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1. Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries

Author

Pirkis, J, Gunnell, D, Shin, S, Del Pozo-Banos, M, Arya, V, Aguilar, PA, Appleby, L, Arafat, SMY, Arensman, E, Ayuso-Mateos, JL, Balhara, YPS, Bantjes, J, Baran, A, Behera, C, Bertolote, J, Borges, G, Bray, M, Brecic, P, Caine, E, Calati, R, Carli, V, Castelpietra, G, Chan, LF, Chang, S-S, Colchester, D, Coss-Guzman, M, Crompton, D, Curkovic, M, Dandona, R, De Jaegere, E, De Leo, D, Deisenhammer, EA, Dwyer, J, Erlangsen, A, Faust, JS, Fornaro, M, Fortune, S, Garrett, A, Gentile, G, Gerstner, R, Gilissen, R, Gould, M, Gupta, SK, Hawton, K, Holz, F, Kamenshchikov, I, Kapur, N, Kasal, A, Khan, M, Kirtley, OJ, Knipe, D, Kolves, K, Kolzer, SC, Krivda, H, Leske, S, Madeddu, F, Marshall, A, Memon, A, Mittendorfer-Rutz, E, Nestadt, P, Neznanov, N, Niederkrotenthaler, T, Nielsen, E, Nordentoft, M, Oberlerchner, H, O'Connor, RC, Papsdorf, R, Partonen, T, Phillips, MR, Platt, S, Portzky, G, Psota, G, Qin, P, Radeloff, D, Reif, A, Reif-Leonhard, C, Rezaeian, M, Roman-Vazquez, N, Roskar, S, Rozanov, V, Sara, G, Scavacini, K, Schneider, B, Semenova, N, Sinyor, M, Tambuzzi, S, Townsend, E, Ueda, M, Wasserman, D, Webb, RT, Winkler, P, Yip, PSF, Zalsman, G, Zoja, R, John, A, Spittal, MJ, Pirkis, J, Gunnell, D, Shin, S, Del Pozo-Banos, M, Arya, V, Aguilar, PA, Appleby, L, Arafat, SMY, Arensman, E, Ayuso-Mateos, JL, Balhara, YPS, Bantjes, J, Baran, A, Behera, C, Bertolote, J, Borges, G, Bray, M, Brecic, P, Caine, E, Calati, R, Carli, V, Castelpietra, G, Chan, LF, Chang, S-S, Colchester, D, Coss-Guzman, M, Crompton, D, Curkovic, M, Dandona, R, De Jaegere, E, De Leo, D, Deisenhammer, EA, Dwyer, J, Erlangsen, A, Faust, JS, Fornaro, M, Fortune, S, Garrett, A, Gentile, G, Gerstner, R, Gilissen, R, Gould, M, Gupta, SK, Hawton, K, Holz, F, Kamenshchikov, I, Kapur, N, Kasal, A, Khan, M, Kirtley, OJ, Knipe, D, Kolves, K, Kolzer, SC, Krivda, H, Leske, S, Madeddu, F, Marshall, A, Memon, A, Mittendorfer-Rutz, E, Nestadt, P, Neznanov, N, Niederkrotenthaler, T, Nielsen, E, Nordentoft, M, Oberlerchner, H, O'Connor, RC, Papsdorf, R, Partonen, T, Phillips, MR, Platt, S, Portzky, G, Psota, G, Qin, P, Radeloff, D, Reif, A, Reif-Leonhard, C, Rezaeian, M, Roman-Vazquez, N, Roskar, S, Rozanov, V, Sara, G, Scavacini, K, Schneider, B, Semenova, N, Sinyor, M, Tambuzzi, S, Townsend, E, Ueda, M, Wasserman, D, Webb, RT, Winkler, P, Yip, PSF, Zalsman, G, Zoja, R, John, A, and Spittal, MJ

Abstract

BACKGROUND: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. METHODS: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. FINDINGS: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well

Published
2022

2. An analysis of age-standardized suicide rates in Muslim-majority countries in 2000-2019

Author

Lew, B, Lester, D, Kõlves, K, Yip, PSF, Chen, Y-Y, Chen, WS, Hasan, MT, Koenig, HG, Wang, ZZ, Fariduddin, MN, Zeyrek-Rios, EY, Chan, CMH, Mustapha, F, Fitriana, M, Dolo, H, Gönültaş, BM, Dadfar, M, Davoudi, M, Abdel-Khalek, AM, Chan, LF, Siau, CS, Ibrahim, N, Lew, B, Lester, D, Kõlves, K, Yip, PSF, Chen, Y-Y, Chen, WS, Hasan, MT, Koenig, HG, Wang, ZZ, Fariduddin, MN, Zeyrek-Rios, EY, Chan, CMH, Mustapha, F, Fitriana, M, Dolo, H, Gönültaş, BM, Dadfar, M, Davoudi, M, Abdel-Khalek, AM, Chan, LF, Siau, CS, and Ibrahim, N

Abstract

Background This study examines the 20-year trend of suicide in 46 Muslim-majority countries throughout the world and compares their suicide rates and trends with the global average. Ecological-level associations between the proportion of the Muslim population, the age-standardized suicide rates, male-to-female suicide rate ratio, and the Human Development Index (HDI) in 2019 were examined. Methods Age-standardized suicide rates were extracted from the WHO Global Health Estimates database for the period between 2000 and 2019. The rates in each country were compared with the age-standardized global average during the past 20 years. The countries were further grouped according to their regions/sub-regions to calculate the regional and sub-regional weighted age-standardized suicide rates involving Muslim-majority countries. Correlation analyses were conducted between the proportion of Muslims, age-standardized suicide rate, male: female suicide rate ratio, and the HDI in all countries. Joinpoint regression was used to analyze the age-standardized suicide rates in 2000-2019. Results The 46 countries retained for analysis included an estimated 1.39 billion Muslims from a total worldwide Muslim population of 1.57 billion. Of these countries, eleven (23.9%) had an age-standardized suicide rate above the global average in 2019. In terms of regional/sub-regional suicide rates, Muslim-majority countries in the Sub-Saharan region recorded the highest weighted average age-standardized suicide rate of 10.02/100,000 population, and Southeastern Asia recorded the lowest rate (2.58/100,000 population). There were significant correlations between the Muslim population proportion and male-to-female rate ratios (r=-0.324, p=0.028), HDI index and age-standardized suicide rates (r=-0.506, p<0.001), and HDI index and male-to-female rate ratios (r=0.503, p<0.001) in 2019. Joinpoint analysis revealed that seven Muslim-majority countries (15.2%) recorded an increase in the average annual per

Published
2022

4. Factors associated with suicide attempts among Australian transgender adults

Author

Zwickl, S, Wong, AFQ, Dowers, E, Leemaqz, SY-L, Bretherton, I, Cook, T, Zajac, JD, Yip, PSF, Cheung, AS, Zwickl, S, Wong, AFQ, Dowers, E, Leemaqz, SY-L, Bretherton, I, Cook, T, Zajac, JD, Yip, PSF, and Cheung, AS

