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.
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)
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)
Hopelessness as a mediator on
suicidal ideation
• Previous literature showed that hopelessness was a
mediator between:
• Depression and suicide intent (Weishaar & Beck, 1992)
• 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)
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.
Procedure in Hong Kong
• Cross-sectional survey design
• Convenience sampling
• 536 self-administered
questionnaires
• 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%)
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%)
Sample Demographics - Gender
Hong Kong
Female,
41.6%
Male,
58.4%
Mainland
Female,
47.6%
Male,
52.4%
Sample Demographics - Age
17-18,
2.3%
Hong Kong
15-16,
34.5%
11-12,
13.6%
13-14,
49.6%
17-18,
0.8%
Mainland 11-12,
11.6%
15-16,
34.3%
13-14,
53.3%
Sample Demographics
– Annual Family Income
Hong Kong
$130,001 $190,000,
13.6%
> $190,001,
7.8%
< $30,000
, 6.0%
$30,001 $70,000,
19.6%
$70,001 $130,000,
53.0%
Mainland
$70,001 $130,000,
0.2%
$130,001 $190,000,
0.2%
$10,001 $70,000,
18.5%
< $10,000
, 81.1%
Sample Demographics
– Religious Belief
Hong Kong
Mainland
Yes,
18.9%
Yes ,
36.9%
No,
63.1%
No,
81.1%
Sample Demographics
– Parent’s Marital Status
Separated
or
divorced,
7.5%
Hong Kong
Married or
living
together,
92.5%
Separated
or
divorced,
3.9%
Mainland
Married or
living
together,
96.1%
Measuring Instruments
Name of the
instrument
Developed by
Year
No. of
items
Measuring area
Scale
Suicidal ideation
sub-scale (C-SIS) of
the Suicidal Risk
Scale
Tse W.L.
2002
13
Adolescent suicidal 4-point Likert
ideation
scale
Chinese
Hopelessness Scale
(C-HOPE)
Shek DTL
(original
version by
Beck et al.)
1993
10
(1974)
Hopelessness
4-point Likert
scale
Chinese Emotional
Intelligence Scale
(C-EIS-R short form)
Chan D
(original
version by
Schutte et al.)
2003
12
(1998)
• Utilization of
emotions
• Self-management
of emotions
• Social skills
• Empathy
5-point Likert
scale
Measuring Instruments (con’t)
Name of the
instrument
Developed by
Year
No. of Measuring area
items
Scale
Chinese Social
Problem Solving
Inventory (C-SPSI-R
short form)
Siu & Shek
(original
version by
D’Zurilla)
2005
(1996
15
• Negative problem
orientation
• Impulsiveness /
carelessness style
• Rational problem
solving
5-point Likert
scale
• Father-Adolescent
Communication
Scale (FACS)
• Mother –
Adolescent
Communication
Scale (MACS)
Shek DTL
2002,
2006
25, 25 Parent-adolescent
communication
4-point Likert
scale
Chinese Family
Assessment
Instrument
(C-FAI short form)
Shek DTL
2000
24
• Mutuality
• Conflict &
Harmony
• Parental Concern
• Parental Control
5-point Likert
scale
Suicidal ideation
Sample items:
• I feel that dying is no big deal
• I think being dead may be better
than what it is now
• 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
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
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
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
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
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.
Table 1
Summary of multiple regression analyses predicting hopelessness from family
functioning, emotional competence, and social problem solving (N = 1063)
Hong Kong (n = 536)
ΔR2
β
t
df
Variable
Controlled demographics
Gender
Age
Religion
Family income
Family Functioning
Mutuality
Father-adolescent communication
Mother-adolescent communication
Conflict & harmony
Parental concern
Parental control
Emotional Management
Utilization of emotions
Self-management of emotions
Social Problem Solving
Rational problem solving
Negative problem orientation
Impulsiveness/carelessness style
.392***
Total R2
Mainland (n = 527)
ΔR
β
t
df
2
.077
.022
.013
.016
2.17*
.61
.37
.47
-.045
-.022
.000
.008
-1.22
-.62
.00
.23
.030
-.169
-.164
-.089
-.138
-.123
.52
-3.54***
-3.62***
-1.68
-3.01**
-2.79**
-.019
-.180
-.038
-.127
-.042
-.180
-.38
-3.79***
-.83
-.260**
-.97
-3.89***
-.077
-.080
-2.03*
-2.00*
-.032
.163
.037
.017
.054
-.82
3.96***
.96
-.128
.251
-.003
521
.330***
.45
1.35
-3.39**
5.77***
-.07
512
Direct and indirect effect of predictors on
suicidal ideation (Hong Kong Sample)
Conflict & Harmony
Father-adolescent
communication
-.169***
Mother-adolescent
communication
-.164***
Parental Concern
-.138**
Parental Control
Utilization of
emotions
Self-management of
emotions
Negative problem
orientation
-.123**
-.158**
Hopelessness
.585***
Suicidal Ideation
-.077*
-.080*
.163***
^Only
significant paths are shown;
regression coefficients shown are standardized
Direct and indirect effect of predictors on
suicidal ideation (Mainland Sample)
Conflict & Harmony
-.127***
-.093*
Parental Control
-.180***
Father-adolescent
communication
Rational problem
solving
-.077*
Hopelessness
-.180***
-.128**
.676***
Suicidal Ideation
.081*
.251***
Negative problem
orientation
^Only
significant paths are shown;
regression coefficients shown are standardized
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
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
Implication
• Enhance emotional
competence, especially selfmanagement 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.
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.
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
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
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
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
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
Practice implications –
enhancing family functioning
• Family workshops and
programs to enhance
family harmony,
parental concern and
minimize family conflict
and parental control.
Practice implications - enhancing
family functioning
• Decrease family conflict and
enhance family harmony by:
1. Decreasing family friction,
quarrels and fighting
2. Enhancing marital and
family relationship
Practice implications – enhancing
family functioning
• Guide the parents to :
• Increase parental concern
and decrease parental
control (e.g. scolding,
forcing the adolescents to
do things)
References
•
•
•
•
•
•
•
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