Suicidal ideation among Chinese adolescents in Hong Kong and Shanghai

1. Suicidal ideation among Chinese adolescents in Hong Kong and Shanghai Sylvia Kwok (Dr.) Associate Professor, Dr. He Xuesong, Professor, Department of Applied Social Studies, City University of Hong Kong.

2. Suicidal ideation in HK & China • The yearly number of suicides increased considerably in the past 10 years by 61% from 784 (12.1%) in 1997 to 1264 (18.6%) in 2003 in Hong Kong. • China’s suicide rate was 23 per 100,000 or 287,000 people killed themselves each year. • According to a study in Beijing and Shanghai, among those who have suicidal ideation, 29.5 % made a plan and 32.3% attempted to commit suicide (Lee et al., 2007)

3. Correlates of suicidal ideation • The cognitive-emotive-behavioral theory stresses the importance of hopelessness, emotional competence and social problem solving in influencing suicidal ideation (Ellis & Bernard, 2006). • The family models emphasize the impact of family processes (e.g. family functioning and parent-adolescent communication) on suicidal ideation (Beavers et al., 1990; Epstein et al., 1993; Olson et al., 1989)

4. Hopelessness as a mediator on suicidal ideation • Anxiety and suicidal behavior (Thompson et al., 2005) • Negative life events and suicidal behavior (Yang & Clum, 2000) • Problem-solving deficits and suicidal ideation (Miros, 2000) • Negative affect and suicidal ideation (Pinto & Whisman, 1996) • Previous literature showed that hopelessness was a mediator between: • Depression and suicide intent (Weishaar & Beck, 1992)

5. Objectives • To study and compare the personal and family correlates of suicidal ideation among the adolescents in Hong Kong and Shanghai. • To examine the mediating role of hopelessness on the relationship between the correlates and suicidal ideation among the adolescents in Hong Kong and Shanghai.

6. Procedure in Hong Kong • 10 secondary schools in Hong Kong Island, Kowloon and the New Territories • Age of participants (M= 14, SD= 1.47) • Intact family (92.5%), non-intact family (7.5%) • Cross-sectional survey design • Convenience sampling • 536 self-administered questionnaires

7. Procedure in Shanghai • Cross-sectional survey design • Convenience sampling • 527 self-administered questionnaires • 3 government-run and subvented schools in Shanghai • Age of participants (M= 14, SD= 1.23) • Intact family (96.1%), non-intact family (3.9%)

8. Sample Demographics - Gender

9. Sample Demographics - Age

10. Sample Demographics – Annual Family Income

11. Sample Demographics – Religious Belief

12. Sample Demographics – Parent’s Marital Status

13. Measuring Instruments

14. Measuring Instruments (con’t)

15. Suicidal ideation • I believe that death is a kind of relief • I really want to put an end to all this so that I don’t have to continue to bear the pain Sample items: • I feel that dying is no big deal • I think being dead may be better than what it is now

16. Hopelessness Sample items: • My future seems dark to me • I don’t expect to get what I really want • I might as well give up because I can’t make things better for myself

17. Emotional competence • Social skills, e.g. help others feel better • Empathy, e.g. know how others feel by their tone of voice • Self-management of emotions, e.g. control over own emotions • Utilization of emotions, e.g. see new possibilities when mood changes

18. Social problem solving • Negative problem orientation, e.g. feel afraid when having problems to solve • Rational problem solving, e.g. use systematic method for comparing alternatives • Impulsiveness / carelessness style, e.g. act on the first idea that occurs

19. Family functioning • Mutuality e.g. Family members accommodate each other • Conflict and harmony e.g. There is much friction among family members • Parental concern e.g. Parents take good care of their children • Parental control e.g. Parents force children to do things • Systemic level of communication e.g. family members enjoy talking with one another

20. Parent-adolescent communication • Father-adolescent communication • Mother-adolescent communication • e.g. I can voice out my thinking and feeling to my father/ mother in our communication • Father/mother knows my feeling even when he/she has not asked me.

21. Table 1Summary of multiple regression analyses predicting hopelessness from family functioning, emotional competence, and social problem solving (N = 1063)

22. Direct and indirect effect of predictors on suicidal ideation (Hong Kong Sample) Conflict & Harmony Father-adolescent communication -.169*** -.158** Mother-adolescent communication -.164*** Parental Concern -.138** -.123** .585*** Parental Control Hopelessness Suicidal Ideation -.077* Utilization of emotions -.080* Self-management of emotions .163*** Negative problem orientation ^Only significant paths are shown; regression coefficients shown are standardized

23. Direct and indirect effect of predictors on suicidal ideation (Mainland Sample) Conflict & Harmony -.127*** -.093* Parental Control -.077* -.180*** Father-adolescent communication Hopelessness Suicidal Ideation -.180*** .676*** Rational problem solving .081* -.128** .251*** Negative problem orientation ^Only significant paths are shown; regression coefficients shown are standardized

24. Discussion • Hopelessness is a mediator in both samples • Father-adolescent communication, parental control and negative problem orientation are significant predictors of hopelessness that lead to suicidal ideation for both samples • Mother-adolescent communication, parental concern, utilization of emotions, self-management of emotions are significant predictors of hopelessness in the Hong Kong sample • Conflict and harmony, Rational problem solving are the significant predictors of hopelessness in the Shanghai sample

25. Implication • Cultivate the sense of hope: • life goals enhancement • positive psychology (emphasize on positive emotions and individual traits) • reinforcement of positive traditional Chinese beliefs about coping with adversity

26. Implication • Enhance emotional competence, especially self-management of emotions, utilization of emotions, for the HK adolescents • Enhance social problem solving skills, i.e. decrease negative problem orientation for both samples, enhance rational problem solving skills for the Shanghai sample.

