community controls who may be experiencing similar strains, in order to explore the role of mental disorders in these deaths and the implication of such strains on their service use pattern. We hypothesized that both work stress and mental illness were associated with suicides, and that mental illness served as the mediator between work stress and suicide. Based on the Behavioral Model, we also assumed work stress associated with their use of services. Methods: A sample of 175 employed individuals (suicides=63; controls=112) drawn from a psychological autopsy (PA) dataset was examined based on demographics and socioeconomic factors, psychiatric diagnoses and use of services, psychosocial factors, and life events. A mediator analysis was conducted to examine the impact of work on suicides. Results: Suicides generally had depression and anxiety, debts, higher impulsivity and poorer social support in comparison to controls. Chronic impact from work, which was fully mediated by psychiatric illness, was found higher among those suicides that did not seek contact with clinical service providers. Limitations: PA is a post-hoc cross-sectional comparison method which does not allow causal analyses. Conclusion: It is important to develop new approaches for engaging vulnerable individuals in the workplace before they become suicidal, as their depression and social isolation can serve to cut them off from help when they are most in need. Occupational mental health programs should be made available for employees and their families. [ABSTRACT FROM AUTHOR]

Background: Little is known about sex knowledge, attitudes, and high-risk sexual behaviors among unmarried youth in Hong Kong. It is of public health importance to investigate this topic to inform sex education, policymaking, and prevention and intervention programs. Methods: Based on the Youth Sexuality Survey conducted by Hong Kong Family Planning Association (FPAHK) in 2011, this study explored the characteristics of sexual knowledge, attitudes, and high-risk sexual behaviors among 1,126 unmarried youth aged 18 to 27 years. Multiple logistic regressions were performed to examine factors associated with unmarried youth's premarital sex, casual relationships, multiple sex partners, and premarital pregnancy. Results: Unmarried youth in Hong Kong had adequate sex knowledge, but contraceptive knowledge was deficient. The majority of unmarried youth (63.8%) held liberal attitudes toward premarital sex and about half held liberal attitudes toward any form of sexual activity and premarital pregnancy. Around 60% held conservative attitudes toward causal sex relationships and multiple sex partners. Males tended to hold more liberal attitudes toward high-risk sex behaviors than female youth. Approximately 41.5% of unmarried youth reported having engaged in premarital sex, whereas less than 10% engaged in high-risk sexual behaviors. Males also reported higher amounts of premarital sex, casual sex relationships, and multiple sex partners. Females reported higher levels of sexual coercion. Logistic regressions indicated that being older, coming from a divorced family, out of school status and liberal attitudes toward risky sex behavior were more likely to engage in premarital sex or high-risk sex behaviors, and being female, being better educated and being immigrants were less likely to engage in premarital sex. However, being immigrants was more likely to engage in casual relationship and to have multiple partners. Conclusions: Premarital sex is becoming more prevalent among unmarried youth in Hong Kong, and a small proportion of young adults are engaging in high-risk sexual behaviors. Sex education and HIV prevention programs should equip them with adequate knowledge on contraception and condom use. Intervention programs can start with their attitudes toward sex. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. Sexual dysfunction is a serious public health problem that affects women's quality of life. However, there is very little epidemiological data on its incidence in Hong Kong Chinese women. Aim. To estimate the prevalence of, and risk factors associated with sexual dysfunction among young and middle-aged women in Hong Kong. Methods. The study was part of the ninth Knowledge, Attitude, and Practice survey conducted by the Family Planning Association of Hong Kong in 2007. The dataset comprised 1,510 face-to-face interviews with Hong Kong Chinese women aged 19-49 living in the community. Main Outcome Measure. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition classification of sexual dysfunction was used to measure female sexual dysfunction (FSD). Results. At least one form of FSD was reported by 37.9% of the sample. Multivariate analysis showed that having sought medical help for sexual problems (odds ratio [OR] = 4.20), having a partner with erectile dysfunction (OR = 2.44) and premature ejaculation (OR = 2.56), perceiving sex as unimportant to marriage (OR = 1.57), and reporting marital dissatisfaction (OR = 1.45) were all significant risk factors for FSD and its specific components among the sample. However, having liberal attitudes to sex (OR = 0.63) was a protective factor. Conclusion. The prevalence of FSD is lower among Hong Kong Chinese young and middle-aged women than in the United States and some Asian countries. Factors contributing to the risk of FSD span the domains of sexual experience, attitudes to sex, and relationship factors. These findings suggest future directions for the delivery of services addressing the prevention and treatment of FSD. Zhang H and Yip PSF. Female sexual dysfunction among young and middle-aged women in Hong Kong: Prevalence and risk factors. J Sex Med 2012;9:2911-2918. [ABSTRACT FROM AUTHOR]

