Social media and mental health in democracy movement in Hong Kong: A population-based study

Social isolation, social media use, and poor mental health among older adults, California Health Interview Survey 2019-2020

BACKGROUND

Older adults' engagement on social media may be a resource to reduce loneliness and improve mental health.

PURPOSE

This study aimed to examine loneliness and social media use and its association with severe psychological distress among older adults and whether social media use moderated the association of loneliness on severe psychological distress among older adults.

METHODS

This study is a secondary analysis of the 2019-2020 California Health Interview Survey. The Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with a K6 score ≥ 13 associated with severe mental illness. Loneliness was measured using a revised Three Item Loneliness Scale (TILS) score. Multiple regression analyses were conducted to examine associations between loneliness and severe psychological distress.

RESULTS

Loneliness, health status, and identification as Asian, remained strong predictors of severe psychological distress among older adults when adjusting for other factors. In bivariate analysis, high-frequent social media users, but did not remain significant when accounting for covariates. Social media use did not moderate the association between loneliness and severe psychological distress.

CONCLUSION

This study underscores the significant impact of loneliness on poor mental health among older adults, emphasizing that while frequent social media use correlates with severe psychological distress, it may not alleviate the association of loneliness on poor mental health, thus highlighting the urgent need to address social isolation and promote genuine social connectedness, particularly among Asian older adults.

The relationship between social media use and psychosocial outcomes in older adults: A systematic review

OBJECTIVES

Social isolation and loneliness are prevalent in older adults and are detrimental to physical and mental health. Social media use has been shown to be effective in maintaining social connections and improving older adults' psychosocial outcomes. This study aimed to systematically review and synthesize current research on this topic.

DESIGN

Searches were conducted in November 2021 (and updated in October 2023) in PsycINFO, PubMed, and CINAHL. Inclusion criteria: (1) participants ≥ 65 years (mean, median, or minimum age) and (2) reported impact of social media use on psychosocial outcomes (including loneliness, depression, anxiety, social connectedness, wellbeing, life satisfaction, and quality of life). Quality appraisal tools were utilized, and results were synthesized using narrative synthesis.

RESULTS

Sixty-four papers met inclusion criteria, including cross-sectional (n = 38), observational longitudinal (n = 6), interventional (n = 9), mixed-methods (n = 4), and qualitative (n = 7) studies. Participant numbers ranged from 6 to 16,925. While associations between social media use and positive psychosocial outcomes were generally reported in cross-sectional studies, the impact of social media use over time from longitudinal studies was mixed and inconclusive.

CONCLUSIONS

While social media use is associated with positive psychosocial outcomes, casual conclusions cannot be drawn. Few longitudinal and randomized controlled trial studies existed, and these reported mixed findings. Large variations in study methodology including participants, measurement of social media use, and outcome measures contributed to the inconsistencies of findings. Addressing this heterogeneity through standardized approaches and more rigorous research may enhance understanding.

Moral injury and its mental health consequences among protesters: findings from Israel's civil protest against the government's judicial reform

Background: Government actions and participating in protracted-duration protests against it affect protesters' mental health, leading to high distress levels, such as posttraumatic and depressive symptoms. Aside from exposure to violence and other issues, protest participation can pose unique challenges to the protesters as they may be exposed to potentially morally injurious events (PMIEs), such as the betrayal of leaders they once trusted. This study's primary objective was to examine the extent of psychological difficulties among civilians participating in long-duration protests in Israel. More specifically, the study aimed to understand the contribution of exposure to protest-related PMIEs to psychological difficulties such as posttraumatic and depressive symptoms.Method: Participants comprised 4036 Israelis who were actively involved in the unfolding civil protest movement against the government-led judicial overhaul between January 2023 and August 2023. The protesters completed validated self-report questionnaires that included measures of PMIE exposure, PTSD and depressive symptoms.Results: About half (44.3%) of the sample met the criteria for self-report diagnosis of major depression and 10.6% for PTSD. Most of the protesters indicated their exposure to at least one moral injury event, with 63.9% reporting exposure to PMIE-Betrayal. Protesters exposed to PMIEs reported significantly higher levels of both PTSD and depression than non-PMIE-exposed protesters. Hierarchical regression analyses revealed that, beyond demographics and protest-related characteristics such as exposure to violence, PMIE dimensions significantly contributed to both PTSD and depression levels.Conclusions: The findings highlight the mental burden of protesters during the civil protests against the judicial overhaul in Israel. More central to the present research, the findings highlight the critical contribution of PMIEs exposure to this burden. Clinicians treating protesters coping with depression and PTSD following the civil actions should attend to their exposure to PMIEs, which may relate to the deleterious psychological effects among protesters.