Abstract

BACKGROUND: Transgender, including gender diverse and non-binary people, henceforth referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm. We aimed to understand the risk and protective factors of a lifetime history of attempted suicide in a community sample of Australian trans adults to guide better mental health support and suicide prevention strategies. METHODS: Using a non-probability snowball sampling approach, a total of 928 trans adults completed a cross-sectional online survey between September 2017 and January 2018. The survey assessed demographic data, mental health morbidity, a lifetime history of intentional self-harm and attempted suicide, experiences of discrimination, experiences of assault, access to gender affirming healthcare and access to trans peer support groups. Logistic regression was used to examine the risk or protective effect of participant characteristics on the odds of suicide. RESULTS: Of 928 participants, 85% self-reported a lifetime diagnosis of depression, 63% reported previous self-harm, and 43% had attempted suicide. Higher odds of reporting a lifetime history of suicide attempts were found in people who were; unemployed (adjusted odds ratio (aOR) 1.55 (1.05, 2.29), p = 0.03), had a diagnosis of depression (aOR 3.70 (2.51, 5.45), p < 0.001), desired gender affirming surgery in the future (aOR 1.73 (1.14, 2.61), p = 0.01), had experienced physical assault (aOR 2.01 (1.37, 2.95), p < 0.001) or experienced institutional discrimination related to their trans status (aOR 1.59 (1.14, 2.23), p = 0.007). CONCLUSION: Suicidality is associated with barriers to gender affirming care, gender based victimisation and institutionalised cissexism. Interventions to increase social inclusion, reduce transphobia and enable timely access to gender affirming care, particularly surgical interventions, are potential areas of intervention.

Published
2021

5. Global imperative of suicidal ideation in ten countries amid the COVID19 pandemic

Author

Cheung, TC, Lam, SC, Lee, PH, Xiang, YT, Yip, PSF, COVID-19, International Research Collaboration on, and Lam, KBH

Abstract

Background: The novel coronavirus (COVID-19) has had a detrimental impact on individuals' psychological well-being; however, a multi-country comparison on the prevalence of suicidal ideation due to the virus is still lacking. Objectives: To examine the prevalence and correlates of suicidal ideation among the general population across 10 countries during the COVID-19 pandemic. Materials and methods: This was a cross-sectional study which used convenience sampling and collected data by conducting an online survey. Participants were sourced from 10 Eastern and Western countries. The Patient Health Questionnaire (PHQ-9) was used to measure the outcome variable of suicidal ideation. Ordinal regression analysis was used to identify significant predictors associated with suicidal ideation. Results: A total of 25,053 participants (22.7% male) were recruited. Results from the analysis showed that the UK and Brazil had the lowest odds of suicidal ideation compared to Macau (p < 0.05). Furthermore, younger age, male, married, and differences in health beliefs were significantly associated with suicidal ideation (p < 0.05). Conclusions: The findings highlight the need for joint international collaboration to formulate effective suicide prevention strategies in a timely manner and the need to implement online mental health promotion platforms. In doing so, the potential global rising death rates by suicide during the pandemic can be reduced.

Published
2020

6. Association between suicide reporting in the media and suicide: systematic review and meta-analysis

Author

Niederkrotenthaler, T, Braun, M, Pirkis, J, Till, B, Stack, S, Sinyor, M, Tran, US, Voracek, M, Cheng, Q, Arendt, F, Scherr, S, Yip, PSF, Spittal, MJ, Niederkrotenthaler, T, Braun, M, Pirkis, J, Till, B, Stack, S, Sinyor, M, Tran, US, Voracek, M, Cheng, Q, Arendt, F, Scherr, S, Yip, PSF, and Spittal, MJ

Abstract

OBJECTIVE: To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019. REVIEW METHODS: Studies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed. RESULTS: 31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature. CONCLUSIONS: Reporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for ce

Published
2020

7. A scenario analysis of future Hong Kong age and labour force profiles and its implications

Author

Lloyd, CJ, Kwok, R, Yip, PSF, Lloyd, CJ, Kwok, R, and Yip, PSF

Abstract

The consequences of reduced fertility and mortality on the age distribution are an issue for most developed countries, but especially for the ‘Asian tiger’ economies. We use functional data analysis forecasting techniques to project the population of Hong Kong. Our projections include error estimates that allow for forecasting error as well as exogenous variations of fertility and migration numbers. We separate out the effects of pure demographic shifts from projected behavioural changes in labour force participation.This enables us to look at the kinds of changes in labour force participation that would be required to offset the aging effects that we estimate.

Published
2019

8. A Projection of Future Hospitalisation Needs in a Rapidly Ageing Society: A Hong Kong Experience

Author

Wu, X, Law, CK, Yip, PSF, Wu, X, Law, CK, and Yip, PSF

Abstract

To assess the impact of ageing on hospitalisation in a rapidly ageing society. A study using retrospective and prospective data was conducted using hospitalisation data with age-specific admission rates in the period from 2001–2010 and demographic data from the period of 2001–2066 by the United Nations. The Hong Kong Special Administrative Region (SAR) with a 7 million population experiences extreme low fertility (1.1 children per woman) and long life expectancy (84 years old). Days of hospitalisation: For the period 2010–2066, the length of stay (LOS) in the age group 85+ is projected to increase by 555.3% while the LOS for the whole population is expected to increase by only 134.4% and by ageing only. In 2010, the proportion in the LOS contributed to by the oldest age group (85+) was 15%. In 2066, this proportion is projected to nearly triple (42%). Around 70% of the projected days of hospitalisation would be taken by people aged 75 years and above. It is projected that this phenomenon would be converted to a more balanced structure when the demographic transition changes into a more stable distribution. Apparently, the impact of ageing on the public hospital system has not been well understood and prepared. The determined result provides insight into monitoring the capacity of the hospital system to cope with a rapidly changing demographic society. It provides empirical evidence of the impact of ageing on the public hospitalisation system. It gives a long term projection up to the year 2066 while the situation would be different from the transient period of 2016–2030. The analysis adopts a fixed rate approach, which assumes the LOS to be only driven by demographic factors, while any improvements in health technologies and health awareness are not accounted for. Only inpatient data from the Hospital Authority were used, nonetheless, they are the best available for the study. Due to the limitation of data, proximity to death is not controlled in conducting this ana

Published
2019

10. The role of media in preventing student suicides: A Hong Kong experience

Author

Cheng, Q, Chen, F, Lee, EST, Yip, PSF, Cheng, Q, Chen, F, Lee, EST, and Yip, PSF

Abstract

Introduction In view of the surge of student suicides in March 2016, a large-scale media involvement was engaged to minimize copycat effects and to extensively spread more preventive information. Methods Trend differences between student suicides in overall as well as youth suicides between 2003 and 2016 were examined. Impacts of media involvement were examined as to the changes of their intensities in reporting student suicides in different manners. Local polynomial smoothing method was used to estimate the intensities throughout the study period. Results The intensity of students’ suicides has been slowly increasing since 2006, which was in contrast to the decreasing trend of overall suicide intensity. After our engagement with the media, acute descriptive-reporting in student suicide news has sharply dropped and remained low since then, whereas preventive-reporting has increased sharply in March and April 2016, but dropped back to normal afterwards. The higher intensity of preventive-reporting seemed to have a protective effect on student suicide. Limitations Data of student suicides in 2016 were substantially extracted from the local news, which may not contain complete information. The analyses suggested, but could not confirm, a causal relationship between the changes of student suicide news-reporting and the incidents of suicides themselves. Conclusions The recent surge of student suicides in Hong Kong was statistically abnormal. Media engagement has changed local suicide news-reporting to become more preventive, which could have contributed to the drop of student suicides. It is essential to sustain the media's coverage of preventive reporting to maintain its enduring effect.