The article presents information on a study on the prohibition of the means for suicide to prevent it. High-risk factors common to suicide include depression and other mental disorders. Removal or withdrawal of the pesticides from market and change in the composition of domestic cooking gas may be effective in suicide prevention. INSET: Search strategy and selection criteria.

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]

. We consider the properties of the local polynomial estimators of a counting process intensity function and its derivatives. By expressing the local polynomial estimators in a kernel smoothing form via effective kernels, we show that the bias and variance of the estimators at boundary points are of the same magnitude as at interior points and therefore the local polynomial estimators in the context of intensity estimation also enjoy the automatic boundary correction property as they do in other contexts such as regression. The asymptotically optimal bandwidths and optimal kernel functions are obtained through the asymptotic expressions of the mean square error of the estimators. For practical purpose, we suggest an effective and easy-to-calculate data-driven bandwidth selector. Simulation studies are carried out to assess the performance of the local polynomial estimators and the proposed bandwidth selector. The estimators and the bandwidth selector are applied to estimate the rate of aftershocks of the Sichuan earthquake and the rate of the Personal Emergency Link calls in Hong Kong. [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]

It is of interest to estimate the size of a crowd in a demonstration. We propose a practical method to obtain an estimate of the size of the crowd and its standard error. This method has been implemented in practice and, compared with other counting methods, is found to be more efficient, more timely and have less scope for bias. The method described in this paper was motivated by the annual 1 July demonstrations in Hong Kong, and data from the 2006 demonstration are used as an example of the proposed method. [ABSTRACT FROM AUTHOR]

Since the open-door reform policy was adopted in China in the late 1970s, many Hong Kong manufacturers have moved their production facilities to the Pearl River Delta (PRD). Over the decades, the Hong Kong/PRD synergy has been the major impetus behind changes in cross-boundary demographic processes. This paper examines several prominent cross-border demographic issues, including the One Way Permit Scheme, Mainland-Hong Kong marriages and births, and Hong Kong people working and taking up residence in China. Some policy issues on migration are also reviewed and the prospects for a holistic population policy are discussed. [ABSTRACT FROM AUTHOR]

In any epidemic, there may exist an unidentified subpopulation which might be naturally immune or isolated and who will not be involved in the transmission of the disease. Estimation of key parameters, for example, the basic reproductive number, without accounting for this possibility would underestimate the severity of the epidemics. Here, we propose a procedure to estimate the basic reproductive number ( R 0) in an epidemic model with an unknown initial number of susceptibles. The infection process is usually not completely observed, but is reconstructed by a kernel-smoothing method under a counting process framework. Simulation is used to evaluate the performance of the estimators for major epidemics. We illustrate the procedure using the Abakaliki smallpox data. [ABSTRACT FROM AUTHOR]

This paper proposes a double-nonparametric procedure to estimate the population size for reporting delay data without the specification of the incidence function and the delay distribution function. Asymptotic results of the proposed estimator are given. Simulation studies show that the proposed procedure works better than the existing estimating procedures. The method has been applied to a suicide reporting system in Hong Kong for improving monitoring and surveillance purposes. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The presence of indebtedness is known to be a risk factor that can trigger stressed persons to contemplate suicide. This study compares the profiles of suicides with and without debt problems based on 2002 Coroner's Court death files. The category of men aged 25–39 has seen a 70% increase in suicide rate since 1997, and the number using carbon monoxide poisoning has increased from 1% of the total deaths in 1997 to about 26% of the total deaths in 2002. Suicides associated with debt problems seem to involve fewer mental and physical problems with formal job attachment than do suicides without debt problems. Gambling is a significant contributing factor to unmanageable indebtedness. [ABSTRACT FROM AUTHOR]