Social Media Use and Depression in Older Adults: A Systematic Review

Social media has become an integral part of everyday life and revolutionized how older adults communicate and interact with others. The aim of the current review was to identify and synthesize quantitative studies addressing the potential relationship between social media use and depression in older adults. Medline, CINAHL, and PsycINFO databases were used to identify studies performed up to July 2020. Keywords identified were depression, social media use, and older adults. A nuanced relationship was revealed between social media use and depression in older adults. There were noted differences in the conceptualization of social media use. The reviewed studies lacked exploration of structural characteristics, examination of content, and quality of interactions in older adults' social media use. Health variables, social factors, and age cohort differences could influence the relationship between social media use and depression. Further studies are needed to enhance the understanding and explore the benefits and potential disadvantages of social media use in older adults. [Research in Gerontological Nursing, 16(2), 97-104.].

A protocol for a type 1 effectiveness-implementation randomized controlled trial of the WHO digital mental health intervention Step-by-Step to address depression among Chinese young adults in Macao (SAR), China

BACKGROUND

Among Chinese college students, the burden of depression is considerably high, affecting up to 30 % of the population. Despite this burden, few Chinese students seek mental health treatment. In addition, depression is highly comorbid with other mental health disorders, such as anxiety. Scalable, transdiagnostic, evidence-based interventions are needed for this population.

OBJECTIVE

The study will evaluate the effectiveness of a World Health Organization transdiagnostic digital mental health intervention, Step-by-Step, to reduce depressive and anxiety symptoms and improve well-being compared with enhanced care as usual and its implementation in a Chinese university community.

METHODS

A type 1 effectiveness-implementation two-arm, parallel, randomized controlled trial will be conducted. The two conditions are 1) the 5-session Step-by-Step program with minimal guidance by trained peer-helpers and 2) psychoeducational information on depression and anxiety and referrals to local community services. A total of 334 Chinese university students will be randomized with a 1:1 ratio to either of the two groups. Depression, anxiety, wellbeing, and client defined problems will be assessed at pre-intervention, post-intervention, and 3-month follow-up. Endline qualitative interviews and focus group discussions will be conducted to explore SbS implementation among service users, university staff, and stakeholders. Data will be analysed based on the intent-to-treat principle.

DISCUSSION

Step-by-Step is an innovative approach to address common mental health problems in populations with sufficient digital literacy. It is a promising intervention that can be embedded to scale mental health services within a university setting. It is anticipated that after successful evaluation of the program and its implementation in the type 1 hybrid design RCT study, Step-by-Step can be scaled and maintained as a low-intensity treatment in universities, and potentially extended to other populations within the Chinese community.

TRIAL REGISTRATION

ChiCTR2100050214.

A Feasibility Study of the WHO Digital Mental Health Intervention Step-by-Step to Address Depression Among Chinese Young Adults

Background: Chinese young adults experience barriers to mental health treatment, including the lack of treatment providers and stigma around treatment seeking. Evidence-based digital mental health interventions are promising and scalable alternatives to face-to-face treatment for this population, but lack rigorous evidence to support scale-up in China. Aim: The study was a feasibility study for a large-scale RCT of Step-by-Step, a behavioral activation-based, mental health intervention to address depression and anxiety symptoms in Chinese young adults. It sought to assess feasibility of recruitment and of delivery of Step-by-Step in a University setting, to assess acceptability of the intervention, and to examine potential effectiveness. Method: An uncontrolled, feasibility trial was conducted to assess the feasibility and acceptability of Chinese Step-by-Step for Chinese University students with elevated depressive symptoms (PHQ-9 scores at or above 10) in Macao, China. Data was collected at two different time points (i.e., baseline and 8-weeks after baseline), administered via questionnaires embedded in an interventional mobile application. Participation rate and dropout rate were measured. Depressive and anxiety symptom severity, well-being, and self-defined stress were assessed. Satisfaction with the program was assessed using qualitative interviews. Results: A total of 173 students were screened, 22.0% (n = 38) were eligible, and 63.2% of them (n = 24) started the intervention. The dropout rate by post-test was 45.8%. Results from completers showed that Step-by-Step was potentially effective in reducing depressive and anxiety symptom severity, and self-defined stress. Students were generally satisfied with the program, but also offered suggestions for continued improvement. Qualitative feedback was reported within the RE-AIM framework, covering recruitment, effectiveness, adoption, implementation, and maintenance. Amendments to the program were made according to the feedback (e.g., adding notification for new session, modify the time zone). Conclusion: A minimally guided Step-by-Step protocol and the study procedure were successfully pilot tested for use for Chinese University students. The intervention was acceptable and no adverse events were reported. The results support the potential effectiveness and feasibility of a large-scale evaluation of the program.