Published
2018

11. A new method of identifying target groups for pronatalist policy applied to Australia

Author

van Wouwe, JP, Chen, M, Lloyd, CJ, Yip, PSF, van Wouwe, JP, Chen, M, Lloyd, CJ, and Yip, PSF

Abstract

A country's total fertility rate (TFR) depends on many factors. Attributing changes in TFR to changes of policy is difficult, as they could easily be correlated with changes in the unmeasured drivers of TFR. A case in point is Australia where both pronatalist effort and TFR increased in lock step from 2001 to 2008 and then decreased. The global financial crisis or other unobserved confounders might explain both the reducing TFR and pronatalist incentives after 2008. Therefore, it is difficult to estimate causal effects of policy using econometric techniques. The aim of this study is to instead look at the structure of the population to identify which subgroups most influence TFR. Specifically, we build a stochastic model relating TFR to the fertility rates of various subgroups and calculate elasticity of TFR with respect to each rate. For each subgroup, the ratio of its elasticity to its group size is used to evaluate the subgroup's potential cost effectiveness as a pronatalist target. In addition, we measure the historical stability of group fertility rates, which measures propensity to change. Groups with a high effectiveness ratio and also high propensity to change are natural policy targets. We applied this new method to Australian data on fertility rates broken down by parity, age and marital status. The results show that targeting parity 3+ is more cost-effective than lower parities. This study contributes to the literature on pronatalist policies by investigating the targeting of policies, and generates important implications for formulating cost-effective policies.

Published
2018

12. Media effects on suicide methods: A case study on Hong Kong 1998-2005

Author

Cheng, Q, Chen, F, Yip, PSF, Cheng, Q, Chen, F, and Yip, PSF

Abstract

Background: Previous studies have suggested that mass media's reports of new suicide methods will increase suicides using the same method. The same pattern seems not to apply to a conventional suicide method, unless it was used by a celebrity. Objective: 1) to examine media effects on both new and non-new suicide methods during 1998 and 2005 in Hong Kong (HK), when a new method by burning charcoal (CB suicide) was spreading in the region. 2) to examine how CB competed with non-CB methods in terms of media coverage and "recruiting" suicidal persons in the socio-economic context. Methods: A self- and mutual- exciting process model was fitted to the data, adjusting for divorce rate, unemployment rate, and property price index. Breaking the whole period into onset, peak, and post-peak stages, the model was fitted again to examine the differences. Results: Comparable copycat effects were found on both CB and non-CB suicide news. The only cross-method media effects were found in the onset stage when non-CB suicide news showed suppressing effect on CB suicides. CB suicides reported a significant self-excitation effect. A higher divorce rate and lower property price index were associated with significantly more suicides incidences and more suicide news. Conclusions: The emerging of CB suicide method did not substitute media coverage of non-CB suicide in HK. Media effects in this case were not limited to new suicide method or celebrity suicide. The effects were further fueled by adverse socio-economic conditions.

Published
2017

13. Nonparametric Estimation of the Number of Drug Users in Hong Kong Using Repeated Multiple Lists

Author

Huggins, RM, Yip, PSF, Stoklosa, J, Huggins, RM, Yip, PSF, and Stoklosa, J

Abstract

Summary We update a previous approach to the estimation of the size of an open population when there are multiple lists at each time point. Our motivation is 35 years of longitudinal data on the detection of drug users by the Central Registry of Drug Abuse in Hong Kong. We develop a two‐stage smoothing spline approach. This gives a flexible and easily implemented alternative to the previous method which was based on kernel smoothing. The new method retains the property of reducing the variability of the individual estimates at each time point. We evaluate the new method by means of a simulation study that includes an examination of the effects of variable selection. The new method is then applied to data collected by the Central Registry of Drug Abuse. The parameter estimates obtained are compared with the well known Jolly–Seber estimates based on single capture methods.

Published
2016

14. Assessing the efficacy of Restricting access to barbecue charcoal for suicide prevention in Taiwan: A community-based intervention trial

Author

Chen, YY, Chen, F, Chang, SS, Wong, J, Yip, PSF, Chen, YY, Chen, F, Chang, SS, Wong, J, and Yip, PSF

Abstract

Objective: Charcoal-burning suicide has recently been spreading to many Asian countries. There have also been several cases involving this new method of suicide in Western countries. Restricting access to suicide means is one of the few suicide-prevention measures that have been supported by empirical evidence. The current study aims to assess the effectiveness of a community intervention program that restricts access to charcoal to prevent suicide in Taiwan. Methods and Findings: A quasi-experimental design is used to compare method-specific (charcoal-burning suicide, non-charcoal-burning suicide) and overall suicide rates in New Taipei City (the intervention site, with a population of 3.9 million) with two other cities (Taipei City and Kaohsiung City, the control sites, each with 2.7 million residents) before (Jan 1st 2009-April 30th 2012) and after (May 1st 2012-Dec. 31st 2013) the initiation of a charcoal-restriction program on May 1st 2012. The program mandates the removal of barbecue charcoal from open shelves to locked storage in major retail stores in New Taipei City. No such restriction measure was implemented in the two control sites. Generalized linear regression models incorporating secular trends were used to compare the changes in method-specific and overall suicide rates before and after the initiation of the restriction measure. A simulation approach was used to estimate the number of lives saved by the intervention. Compared with the preintervention period, the estimated rate reduction of charcoal-burning suicide in New Taipei City was 37% (95% CI: 17%, 50%) after the intervention. Taking secular trends into account, the reduction was 30% (95% CI: 14%, 44%). No compensatory rise in non-charcoal-burning suicide was observed in New Taipei City. No significant reduction in charcoal-burning suicide was observed in the other two control sites. The simulation approach estimated that 91 (95%CI [55, 128]) lives in New Taipei City were saved during the 20 mo

Published
2015

16. Healthy life expectancy in Hong Kong Special Administrative Region of China

Author

Yip, PSF and Law, CK

Subjects
Adult, Male, Chronic Disease - Epidemiology, Adolescent, Infant, Middle Aged, Disabled Persons - Statistics & Numerical Data, Age Distribution, Child, Preschool, Prevalence, Hong Kong, Humans, Regression Analysis, Female, Quality-Adjusted Life Years, China - Epidemiology, Sex Distribution, Child, Life Expectancy - Trends
Abstract

Sullivan's method and a regression model were used to calculate healthy life expectancy (HALE) for men and women in Hong Kong Special Administrative Region (Hong Kong SAR) of China. These methods need estimates of the prevalence and information on disability distributions of 109 diseases and HALE for 191 countries by age, sex and region of the world from the WHO's health assessment of 2000. The population of Hong Kong SAR has one of the highest healthy life expectancies in the world, Sullivan's method gives higher estimates than the classic linear regression method. Although Sullivan's method accurately calculates the influence of disease prevalence within small areas and regions, the regression method can approximate HALE for all economies for which information on life expectancy is available, This paper identifies some problems of the two methods and discusses the accuracy of estimates of HALE that rely on data from the WHO assessment., link_to_OA_fulltext