This paper considers the effect of imperfect vaccination in a susceptible-infected-removal (SIR) epidemic model. The minimum proportion of the population that needs to be vaccinated to prevent a major epidemic depends on the vaccine efficacy and the basic reproductive rate for the SIR model, allowing for imperfect and variable vaccination. Martingale theory is used to derive estimates and associated standard errors for these parameters. Asymptotic properties of the resulting estimators are investigated. Data for a mumps outbreak are used as an illustrative example. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Kernel smoothing methods are used to extend the Poisson log-linear approach to the estimation of the size of population using multiple lists to an open population when the multiple lists are recorded at each time point. The data is marginal as only the lists at each time point are available and the transitions of individuals between lists at different time points are not observable. Our analysis is motivated by and applied to data on the number of drug addicts in the Hong Kong Special Administrative Region. [ABSTRACT FROM AUTHOR]

Background: The short-term effect of celebrity suicide on the overall suicide rate is widely known, but long-term effects remain unclear. Objective: To examine whether celebrity suicide is associated with suicidal ideation over a longer period. Design: This is a study on the effect of the suicide of a famous Hong Kong entertainment celebrity, who committed suicide on 1 April 2003, on suicide thoughts of the community. A population-based survey was conducted between December 2003 and July 2004. Respondents were asked about their suicidal ideation, psychological well-being, life events, and whether or not they had been affected by celebrity suicide. Setting: Hong Kong Special Administrative Region, the People's Republic of China. Participants: 2016 respondents aged between 20 and 59 years. Results: After controlling for some known suicide risk factors, celebrity suicide was shown to be independently associated with suicidal ideation. People who had indicated to have been affected by celebrity suicide were 5.93 times (95% CI 2.56% to 13.72%, p=0) more likely to have severe level of suicidal ideation (Adult Suicidal Ideation Questionnaire score ≥31) than people who had not been affected. Respondents having greater anxiety symptoms, less reason for living and more focus on irrational values were also found to have had their suicide ideation affected by celebrity suicide. Conclusions: Celebrity suicide is a risk factor for suicidal ideation over a short term as well as over a long term. Raising awareness of the possible negative effect of celebrity suicide through suicide prevention programmes in the community is needed. [ABSTRACT FROM AUTHOR]

A unified likelihood-based approach is proposed to estimate population size for a continuous-time closed capture–recapture experiment with frailty. The frailty model allows the capture intensity to vary with individual heterogeneity, time, and behavioral response. The individual heterogeneity effect is modeled as being gamma distributed. The first-capture and recapture intensities are assumed to be in constant proportion but may otherwise vary arbitrarily through time. The approach is also extended to capture–recapture experiments with possible random removals. Simulation studies are conducted to examine the performance of the proposed estimators. By asymptotic efficiency comparison and simulation studies, the proposed estimators have been shown to be superior to their discrete-time model counterparts in genuine continuous-time capture–recapture experiments. [ABSTRACT FROM AUTHOR]

Background: Lengthy questionnaires reduce data quality and impose a burden on respondents. Previous researchers proposed that a single item ("My future seems dark to me") and a 4-item component of the Beck's Hopelessness Scale (BHS) can summarise most of the information the BHS provides. There is no clear indication of what BHS cutoff values are useful in identifying people with suicide tendency. Methods: In a population-based study of Chinese people aged between 15 and 59 in Hong Kong, the Chinese version of the BHS and the Centre for Epidemiologic Studies -- Depression scale were administered by trained interviewers and suicidal ideation and suicidal attempts were self-reported. Receiver operating characteristics curve analysis and regression analysis were used to compare the performance of the BHS and its components in identifying people with suicidality and depression. Smoothed level of suicidal tendency was assessed in relation to scores on the BHS and its component to identify thresholds. Results: It is found that the 4-item component and, to a lesser extent, the single item of the BHS perform in ways similar to the BHS. There are non-linear relationship between suicidality and scores on the BHS and the 4-item component; cutoff values identified accordingly have sensitivity and specificity of about 65%. Conclusion: The 4-item component is a useful alternative to the BHS. Shortening of psycho-social measurement scales should be considered in order to reduce burden on patients or respondents and to improve response rate. [ABSTRACT FROM AUTHOR]

A semiparametric estimation procedure is proposed to model capture–recapture data with the aim of estimating the population size for a closed population. Individuals' covariates are possibly time dependent and missing at noncaptured times and may be measured with error. A set of estimating equations (EEs) based on covariate process and capture–recapture data is constructed to estimate the relevant parameters and the population size. These EEs can be solved by an algorithm similar to an EM algorithm. Simulation results show that the proposed procedures work better than the naive estimate. In some cases they are even better than “ideal” estimates, for which the true values of covariates are available for all captured subjects over the entire experimental period. We apply the method to a capture–recapture experiment on the bird species Prinia flaviventris in Hong Kong. [ABSTRACT FROM AUTHOR]