27. Implications: Enhancement of parent-adolescent communication • Parallel groups and workshops on communication skills training (e.g. positive parenting program, adolescent communication training) for both parents (especially the fathers) and the adolescents.

28. Positive parenting program • Guide the parents to: • Be kind and friendly • Respect and trust the adolescents • Provide space, a free and relaxing atmosphere for communication

29. Positive parenting program • Answer the adolescents’ questions sincerely • Guide them to think out different solutions, evaluate their pros and cons, and let them make decisions • Encourage the adolescents to express their thinking and feeling openly, and to raise problems for discussion

30. Positive parenting program • Take initiative to communicate with the adolescents • Look at things from the adolescents’ perspectives • Be willing to listen to what the adolescents talk • Reflect the adolescents’ thinking and feeling

31. Positive parenting program • Things to avoid: • Dominating the discussion • Ordering, ridiculing, criticizing, provoking, indoctrinating the adolescents • Troubling and nagging the adolescents continuously • Using double-bind messages

32. Adolescent communication training • Guide the adolescents to: • Respect, trust the parents • Take initiative to communicate with the parents • Express their feeling and thinking • Discuss problems with their parents • Look at things from the parents’ perspectives • Understand the parents’ thinking and feeling

33. Practice implications – enhancing family functioning • Family workshops and programs to enhance family harmony, parental concern and minimize family conflict and parental control.

34. Practice implications - enhancing family functioning • Decrease family conflict and enhance family harmony by: • Decreasing family friction, quarrels and fighting • Enhancing marital and family relationship

35. Practice implications – enhancingfamily functioning • Guide the parents to : • Increase parental concern and decrease parental control (e.g. scolding, forcing the adolescents to do things)

36. References • Beavers, W. R., Hampson, R. B., & Hulgus, Y. F. (1990). Manual: Beavers Systems Model of Family Assessment. Dallas: Southwest Family Institute. • Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861-865. • Chan, D. W. (2003). Dimensions of emotional intelligence and their relationships with social coping among gifted adolescents in Hong Kong. Journal of Youth and Adolescence, 32, 409-418. • D’Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. (1996). Manual for the Social Problem-Solving Inventory-Revised (SPSI-R). North Tonawanda, NY: Multi-Health System, Inc. • Ellis, A., & Bernard, M. E. (2006). Rational Emotive Behavioural Approaches to Childhood Disorders: Theory, Practice and Research. New York: Springer. • Epstein, N. B., Bishop, D., Ryan, C., Miller, I., & Keitner, G. (1993). The McMaster Model: View of healthy family functioning. In F. Walsh (Ed.), Normal Family Processes (pp. 138-160). New York: Guilford Press. • Lee, S., Fung, S. C., Tsang, A., Liu, Z. R., Huang, Y. Q., He, Y. L., . . . Kessler, R. C. (2007). Lifetime prevalence for suicide ideation, plan and attempt in metropolitan China. ActaPsychiatricaScandinavica, 116(6), 429-437.

37. References (con’t) • Miros, N. J. (2000). Depression, anger, and coping skills as predictors of suicidal ideation in young adults: Examination of the diathesis-stress-hopelessness theory. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61, 3286. • Olson, D. H., Russell, C. S., & Sprenkle, D. H. (1989). Circumplex Model: Systemic Assessment And Treatment of Families. New York: Haworth Press. • Pinto, A., & Whisman, M. A. (1996). Negative affect and cognitive biases in suicidal and nonsuicidalhospitalised adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 158-165. • Schuttle, S. Malouff, M., Hall, L., Haggerty, D., Cooper, J., Goldern, C., et al. (1998). Development and validation of a measure of emotional intelligence. Personality and Individual Differences, 25, 167-177. • Shek, D. T. L. (1993). Measurement of pessimism in Chinese adolescents: The Chinese hopelessness scale. Social Behaviour and Personality, 21, 107-119. • Shek. D. T. L. (2000). Assessment of family functioning in Chinese adolescents. In N. N. Singh (Ed.), International Perspectives on Child and Adolescent Mental Health. Holland: Elsevier.

38. References (con’t) • Shek, D. T. L. (2002). Assessment of family functioning in Chinese adolescents: The Chinese version of the family assessment device. Research on Social Work Practice, 12, 502-524. • Shek, D. T. L., Lee, T. Y., Lee, B. M., & Chow, J. (2006). Perceived parental control and psychological well-being in Chinese adolescents in Hong Kong. International Journal of Adolescent Medicine and Health, 18, 535-545. • Siu, A. M. H., & Shek, D. H. L. (2005). Psychometric properties of the Chinese Family Assesssment Instrument in Chinese adolescents in Hong Kong. Adolescence, 40, 817-830. • Thompson, A., Mazza, J., Herting, R., Randell, P., & Eggert, L. (2005). The mediating roles of anxiety, depression, and hopelessness on adolescent suicidal behaviours. Suicide and Life-threatening Behaviour, 35, 14-34. • Tse, J. W. L., & Bagley, C. (2002). Suicidal Behaviour, Bereavement and Death Education in Chinese Adolescents. London, UK: Ashgate Publishing. • Weishaar, M. E., & Beck, A. T. (1992). Hopelessness and suicide. International Review of Psychiatry, 4, 177-184. • Yang, B. & Clum, G. A. (1996). Childhood stress leads to later suicidality via its effect on cognitive functioning. Suicide and Life-threatening Behaviour, 30, 183-198.