Published
2003

17. Gender selection in China: Its meanings and implications

Author

Ng, EHY, Chan, CHY, Yip, PSF, Chan, CLW, Ho, PC, and Au, JSK

Subjects
Population control, Infertility, Male preference, Gender selection, Gender ratio, Chinese culture
Abstract

With the advancement of assisted reproduction technologies, people are offered wider choices to choose the gender of their offspring and to construct 'ideal-typed' families with specific gender structure. Gender selection is welcomed by many societies with gender-specific preference, especially those patriarchal societies such as Chinese communities. It is not only a medical procedure but also a social orientation, which reveals much of the underlying preference towards gender. This paper explores the cultural dimensions to gender selection and its psychosocial meanings and implications in Chinese societies, especially after the establishment of One Child Policy in China. Problems associated with son preference in the culture with strong gender stereotyping are addressed. We believe that gender selection for social reasons should not be allowed since undesirable outcomes will be resulted under such strict population control program., link_to_OA_fulltext

Published
2002

18. Changes in suicide rates following media reports on celebrity suicide: a meta-analysis

Author

Niederkrotenthaler, T, Fu, K-W, Yip, PSF, Fong, DYT, Stack, S, Cheng, Q, Pirkis, J, Niederkrotenthaler, T, Fu, K-W, Yip, PSF, Fong, DYT, Stack, S, Cheng, Q, and Pirkis, J

Abstract

BACKGROUND: A growing number of studies indicate that sensationalist reporting of suicide is associated with increases in suicide rates, but in the light of some negative findings, the issue has remained controversial. The aim of this study was to evaluate the best current evidence on the association between celebrity suicide stories and subsequent suicides. METHODS: Literature searches of six data sources (Medline, Psychlit, Communication Abstracts, Education Resources Information Center, Dissertation Abstracts and Australian Public Affairs Database (APAIS)) were conducted. Studies were included if they (1) adopted an ecological design, (2) focused on celebrity suicide, (3) had completed suicide as outcome variable, (4) analysed suicide rates across all suicide methods, (5) used data from after World War II and (6) satisfied basic quality criteria. RESULTS: 10 studies with totally 98 suicides by celebrities met the criteria. The pooled estimate indicated a change in suicide rates (suicides per 100 000 population) of 0.26 (95% CI 0.09 to 0.43) in the month after a celebrity suicide. There was substantial heterogeneity between studies, which was explained by the type of celebrity (entertainment elite vs others) and the region of study, as indicated by mixed-effects meta-regression. The region-of-study-specific effect of reporting a suicide by an entertainment celebrity was 0.64 (95% CI 0.55 to 0.73) in North America, 0.58 (95% CI 0.47 to 0.68) in Asia, 0.36 (95% CI -0.10 to 0.61) in Australia and 0.68 (95% CI 0.51 to 0.85) in Europe. There was no indication of publication bias. CONCLUSIONS: Reports on celebrity suicide are associated with increases in suicides. Study region and celebrity type appear to have an impact on the effect size.

Published
2012

19. Spatial analysis of suicide mortality in Australia: Investigation of metropolitan-rural-remote differentials of suicide risk across states/territories

Author

Cheung, YTD, Spittal, MJ, Pirkis, J, Yip, PSF, Cheung, YTD, Spittal, MJ, Pirkis, J, and Yip, PSF

Abstract

Studies of suicide epidemiology in regions of Australia have been conducted, but the spatial pattern in the whole country has not been fully investigated. This study aimed at visualizing the sex-specific suicide pattern over the country from 2004 to 2008, and studying the metropolitan-rural-remote differentials of suicide across all states/territories. We applied a Poisson hierarchical model to yield smoothed sex specific, age standardized mortality ratios of suicide in all postal areas, and compiled the age-standardized suicide rates across different levels of remoteness and different jurisdictions. We identified the area variation of suicide risk across states/territories, and metropolitan-rural-remote differential with rates higher in rural and remote areas for males. Spatial clusters of some high risk postal areas were also identified. Socio-economic deprivation, compositional factors, high risks for Indigenous people and low access to mental health service are the underlying explanations of the elevation of suicide risk in some areas. These findings suggest that it is important to take geographical variations in suicide risk into account in national policy making. Particular suicide prevention interventions might be targeted at males living in remote areas, and some localized areas in metropolitan zones.

Published
2012

21. A nonparametric estimation of the infection curve

Author

Lin, H, Yip, PSF, Huggins, RM, Lin, H, Yip, PSF, and Huggins, RM

Abstract

Predicting the future course of an epidemic depends on being able to estimate the current numbers of infected individuals. However, while back-projection techniques allow reliable estimation of the numbers of infected individuals in the more distant past, they are less reliable in the recent past. We propose two new nonparametric methods to estimate the unobserved numbers of infected individuals in the recent past in an epidemic. The proposed methods are noniterative, easily computed and asymptotically normal with simple variance formulas. Simulations show that the proposed methods are much more robust and accurate than the existing back projection method, especially for the recent past, which is our primary interest. We apply the proposed methods to the 2003 Severe Acute Respiratory Syndorme (SARS) epidemic in Hong Kong.

Published
2011

22. Who wants a slimmer body? The relationship between body weight status, education level and body shape dissatisfaction among young adults in Hong Kong.

Author

Cheung, YTD, Lee, AM, Ho, SY, Li, ETS, Lam, TH, Fan, SYS, Yip, PSF, Cheung, YTD, Lee, AM, Ho, SY, Li, ETS, Lam, TH, Fan, SYS, and Yip, PSF

Abstract

BACKGROUND: Body shape dissatisfaction has been thought to have an indispensable impact on weight control behaviors. We investigated the prevalence of body shape dissatisfaction (BSD) and explored its association with weight status, education level and other determinants among young adults in Hong Kong. METHODS: Information on anthropometry, BSD, and socio-demographics was collected from a random sample of 1205 young adults (611 men and 594 women) aged 18-27 in a community-based household survey. BSD was defined as a discrepancy between current and ideal body shape based on a figure rating scale. Cross-tabulations, homogeneity tests and logistic regression models were applied. RESULTS: The percentages of underweight men and women were 16.5% and 34.9% respectively, and the corresponding percentages of being overweight or obese were 26.7% and 13.2% for men and women respectively. Three-quarters of young adults had BSD. Among women, 30.9% of those underweight and 75.5% of those with normal weight desired a slimmer body shape. Overweight men and underweight women with lower education level were more likely to have a mismatch between weight status and BSD than those with higher education level. After controlling for other determinants, underweight women were found to have a higher likelihood to maintain their current body shapes than other women. Men were found to be less likely to have a mismatch between weight status and BSD than women. CONCLUSIONS: Overweight and obesity in men and underweight in women were prevalent among Hong Kong young adults. Inappropriate body shape desire might predispose individuals to unhealthy weight loss or gain behaviors. Careful consideration of actual weight status in body shape desire is needed in health promotion and education, especially for underweight and normal weight women and those with a low education level.

