Attitudes, coping, online expression, help-seeking, and engagement in open discussion regarding suicide among Hong Kong youths : a sequential exploratory mixed-methods study

Abstract

In recent decades, Hong Kong (HK) has witnessed a noteworthy rise in the prevalence of mental health issues among adolescents. Despite the substantial efforts that various stakeholders have devoted, preventing, or reducing youth suicides poses a range of challenges. A comprehensive evaluation is therefore urgently needed of local adolescents’ suicide-related perceptions, behavioral patterns, and emerging requirements. This thesis aimed to examine attitudes, coping styles, online expression, helpseeking, and engagement in open discussion regarding suicide among HK youths aged 15-19, adopting a sequential exploratory mixed-methods approach. Phase 1 qualitative analyses were based on six focus groups and 12 individual interviews (N = 40), while Phase 2 quantitative data were collected via a cross-sectional questionnaire survey with students from nine local secondary schools (N = 1,676). In terms of perceptions, HK adolescents demonstrated five principal types of suicidal attitudes: two predominant attitudes (i.e., “permissiveness” and “sympathy and empathy”); two negative attitudes (i.e., “negative appraisal” and “stigmatization”); and one Asian-specific attitude (i.e., “indifference”). Significant associations were established between suicidal attitudes and a range of factors, such as one’s own risk of suicide, use of social media (SM), and academic performance. “Stigmatization” and “perceived unpreventability” of suicide may further affect youths’ behaviors, for instance, their reactions and their involvement in external support when confronted with peer suicide. Regarding behavioral patterns, the majority of HK adolescents were prone to being supportive, embracing informal assistance, and refusing professional intervention in the face of peer suicide. With the rapid growth of digital communication technology, substantial variations were found in adolescents’ SM use and online expression. Certain aspects of online expression—including purposes, frequencies, and platform preferences—were significantly linked with help-seeking propensity and suicide risk. Notably, private online expression (i.e., using the Instagram feature “Close Friends” and multiple SM accounts) has become prevalent among youths due to its high-level confidentiality and privacy protection. However, a heavy reliance on these features may expose youngsters to an increased risk of suicide and a decreased willingness to seek formal help. Concerning needs for mental health support, HK youths favored strategies for the development of practical skills and knowledge (i.e., “self-value recognition” and “interpersonal communication”), followed by school-based programs (e.g., “counseling” and “career planning services”) and online services (e.g., “celebrity promos” and “online support platforms”). When asked for opinions on open suicide discussion, most adolescents expressed concern about it being taboo and reluctance to be engaged. Peer groups (i.e., “direct peer disclosure” or discussion in “smaller circles with known individuals”) and online platforms (i.e., Instagram, WhatsApp, and Snapchat) were contexts preferred by adolescents for suicide-related discussions. Some youths also displayed worries about suicide prevention that stem from beliefs in suicide fatalism, perceived unpreventability, and the contagion effect. Findings from this research highlight the insufficiency of appropriate education and effective intervention among at-risk adolescents. Specific measures should be implemented to facilitate the communication of suicide-related topics, the training for adolescent peer gatekeepers, the development of online services for emotional support, and the design of suicide prevention programs for the young population.