Background: China accounts for more than 30% of the world's suicides and displays a unique pattern of suicide rates. Prior research had established the link between macrosocial changes and suicide. Comprehensive surveillance system of suicide in this rapidly developing country is much needed. This paper examined the trends of national-, region-, gender-, and age-specific suicide rates, and male to female ratios in suicide in China for the period of 1991-2000, which was a time that rapid economic and social changes took place.Methods: A regression model was used to detect any variations in national-, region-, gender-, and age-specific suicide rates and gender ratios reported by the most recent mortality statistics from China's Ministry of Health.Results: National, urban, and rural suicide rates for both men and women decreased significantly for the period of 1991-2000; age-specific suicide rates, however, showed that there were different patterns of changes in suicide rates in rural and urban areas. Although elderly suicide rates showed the most significant decrease in urban areas, younger women showed the largest decrease in rural areas; male to female gender ratio in suicide increased significantly in the urban areas, but no significant change was found in rural areas.Conclusions: Possible explanations that may account for the downward trends in suicide rates and increase in male to female gender ratio in urban area were provided. Longer historical studies are needed to reveal the relationship between macrosocial changes and the pattern of suicide. [ABSTRACT FROM AUTHOR]

This paper compares the properties of various estimators for a beta-binomial model for estimating the size of a heterogeneous population. It is found that maximum likelihood and conditional maximum likelihood estimators perform well for a large population with a large capture proportion. The jackknife and the sample coverage estimators are biased for low capture probabilities. The performance of the martingale estimator is satisfactory, but it requires full capture histories. The Gibbs sampler and Metropolis-Hastings algorithm provide reasonable posterior estimates for informative priors. [ABSTRACT FROM AUTHOR]

The seasonality of suicides in the USA increased from the 1970s to the 1990s. A significant proportion of suicide variation due to the seasonal component has been reported. Noted increments in seasonal rhythms in the latter part of the 1980s and 1990s seem to support those of Warren, et al. but contradict the conclusions of diminishing drawn by Hakko, ext at, Rhimer, et at, and Yip, et al. [ABSTRACT FROM AUTHOR]

Suicide is the leading cause of death in Hong Kong SAR for the youth aged 15–24. This study examined the prevalence of suicidality among secondary school students in Hong Kong using a representative, territory-wide sample of 2,586 students. Suicidal behaviors can be conceptualized as a spectrum of self-destructive behaviors. Cumulative logit model analysis indicated that a range of factors, such as unhappy family life, were associated with increasing levels of suicidality. Use of illicit drugs, inhalants, and tobacco differentiated attempters from ideators. The implications of the research findings are discussed. [ABSTRACT FROM AUTHOR]

To identify the risk period and the risk factors for suicide in Chinese psychiatric patients after discharge from inpatient psychiatric treatment. The nature of psychiatric aftercare provided to these patients was also explored. A case control study with 73 patients who were discharged from a large psychiatric unit in Hong Kong between January 1996 and December 1999 and had received coroners’ verdict of suicide or undetermined death within the same period. Controls were 73 surviving patients discharged from the same unit. They were individually matched for sex, age, psychiatric diagnosis, and date of discharge. Post-discharge clustering of suicides was observed among the cases. Nearly 80% of them died within 1 year of discharge. The most common principal diagnosis among the cases was schizophrenia and related psychotic disorders. Multivariate analysis showed that suicide was associated with: unemployment (OR = 12.2, 95% CI = 2.1 − 70.4), past suicidal attempts (OR = 3.4, 95% CI = 1.2 − 9.6), maternal mental illness (OR = 13.4, 95% CI = 1.0 − 170.0), and suicidal ideation or attempt before the last admission (OR = 5.0, 95% CI = 1.4 − 18.0). The psychiatric aftercare received by cases and controls were generally similar. However, cases were more likely to have had contact with health care services in the last week before death (OR = 4.0, 95% CI = 1.3 − 11.9). Suicidal risk is high in Chinese psychiatric patients soon after discharge. They share some common risk factors for suicide identified in Western studies but several differences are evident: the predominance of schizophrenia in the suicides; the lower prevalence of substance abuse and comorbidity; the low proportion of patients living alone; and the increased clinical contact before death but the less suicidal intent expressed in Chinese patients. It is necessary to consider these socio-cultural factors in assessment of suicidal risk and implementation of suicide prevention strategies in Chinese psychiatric patients. [ABSTRACT FROM AUTHOR]