Published
2011

23. A chain multinomial model for estimating the real-time fatality rate of a disease, with an application to severe acute respiratory syndrome

Author

Yip, PSF, Lau, EHY, Lam, KF, Huggins, RM, Yip, PSF, Lau, EHY, Lam, KF, and Huggins, RM

Abstract

It is well known that statistics using cumulative data are insensitive to changes. World Health Organization (WHO) estimates of fatality rates are of the above type, which may not be able to reflect the latest changes in fatality due to treatment or government policy in a timely fashion. Here, the authors propose an estimate of a real-time fatality rate based on a chain multinomial model with a kernel function. It is more accurate than the WHO estimate in describing fatality, especially earlier in the course of an epidemic. The estimator provides useful information for public health policy makers for understanding the severity of the disease or evaluating the effects of treatments or policies within a shorter time period, which is critical in disease control during an outbreak. Simulation results showed that the performance of the proposed estimator is superior to that of the WHO estimator in terms of its sensitivity to changes and its timeliness in reflecting the severity of the disease.

Published
2005

29. Long-term impact of celebrity suicide on suicidal ideation: results from a population-based study.

Author

Fu K and Yip PSF

Abstract

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 > or = 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]

Published
2007
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30. Suicide in Hong Kong: a case-control psychological autopsy study.

Author

Chen EYH, Chan WSC, Wong PWC, Chan SSM, Chan CLW, Law YW, Beh PSL, Chan KK, Cheng JWY, Liu KY, and Yip PSF

Abstract

Background. The relative contribution of psychosocial and clinical risk factors to suicide among Chinese populations is an important issue. In Hong Kong, this issue requires vigorous examination in light of a 50% increase in suicide rate between 1997 and 2003.Method. Using a case-control psychological autopsy method, 150 suicide deceased were compared with 150 living controls matched by age and gender. Semi-structured interviews were conducted with the next-of-kin of the subjects. Data were collected on a wide range of potential risk and protective factors, including demographic, life event, clinical and psychological variables. The relative contribution of these factors towards suicide was examined in a multiple logistic regression model.Results. Six factors were found to significantly and independently contribute to suicide: unemployment, indebtedness, being single, social support, psychiatric illness, and history of past attempts.Conclusions. Both psychosocial and clinical factors are important in suicides in Hong Kong. They seem to have mediated suicide risk independently. In addition, socio-economic adversities seem to have played a relatively important role in the increasing suicide rate in Hong Kong. [ABSTRACT FROM AUTHOR]

Published
2006
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31. Original Article. Fetal growth, early postnatal growth and motor development in Pakistani infants

Author

Cheung, YB, Yip, PSF, and Karlberg, JPE

Abstract

Background Studies have often compared the postnatal motor development of ‘small’ versus ‘normal’ newborns. Not much is known about the associations between a broad spectrum of size at birth and motor development. The effect of early postnatal growth on motor development is little researched. Growth failure in terms of shortness and thinness should be differentiated, but not many studies have the data for this analysis.Methods This is a longitudinal study of infants born in Lahore, Pakistan, between 1984 and 1987. Age at commencement of independent walking and age at ‘building a 3-cube tower’ were taken as indicators of gross and fine motor development, respectively. Size at birth was captured by length and thinness as continuous variables; postnatal growth from birth to 6 months of age was measured by changes in length and thinness. Adjustment for covariates and handling of censored cases were performed by generalized log gamma regression.Results Thinness at birth and postnatal stunting and wasting had a linear, inverse association with gross motor development (each P < 0.05). Birth length had a non-linear, inverse association with this outcome (P < 0.05). Birth length, thinness at birth and postnatal wasting had a linear, inverse association with fine motor development (each P < 0.05).Conclusion Both fetal and early postnatal growth over a broad spectrum may affect infants' motor development. It is not just the babies who were very small at birth that suffered. Birth length appeared to be more influential than other anthropometric indicators.KEY MESSAGESshortness at birth, thinness at birth and postnatal wasting were inversely related messages to the age at commencement of milestones of gross and fine motor development.postnatal stunting was inversely related to the age at commencement of a gross motor milestone.variation of growth over a broad spectrum was related to the outcome measures; it was not just the babies who were very small that suffered.shortness at birth appeared to be more important than other aspects of fetal and early postnatal growth in determining motor development.

Published
2001

36. Suicidality and cultural values among Hong Kong adolescents.

Author

Lam TH, Stewart SM, Yip PSF, Leung GM, Ho LM, Ho SY, and Lee PWH

Abstract

Scholars have proposed that individualistic values resulting from globalization are associated with increasing behavioral and emotional problems among youth in modernizing cultures. This study examined specific individualistic and traditional values in the context of suicidal ideation and behaviors in Hong Kong among community adolescent youths (N=2427) ages 14-18 years. Participants indicated the extent to which self-direction/independence and obedience/respect for elders were important to them. They also reported on four progressive levels of suicidality: whether in the last year they had experienced suicidal ideation, made plans for a suicide attempt, attempted suicide, and (for attemptors) made a serious attempt requiring medical attention. After controlling for quality of family relationships and depressive symptoms, at least one of the values predicted suicidality at all but the highest level. There were sex-specific associations between values and suicidality. In general, endorsement of self-direction was correlated with reduced risk of suicidality for boys and was irrelevant to girls. In contrast, traditional emphases on obedience and respect for elders were more frequently protective against suicidality for girls and were inconsistent predictors for boys. The relationship between values and suicidality was generally independent of the effect of family relationships and depressive symptoms. Thus, values were associated with adolescent suicidality, but not consistently in the direction predicted by some theorists, and the association depended upon the adolescent's sex. [ABSTRACT FROM AUTHOR]

Published
2004
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37. The Lancet Commission on self-harm.

Author

Moran P, Chandler A, Dudgeon P, Kirtley OJ, Knipe D, Pirkis J, Sinyor M, Allister R, Ansloos J, Ball MA, Chan LF, Darwin L, Derry KL, Hawton K, Heney V, Hetrick S, Li A, Machado DB, McAllister E, McDaid D, Mehra I, Niederkrotenthaler T, Nock MK, O'Keefe VM, Oquendo MA, Osafo J, Patel V, Pathare S, Peltier S, Roberts T, Robinson J, Shand F, Stirling F, Stoor JPA, Swingler N, Turecki G, Venkatesh S, Waitoki W, Wright M, Yip PSF, Spoelma MJ, Kapur N, O'Connor RC, and Christensen H

