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

• Published in: Psychological medicine Vol. 53; no. 10; pp. 4603 - 4613
• Main Authors: Wong, Stephanie M. Y., Ip, Charlie H., Hui, Christy L. M., Suen, Y. N., Wong, Corine S. M., Chang, W. C., Chan, Sherry K. W., Lee, Edwin H. M., Lui, Simon S. Y., Chan, K. T., Wong, Michael T. H., Chen, Eric Y. H.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.07.2023
• Subjects: Alcohol use; Behavior; Cognitive ability; Coronaviruses; COVID-19; Depressive personality disorders; Epidemiology; Family relations; Hopelessness; Mental depression; Mental health; Neurosis; Neuroticism; Original; Original Article; Pandemics; Population; Rumination; Self destructive behavior; Self injury; Social unrest; Stigma; Suicidal behavior; Suicidal ideation; Suicide; Suicides & suicide attempts; Young adults; Youth; Hong Kong China; China; COVID-19; epidemiological study; youth mental health; suicidal behaviours; suicide-related rumination; risk factors; family functioning
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291722001519

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. 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. 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. 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.