Suicide rates in Hong Kong increased with age, and the highest suicide rate occurred among the oldest age groups. Hong Kong has one of the highest elderly suicide rates in the world. The elderly suicide rate was four to five times above the average. Furthermore, gender differences were observed among different marital status groups. For example, single males had a much higher rate than single females and married males had a higher rate than their widowed counterparts. The suicide rate for an economically inactive person was six times higher than for an active one. Jumping has become increasingly common and seems to substitute for other methods of suicide. Winter months and the Chinese New Year period had the lowest suicide occurrence. Some explanations are given. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

SUMMARY A two-step procedure based on a partial likelihood is proposed to estimate the size of a closed population for multiple recapture studies in continuous time when the capture rates are permitted to depend on covariates associated with individuals. The asymptotic and small-sample properties of the resulting estimators are investigated. [ABSTRACT FROM AUTHOR]

Purpose: Suicide in young adulthood is a vital public health concern. There have been few systematic studies that examined the prevalence and transition of suicidal ideation classes in young adults and the factors associated with the transition. Methods: This two-wave survey recruited 1269 young adults (Mean age = 24.0 years, 70.1% males) in Hong Kong. The participants completed the Suicidal Ideation Attributes Scale, Chinese Health Questionnaire, and help-seeking behaviors in 2018 and 2019. Latent profile analysis was used to classify the participants into latent classes of suicidal ideation with substantive checking under the 3-step approach. Latent transition analysis with measurement invariance examined the transition among the latent classes from 2018 to 2019 and the associations with help-seeking behaviors and change in psychological distress. Results: Three latent classes of suicidal ideation were identified and over two-thirds of the participants belonged to the Low-risk class with minimal suicidal ideation. The prevalence of the High-risk class dropped from 10.2 to 7.2%, while that of the Moderate-risk class remained stable from 2018 to 2019. Increases in psychological distress predicted higher probabilities to remain at or transit into more risky classes. Engagement in help-seeking behaviors showed differential transitions in suicidal ideation across time. Conclusion: The findings suggest three latent classes of suicidal ideation with distinct profiles among the young adults. Deterioration in psychological distress showed a temporal effect on worsening of suicidal ideation over a 1-year period. Future studies should elucidate the comparative effectiveness of help-seeking behaviors via online and offline channels. [ABSTRACT FROM AUTHOR]

This study examines the patterns and determinants of multidimensional poverty and related welfare interventions in Hong Kong. These patterns unveil which dimension or combinations of dimensions contribute the most to multidimensional poverty. These results are useful in informing poverty‐alleviation policies as they help to identify who should be targeted and which welfare transfer programme(s) should be enhanced. Data were drawn from the first wave (2015) of the Hong Kong Panel Survey for Poverty Alleviation (N = 1458). A latent‐class analysis revealed four types of multidimensional poverty: severely deprived, housing‐led poor, socially and status excluded and neighbourhood poor. A multinomial logistic regression was conducted and identified distinctive determinants of the four types of poverty. The groups that require paramount attention from policymakers are older adults over age 70, households with members with disabilities or chronic diseases and households with five or more members. The assessment of the coverage and intensity of cash and in‐kind transfers showed that the coverage of cash transfers for the severely deprived and housing transfers for the housing‐led poor was inadequate. The approach proposed in this study exemplifies ways to transform multidimensional poverty research into evidence‐based policymaking. [ABSTRACT FROM AUTHOR]

Despite much attention paid to the surging divorce rate in China, knowledge on divorce patterns and trends at the subnational level is still very limited. This study aims to systematically explore social and economic factors affecting divorce trends between 1990 and 2015 at the provincial level from a tempo–spatial perspective. Traditional fixed effects panel regression and fixed effects spatial autoregression are adopted. Divorce maps demonstrated great variations in the levels and trends of divorce across provinces, highlighting the spatial diversities obscured in the national divorce trend. It is further revealed that factors such as economic development, urbanisation, and employment have augmented their influence over time. Factors that reflect gender equality issues such as the gender gap in education, employment, and sex ratio at birth have different effects across the East, Central and West regions in China. These findings provide insights into the future prospects of divorce in China. [ABSTRACT FROM AUTHOR]