Subjects
Humans, Self-Injurious Behavior psychology
Abstract

Competing Interests: Declaration of interests PM reports grants from National Institute for Health and Care Research (NIHR), the Medical Research Council (MRC), Bristol & Weston Hospitals Charity, and The Cassell Hospital Charitable Trust; and salary support from the NIHR Applied Research Collaboration Southwest, the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation, and Avon and Wiltshire Mental Health Partnership NHS Trust. NK reports grants from NIHR, Health Quality Improvement Partnership, and the Department of Health and Social Care; has received salary support from the Greater Manchester NIHR Patient Safety Research Collaboration, Mersey Care NHS Foundation Trust, and the University of Manchester; has chaired and contributed to committees for the National Institute for Health and Clinical Excellence (NICE) guidelines, including those on the management of self-harm; and is a member of the National Suicide Prevention Strategy Advisory Group (England). RCO is a trustee and science council member of MQ Mental Health Research, president of the International Association for Suicide Prevention, co-chair of the academic advisory group to the Scottish Government's National Suicide Prevention Leadership Group, and a board member of the International Academy of Suicide Research; was a member of the NICE guideline group for the management of self-harm; and reports grants from Medical Research Foundation, the Mindstep Foundation, Chief Scientist Office, MRC, Public Health Scotland, Scottish Government, NIHR, Shout 85258, Scottish Association for Mental Health, Zoetis Foundation, Jonathan's Voice, ADHD UK, and Barfil Charitable Trust. HC reports grants from the National Health and Medical Research Council (NHMRC), the Medical Research Future Fund, Paul Ramsay Foundation, and the Australian Government; is Scientia Professor at the University of New South Wales, supported by an NHMRC Elizabeth Blackburn Research Fellowship, and chief investigator on the NHMRC Centre for Research Excellence in Suicide Prevention; sits on the Million Minds Committee; and is a director of the Black Dog Institute Board and the Ramsay Health Care Research Foundation. MS declares salary support through academic scholar awards from Sunnybrook Health Sciences Centre and the University of Toronto. OJK is currently supported by a Research Foundation Flanders Senior Postdoctoral Fellowship; reports grants from Research Foundation Flanders and the King Baudouin Foundation; is co-chair of the International Association for Suicide Prevention Early Career Group, for which she receives complimentary student membership; is a former member of the Samaritans research ethics board; and has previously received travel grants and waived registration to present at conferences of the International Academy of Suicide Research. JP reports grants from NHMRC, the Medical Research Future Fund, Department of Health of the Australian Government, New South Wales Health, and the National Suicide Prevention Office. LFC is the vice president of the International Association for Suicide Prevention and is a permanent member of the Malaysian technical working group for suicide prevention; reports grants from the Centre of Pesticide Suicide Prevention at the University of Edinburgh; has received honorarium from Johnson & Johnson as a consultant and speaker; and, through her institution, has received access to the industry-sponsored medication sampling programme (compassionate patient programme) for clinical use for medication samples of esketamine (Johnson & Johnson), brexpiprazole (Lundbeck), Abilify Maintena (Lundbeck), and Trinza (Johnson & Johnson). DK is funded through the Elizabeth Blackwell Institute for Health Research at the University of Bristol, which is supported by the Wellcome Trust; has received grants from the Centre for Pesticide Suicide Prevention and the American Foundation for Suicide Prevention; and is a steering group member of the UK's National Suicide Prevention Alliance, and the Migration Health and Development Research Initiative. VP has consulted with Google and Modern Health (unrelated to the scope of this project). AC reports grants from Wellcome Trust, Leverhulme Trust, Economic and Social Research Council; has received funded consultancy from the Scottish Government and Alcohol Change UK; and is a member of the academic advisory group to the Scottish Government's National Suicide Prevention Leadership Group. SPe reports a 2021–2024 Vanier Canada Graduate Scholarship from the Canadian Institutes of Health Research. NS is a lived experience advisor to the Wellcome Trust, consumer academic at the University of Melbourne, lived experience lead at the Royal Children's Hospital, member of the Lived Experience Air Academy for University of Wollongong's Project Air, lived experience director for the Australian BPD Foundation, and associate at yLab (a division of the Foundation for Young Australians); reports previous employment with Orygen, and previous roles with the Youth Affairs Council of Victoria, Victorian Department of Families, Fairness, and Housing, Victorian Department of Premier and Cabinet, and Moonee Valley City Council; funded travel through Black Dog Institute and International Association of Suicide Prevention; and a current research tie to Orygen. FSt reports a grant from the Burdett Trust for Nursing and support from Abertay University. PSFY is a member of the advisory committee on mental health for the government of the Hong Kong Special Administrative Region. All other authors declare no competing interests.

Published
2024
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38. Psychological responses to the COVID-19 pandemic and situational impact: A network analysis in Hong Kong residents.

Author

Fong TCT, Chang K, Ho RTH, Chio FHN, Yip PSF, and Wen M

Subjects
Humans, Hong Kong epidemiology, Female, Male, Adult, SARS-CoV-2, Surveys and Questionnaires, Middle Aged, Young Adult, Pandemics, Mental Health, Loneliness psychology, Psychological Distress, Adolescent, Cross-Sectional Studies, Social Network Analysis, COVID-19 psychology, COVID-19 epidemiology, Resilience, Psychological
Abstract

Background: The COVID-19 pandemic has had situational impacts and induced various psychological responses among residents. The present study aims to analyze the network structure of psychological responses to the pandemic and their relationships with situational impact, resilience, and well-being through a network approach., Methods: An online survey recruited 1122 residents (mean age = 32.5 years, 65.4 % female) in Hong Kong from October 2020 to October 2021. The participants completed the Mental Impact and Distress Scale: Psychological Response (MIDc-PR) and other validated measures. Gaussian graphical modeling was conducted in R to identify the central MIDc-PR symptoms and their bridge linkages with situational impact, resilience, and well-being., Results: In the MIDc-PR network, the central symptoms were 'Routine' and 'Images' for Anticipation and 'Tense' and 'Lonely' for Modulation, with 12 bridge edges between the two clusters. In the combined network, the MIDc-PR nodes showed 12 bridge edges with situational impact, particularly in the health domain. 'Concerned', 'Sleep', and 'Lonely' showed negative linkages with resilience; 'Unmotivated' and 'Trapped' showed negative linkages with well-being. The network models showed good levels of stability and did not differ significantly in network structure and global strength across gender and age groups., Limitations: The cross-sectional study design only allowed undirected associations in the network and could not model the within-subject effects., Conclusions: The study findings contributed to the literature by elucidating the network structure of psychological responses to the pandemic. The central and bridge symptoms have clinical implications as potential targets for future interventions., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Published
2024
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39. Intergenerational Educational Mobility and Cognitive Trajectories Among Middle-Aged and Older Chinese People: An Application of Growth Mixture and Mobility Contrast Models in Longitudinal Analysis.

Author

Shi S, Chen YC, Gugushvili A, and Yip PSF

Subjects
Humans, Male, Female, Aged, Longitudinal Studies, China epidemiology, Middle Aged, Prospective Studies, Intergenerational Relations, Sex Factors, Cognitive Dysfunction epidemiology, East Asian People, Educational Status, Cognition physiology
Abstract

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., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Published
2024
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40. Comorbidity among symptoms of internet gaming disorder, social withdrawal, and depression in 3430 young people in Hong Kong: A network analysis.

Author

Fong TCT, Junus A, Wen M, and Yip PSF

Subjects
Humans, Male, Hong Kong epidemiology, Female, Young Adult, Adolescent, Cross-Sectional Studies, Adult, Surveys and Questionnaires, Video Games statistics & numerical data, Video Games psychology, Internet Addiction Disorder epidemiology, Internet Addiction Disorder psychology, Comorbidity, Depression epidemiology, Depression psychology, Social Isolation psychology
Abstract

Background: The present study aimed to examine the comorbidity among symptoms of internet gaming disorder (IGD), social withdrawal, and depression using the network perspective., Methods: An online survey recruited 3430 young people in Hong Kong (mean age = 19.4 years, 80.5 % male) via gaming channels in 2019. The participants completed the 9-item IGD Scale, Hikikomori Questionnaire, and Patient Health Questionnaire-9. Network analysis was conducted using R to estimate the central symptoms of IGD and depression in individual networks and identified the bridge symptoms in combined network of IGD, social withdrawal, and depressive symptoms., Results: All network models showed high stability. 'Withdrawal', 'Loss of control', and 'Tolerance' were the central IGD symptoms, while 'Depressed mood' and 'Self-blame/guilt' were the central depressive symptoms. The bridge symptoms were 'Gaming as escape or mood relief' from IGD cluster, 'Depressed mood' and 'Self-blame/guilt' from depression cluster, and 'Marked social isolation at home' and 'Significant distress due to social isolation' from social withdrawal cluster. The combined network showed no significant differences in network structure and global strength across gender and age groups., Limitations: The cross-sectional sample only indicated undirected associations between the symptoms in the three clusters and could not model the intra-individual variation., Conclusions: The present study provided the first results on the comorbidity among IGD, social withdrawal, and depression at a symptom level among Chinese young people via network analysis. The bridge symptoms highlight potential targets for interventions of comorbidity among the disorders., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Published
2024
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41. Using Discrete-Event Simulation to Model Web-Based Crisis Counseling Service Operation: Evaluation Study.

