Prevalence and correlates of suicidal behaviours in a representative epidemiological youth sample in Hong Kong: the significance of suicide-related rumination, family functioning, and ongoing population-level stressors

Abstract

Background Young people are most vulnerable to suicidal behaviours but least likely to seek help. A more elaborate study of the intrinsic and extrinsic correlates of suicidal ideation and behaviours particularly amid ongoing population-level stressors and the identification of less stigmatising markers in representative youth populations is essential. Methods Participants (n = 2540, aged 15–25) were consecutively recruited from an ongoing large-scale household-based epidemiological youth mental health study in Hong Kong between September 2019 and 2021. Lifetime and 12-month prevalence of suicidal ideation, plan, and attempt were assessed, alongside suicide-related rumination, hopelessness and neuroticism, personal and population-level stressors, family functioning, cognitive ability, lifetime non-suicidal self-harm, 12-month major depressive disorder (MDD), and alcohol use. Results The 12-month prevalence of suicidal ideation, ideation-only (no plan or attempt), plan, and attempt was 20.0, 15.4, 4.6, and 1.3%, respectively. Importantly, multivariable logistic regression findings revealed that suicide-related rumination was the only factor associated with all four suicidal outcomes (all p < 0.01). Among those with suicidal ideation (two-stage approach), intrinsic factors, including suicide-related rumination, poorer cognitive ability, and 12-month MDE, were specifically associated with suicide plan, while extrinsic factors, including coronavirus disease 2019 (COVID-19) stressors, poorer family functioning, and personal life stressors, as well as non-suicidal self-harm, were specifically associated with suicide attempt. Conclusions Suicide-related rumination, population-level COVID-19 stressors, and poorer family functioning may be important less-stigmatising markers for youth suicidal risks. The respective roles played by not only intrinsic but also extrinsic factors in suicide plan and attempt using a two-stage approach should be considered in future preventative intervention work.

Prevalence, time trends, and correlates of major depressive episode and other psychiatric conditions among young people amid major social unrest and COVID-19 in Hong Kong: a representative epidemiological study from 2019 to 2022

“…While influences of social unrest and the COVID-19 on mental health have already been reported in prior work, 2 , 3 , 4 , 12 our study provided additional information concerning their additive influences on mental health in a representative epidemiological youth sample with consideration of a wide range of personal and environmental factors. By segregating our analyses into four periods, we showed that the prevalence of disorders and their risk factors could be subject to large-scale environmental changes.…”

“… 18 , 19 , 20 As in the study showing increased youth suicide rate in Japan during COVID-19, 37 our previous work has also shown that both personal factors and COVID-19 stressors can contribute to suicidal ideation and attempts in the local youth population. 2 The epidemiology of mental disorders thus requires consideration of the complex interactions between individual vulnerabilities, personal risk factors, and ongoing changes at the population level. 3 , 9 , 40 …”

“…Consenting participants were invited for a face-to-face interview by a trained researcher with an option of online video conferencing following the same procedures during the pandemic. Study details are described elsewhere, 2 , 21 , 22 , 23 , 24 with details of the sample size calculation provided in Appendix pp 2.…”

“… 1 The co-occurrence of large-scale societal and global changes over recent years, such as social unrest and the COVID-19 pandemic, has posed even greater mental health challenges. 2 , 3 , 4 With the burden of youth mental disorders and their long-term implications, identifying factors associated with elevated risks related to environmental changes and help-seeking is critical for improving early risk detection and reducing treatment delay.…”

Excessive fear of clusters of holes, its interaction with stressful life events and the association with anxiety and depressive symptoms: large epidemiological study of young people in Hong Kong

“…Details of the HK-YES have been reported elsewhere. [18][19][20][21][22][23] Written informed consent was obtained from all participants, with consent obtained from parents or legal guardians for those below the age of 18. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.…”