Objective: Cancer patients have elevated suicide risk compared to the general population. However, little is known about the characteristics of cancer patients who have died by suicide. The objectives of the study were to compare the characteristics of suicide cases with, and without cancer, and determine whether age was associated with differences in characteristics. Methods: A total of 14,446 suicide cases between 2003 and 2017 in Hong Kong were identified using Coroner's Court reports. Cases were grouped by cancer status, based on medical history in the reports. Information extracted from the reports included sociodemographic variables and detailed descriptions of the suicide event. Univariate analyses and overall and subgroup multiple logistic regressions were performed to compare characteristics between the two groups. Results: Of the 14,446 suicide cases, 1,461 (10.11%) had a cancer history. Compared to noncancer cases, cancer patients were generally older and less likely to live alone; more likely to use violent methods; less likely to have histories of physical and psychiatric problems; and more likely to communicate about their suicidal intent before death. Age was significantly associated with differences between cancer and noncancer cases. Conclusions: Cancer suicide cases have different characteristics from noncancer cases. Mental health screening may not be sufficient for suicide prevention among cancer patients. Healthcare professionals and caregivers should be aware of cancer patients' suicide risk, even when there are no signs of psychiatric disturbance. [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]

Objective: To examine whether we live healthier as we live longer in Hong Kong, which has one of the highest life expectancies in the world. Methods: Sullivan's method was used to evaluate the chronic disease--free life expectancy (CDFLE), life expectancy in good self-perceived health (GPHLE), and impairment-free life expectancy (IFLE) among population aged 50 years and older in Hong Kong in 2007--2016. Results: In spite of the marked improvement in life expectancy in Hong Kong, the increase in GPHLE was much smaller, while CDFLE and IFLE even declined for both genders. The situation was more severe among older population. Discussion: People in Hong Kong live longer but with worsening health. The expansion of chronic diseases, self-perceived poor health, and impairments among older adults calls for more fiscal investments, government attention, and public health policies. [ABSTRACT FROM AUTHOR]

In China in 2017, the elderly dependency ratio (EDR) – which is the number of elderly per 100 working-age population – was 14.8. This represents a huge increase from 6.7 in 1970. The speed and magnitude of the ageing trend remains a serious threat to the sustainable development of China. However, the EDRs exhibit wide and unusual spatial variations within the nation. In this study, based on a decomposition analysis, the spatial pattern of the EDRs across 31 provinces in China in 2000 and 2010 are investigated. The analyses attributed the change in the EDRs to four factors: working-age migration, mortality of the population aged 5–54, population momentum, and growth of the elderly population. It is found that the impacts of internal migration offset or even reverse the regional differentials in fertility and mortality, leading to an unusual ageing pattern in China. More developed provinces attracted young workers, which reduced the EDRs despite persistent low fertility; whereas the less developed provinces saw young workers outflow, increasing the EDRs despite the relatively high fertility rate. To some extent, it could be said that some provinces are 'growing old before growing rich', while other provinces are growing rich without growing old. [ABSTRACT FROM AUTHOR]

A timely estimate of suicide incidence is important for surveillance and monitoring but always difficult if not possible. The delay in reporting suicide cases between the time of occurrence of the deaths and them being registered is unavoidable. There is at least one year if not more of the delay time in the latest WHO website reporting the suicide statistics of most countries. Based on the daily newspaper reporting on suicide incidence, this study proposes a method to estimate the unknown incidence in a timely manner. It is shown that demographic characteristics such as age, suicide methods, and the districts of the deceased were significantly associated with the probability of the newspapers reporting the suicides. By incorporating this information on the daily suicide news reports into estimating the probability of the newspapers reporting the suicides, the daily number of suicide cases can be estimated. The proposed method is applied to estimate the number of suicides in Hong Kong where there is the Coroner's Court to investigate into suicide deaths, but it takes at least six months to deliver a verdict. The present method can generate timely and accurate estimations on the daily count of suicide deaths with only a one day lag. In a threefold nested cross-validation, the proposed approach has achieved an average RMSE of 1.38, MAE of 1.10, and R2 of 0.24. It can also serve as a surveillance system in providing estimations of temporal clusters of suicides with certain characteristics timelessly and accurately. [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]