Author

Chiang B, Law YW, and Yip PSF

Abstract

Background: According to the Organisation for Economic Co-operation and Development, its member states experienced worsening mental health during the COVID-19 pandemic, leading to an increase of 60% to 1000% in digital counseling access. Hong Kong, too, witnessed a surge in demand for crisis intervention services during the pandemic, attracting both nonrepeat and repeat service users during the process. As a result of the continuing demand, platforms offering short-term emotional support are facing an efficiency challenge in managing caller responses., Objective: This aim of this paper was to assess the queuing performance of a 24-hour text-based web-based crisis counseling platform using a Python-based discrete-event simulation (DES) model. The model evaluates the staff combinations needed to meet demand and informs service priority decisions. It is able to account for unbalanced and overlapping shifts, unequal simultaneous serving capacities among custom worker types, time-dependent user arrivals, and the influence of user type (nonrepeat users vs repeat users) and suicide risk on service durations., Methods: Use and queue statistics by user type and staffing conditions were tabulated from past counseling platform database records. After calculating the data distributions, key parameters were incorporated into the DES model to determine the supply-demand equilibrium and identify potential service bottlenecks. An unobserved-components time-series model was fitted to make 30-day forecasts of the arrival rate, with the results piped back to the DES model to estimate the number of workers needed to staff each work shift, as well as the number of repeat service users encountered during a service operation., Results: The results showed a marked increase (from 3401/9202, 36.96% to 5042/9199, 54.81%) in the overall conversion rate after the strategic deployment of human resources according to the values set in the simulations, with an 85% chance of queuing users receiving counseling service within 10 minutes and releasing an extra 39.57% (3631/9175) capacity to serve nonrepeat users at potential risk., Conclusions: By exploiting scientifically informed data models with DES, nonprofit web-based counseling platforms, even those with limited resources, can optimize service capacity strategically to manage service bottlenecks and increase service uptake., (©Byron Chiang, Yik Wa Law, Paul Siu Fai Yip. Originally published in JMIR Formative Research (https://formative.jmir.org), 07.08.2024.)

Published
2024
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42. Latent heterogeneity of deviant behaviors and associated factors among ethnic minority adolescents: a latent class analysis.

Author

Cui K, Fong TCT, and Yip PSF

Abstract

Background: Deviant behaviors are common during adolescence. Despite the diversity of juvenile delinquency, the patterns of deviant behaviors remain unclear in ethnic minorities. The present study aimed to evaluate the latent heterogeneity of deviant behaviors and associated factors in ethnic minority Yi adolescents., Methods: The present study recruited a large sample of 1931 ethnic minority Yi adolescents (53.4% females, mean age = 14.7 years, SD 1.10) in five secondary schools in 2022 in Sichuan, China. The participants completed measures on 13 deviant behaviors and demographic characteristics, attitudinal self-control, and psychological distress. Sample heterogeneity of deviant behaviors was analyzed via latent class analysis using class as the cluster variable., Results: The data supported three latent classes with measurement invariance by sex. 68.2%, 28.0%, and 3.8% of the sample were in the Normative, Borderline, and Deviant class, with minimal, occasional, and extensive deviant behaviors, respectively. The Deviant class was more prevalent in males (6.5%) than females (1.6%). There were significant class differences in domestic violence, school belonging, self-control, anxiety, and depressive symptoms. Males, domestic violence, low school belonging, and impaired self-control significantly predicted higher odds of the Deviant and Borderline classes compared to the normative class., Conclusion: This study provided the first results on three latent classes of deviant behaviors with distinct profiles in ethnic minority adolescents in rural China. These results have practical implications to formulate targeted interventions to improve the psycho-behavioral functioning of the at-risk adolescents in ethnic minorities., (© 2024. The Author(s).)

Published
2024
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43. Addressing the rising rates of youth suicide: understanding causes and formulating prevention strategies using the iceberg model.

Author

Chang YT, Chang SS, Chan LF, Chen YY, Cheng Q, Shimizu Y, Nishina Y, Zhou L, and Yip PSF

Abstract

Competing Interests: Y-TC and S-SC are supported by grants from Taiwan National Science and Technology Council (NSTC 112-2314-B-002-213-MY3). S-SC is supported by Ministry of Health and Welfare (M1202303) and Ministry of Education (113M316, 112M311), Taiwan. S-SC is affiliated with the Population Health and Welfare Research Center from the Featured Areas Research Center Program within the framework of the Higher Education SPROUT Project by the Ministry of Education (MOE), Taiwan (grant number NTU-113L900401). PSFY is supported by the Strategic Topic Grants Scheme (STG4/M-701/23-N) and a grant from the Hong Kong Research Grants Council General Research Fund (17606521).

Published
2024
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44. Tracking and Profiling Repeated Users Over Time in Text-Based Counseling: Longitudinal Observational Study With Hierarchical Clustering.

Author

Xu Y, Chan CS, Chan E, Chen J, Cheung F, Xu Z, Liu J, and Yip PSF

Subjects
Humans, Longitudinal Studies, Cluster Analysis, Female, Adult, Male, Middle Aged, Text Messaging statistics & numerical data, Young Adult, Counseling methods, Counseling statistics & numerical data
Abstract

Background: Due to their accessibility and anonymity, web-based counseling services are expanding at an unprecedented rate. One of the most prominent challenges such services face is repeated users, who represent a small fraction of total users but consume significant resources by continually returning to the system and reiterating the same narrative and issues. A deeper understanding of repeated users and tailoring interventions may help improve service efficiency and effectiveness. Previous studies on repeated users were mainly on telephone counseling, and the classification of repeated users tended to be arbitrary and failed to capture the heterogeneity in this group of users., Objective: In this study, we aimed to develop a systematic method to profile repeated users and to understand what drives their use of the service. By doing so, we aimed to provide insight and practical implications that can inform the provision of service catering to different types of users and improve service effectiveness., Methods: We extracted session data from 29,400 users from a free 24/7 web-based counseling service from 2018 to 2021. To systematically investigate the heterogeneity of repeated users, hierarchical clustering was used to classify the users based on 3 indicators of service use behaviors, including the duration of their user journey, use frequency, and intensity. We then compared the psychological profile of the identified subgroups including their suicide risks and primary concerns to gain insights into the factors driving their patterns of service use., Results: Three clusters of repeated users with clear psychological profiles were detected: episodic, intermittent, and persistent-intensive users. Generally, compared with one-time users, repeated users showed higher suicide risks and more complicated backgrounds, including more severe presenting issues such as suicide or self-harm, bullying, and addictive behaviors. Higher frequency and intensity of service use were also associated with elevated suicide risk levels and a higher proportion of users citing mental disorders as their primary concerns., Conclusions: This study presents a systematic method of identifying and classifying repeated users in web-based counseling services. The proposed bottom-up clustering method identified 3 subgroups of repeated users with distinct service behaviors and psychological profiles. The findings can facilitate frontline personnel in delivering more efficient interventions and the proposed method can also be meaningful to a wider range of services in improving service provision, resource allocation, and service effectiveness., (©Yucan Xu, Christian Shaunlyn Chan, Evangeline Chan, Junyou Chen, Florence Cheung, Zhongzhi Xu, Joyce Liu, Paul Siu Fai Yip. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.05.2024.)

Published
2024
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45. Utility of Single Items within the Suicidal Behaviors Questionnaire-Revised (SBQ-R): A Bayesian Network Approach and Relative Importance Analysis.

Author

Huen JMY, Osman A, Lew B, and Yip PSF

Abstract

The Suicidal Behaviors Questionnaire-Revised (SBQ-R) comprises four content-specific items widely used to assess the history of suicide-related thoughts, plans or attempts, frequency of suicidal ideation, communication of intent to die by suicide and self-reported likelihood of a suicide attempt. Each item focuses on a specific parameter of the suicide-related thoughts and behaviors construct. Past research has primarily focused on the total score. This study used Bayesian network modeling and relative importance analyses on SBQ-R data from 1160 U.S. and 1141 Chinese undergraduate students. The Bayesian network analysis results showed that Item 1 is suitable for identifying other parameters of the suicide-related thoughts and behaviors construct. The results of the relative importance analysis further highlighted the relevancy of each SBQ-R item score when examining evidence for suicide-related thoughts and behaviors. These findings provided empirical support for using the SBQ-R item scores to understand the performances of different suicide-related behavior parameters. Further, they demonstrated the potential value of examining individual item-level responses to offer clinically meaningful insights. To conclude, the SBQ-R allows for the evaluation of each critical suicide-related thought and behavior parameter and the overall suicide risk.

Published
2024
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46. Examining the Spread of Charcoal-Burning Suicide in Taiwan.

Author

Chen YY, Yang CT, Wong LH, Lam TM, and Yip PSF

Subjects
Humans, Taiwan epidemiology, Male, Female, Adult, Middle Aged, Young Adult, Adolescent, Aged, Carbon Monoxide Poisoning epidemiology, Charcoal, Suicide statistics & numerical data
Abstract

Background: Charcoal-burning has become a predominant method of suicide in many East-Asian countries since the 1990s. Aims: To explore charcoal-burning suicide trends from 1996 to 2020 in Taiwan. Methods: Joinpoint regression models were applied to identify suicide trends over the study period. Decompositional analyses quantified the contributions of age, sex, suicide method, and area of residence to suicide rate trends, accounting for age and geographical distribution of the general population, with a focus on charcoal-burning suicide. Results: There were three stages of suicide rate trends: increasing (1996-2006), descending (2006-2011), and levelling-off (2011-2020). Suicide by charcoal-burning accounted for 70% of the increasing suicide rates between 1996 and 2006 and 50% of the decreasing rates in the descending stage (2011-2020). During the levelling-off stage, suicide by charcoal-burning continued to decrease, albeit slowly. During the descending stage, there was a partial "substitution" of jumping for charcoal-burning. During the levelling-off stage, suicide by hanging partially "substituted" for suicide by charcoal-burning. Limitations: The variables included were limited by data availability. Conclusions: Charcoal-burning remains the second most common method of suicide in Taiwan today. Charcoal-burning has been partially replaced in the last 10 years by jumping and hanging. Monitoring suicide methods and trends is essential for suicide prevention interventions.

Published
2024
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47. Female Labor-Force Participation as Suicide Prevention: A Population Study in Taiwan.

Author

Chen YY, Fong TCT, Yip PSF, and Canetto SS

Abstract

Objective: Female 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., Methods: 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., Results: 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])., Conclusion: 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.

Published
2024
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48. Suicide prevention in Hong Kong: pushing boundaries while building bridges.

Author

Yip PSF, Caine ED, Yeung CY, Law YW, and Ho RTH

Abstract

Hong Kong is a natural laboratory for studying suicides-small geographic footprint, bustling economic activity, rapidly changing socio-demographic transitions, and cultural crossroads. Its qualities also intensify the challenges posed when seeking to prevent them. In this viewpoint, we showed the research and practices of suicide prevention efforts made by the Hong Kong Jockey Club Centre for Suicide Research and Prevention (CSRP), which provide the theoretical underpinning of suicide prevention and empirical evidence. CSRP adopted a multi-level public health approach (universal, selective and indicated), and has collaboratively designed, implemented, and evaluated numerous programs that have demonstrated effectiveness in suicide prevention and mental well-being promotion. The center serves as a hub and a catalyst for creating, identifying, deploying, and evaluating suicide prevention initiatives, which have the potential to reduce regional suicides rates when taken to scale and sustained., Competing Interests: None., (© 2024 The Authors.)

Published
2024
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49. Evaluating potential effects of distress symptoms' interventions on suicidality: Analyses of in silico scenarios.

Author

Junus A and Yip PSF

Subjects
Young Adult, Humans, Mental Health, Anxiety, Psychopathology, Suicidal Ideation, Suicide psychology
Abstract

Background: Complexity science perspectives like the network approach to psychopathology have emerged as a prominent methodological toolkit to generate novel hypotheses on complex etiologies surrounding various mental health problems and inform intervention targets. Such approach may be pivotal in advancing early intervention of suicidality among the younger generation (10-35 year-olds), the increasing burden of which needs to be reversed within a limited window of opportunity to avoid massive long-term repercussions. However, the network approach currently lends limited insight into the potential extent of proposed intervention targets' effectiveness, particularly for target outcomes in comorbid conditions., Methods: This paper proposes an in silico (i.e., computer-simulated) intervention approach that maps symptoms' complex interactions onto dynamic processes and analyzes their evolution. The proposed methodology is applied to investigate potential effects of changes in 1968 community-dwelling individuals' distress symptoms on their suicidal ideation. Analyses on specific subgroups were conducted. Results were also compared with centrality indices employed in typical network analyses., Results: Findings concur with symptom networks' centrality indices in suggesting that timely deactivating hopelessness among distressed individuals may be instrumental in preventing distress to develop into suicidal ideation. Additionally, however, they depict nuances beyond those provided by centrality indices, e.g., among young adults, reducing nervousness and tension may have similar effectiveness as deactivating hopeless in reducing suicidal ideation., Limitations: Caution is warranted when generalizing findings here to the general population., Conclusion: The proposed methodology may help facilitate timely agenda-setting in population mental health measures, and may also be augmented for future co-creation projects., Competing Interests: Declaration of competing interest All authors declare no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Published
2024
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50. Exploring the link between the increase in high-rise buildings and youth jumping suicide in Taiwan: A longitudinal study.

Author

Chen YY, Yeung CY, and Yip PSF

Subjects
Humans, Adolescent, Aged, Taiwan, Longitudinal Studies, Suicide
Abstract

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., (© 2024 The Authors. Suicide and Life-Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Published
2024
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