The Influence of Intrapersonal, Interpersonal, and Community Protective Factors on Hong Kong Adolescents' Stress Arising from Political Life Events and Their Mental Health

Precarious political circumstances can take a mental toll on young people. Adopting a socio-ecological perspective, this study investigated the influence of stress arising from political life events, intrapersonal factors (i.e., meaning in life, resilience), interpersonal factors (i.e., social support, associational social capital), and community factors (i.e., perceived empowerment in the community, perceived opportunities for civic engagement) on the mental health of youth in Hong Kong. Furthermore, it examined the moderating effects of these factors on the relationship between stress arising from political life events and mental health. A cross-sectional quantitative survey with a stratified purposive sampling data collection method was conducted. A total of 1330 secondary school students were recruited for this study. Multiple regression analysis was performed to examine both direct and moderation effects. The results indicate that high stress arising from political life events, low meaningfulness in life, low resilience, low social support, low youth empowerment in the community, and high civic engagement in the community were related to high mental distress. None of the presumed moderators moderated the relationship between stress due to political life events and mental distress. Assessing and addressing stress due to political life events would be potentially important in mental health programs for Hong Kong adolescents in precarious political situations.

Knowledge and awareness of COVID-19 among Indonesian migrant workers in the Greater China Region

OBJECTIVES

Migrant workers are one of the most vulnerable population groups during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated knowledge and awareness of COVID-19 among Indonesian migrant workers (IMWs) in Macao (SAR), Hong Kong (SAR), and Taiwan.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Data were collected through an online survey in February and March 2020 to gain information on (1) participants' sociodemographic characteristics, (2) experience and awareness regarding COVID-19 information, and (3) knowledge and understanding of COVID-19. A series of Chi-squared, t-test, and logistic regression analyses were conducted.

RESULTS

The survey was completed by 491 participants (92.1% female). Knowledge of COVID-19 was obtained from multiple sources, including a large proportion from online social media. However, participants who obtained information from their employer, local social networks, and migrant organisations answered a greater number of questions correctly. One-third of participants reported receiving hoax, fake news, and incorrect information and obtained information from unverified sources. Participants were most interested in information about how to cure COVID-19, and 57.8% knew that no specific drug or vaccine was currently available. Almost all participants correctly identified fever and wearing a facemask as the main COVID-19 symptom and prevention strategy, respectively. Participants with senior high school or higher education and who worked as domestic or care workers had a greater knowledge of COVID-19 than their counterparts.

CONCLUSIONS

Public health communication strategies using multiple channels, including employers and community organisations, would help to minimise COVID-19 knowledge gaps. In addition, it is recommended that digital literacy content is added to public health campaigns.

Mental health during and after protests, riots and revolutions: A systematic review

OBJECTIVES

Protests, riots and revolutions have long been a part of human history and are increasing globally, yet their impact on mental health remains largely unknown. We therefore systematically reviewed studies on collective actions and mental health.

METHOD

We searched PubMed, Web of Science, PsycINFO and CINAHL Plus for published studies from their inception until 1 January 2018. Study quality was rated using the Newcastle-Ottawa Scale.

RESULTS

We identified 52 studies (n = 57,487 participants) from 20 countries/regions. The prevalence of post-traumatic stress disorder ranged from 4% to 41% in riot-affected areas. Following a major protest, the prevalence of probable major depression increased by 7%, regardless of personal involvement in the protests, suggestive of community spillover effects. Risk factors for poorer mental health included female sex, lower socioeconomic status, exposure to violence, interpersonal conflicts, frequent social media use and lower resilience and social support. Nevertheless, two studies suggested that collective actions may reduce depression and suicide, possibly due to a collective cathartic experience and greater social cohesion within subpopulations.

CONCLUSION

We present the first systematic review of collective actions and mental health, showing compelling evidence that protests even when nonviolent can be associated with adverse mental health outcomes. Health care professionals therefore need to be vigilant to the mental and psychological sequelae of protests, riots and revolutions. Further research on this emerging sociopolitical determinant of mental health is warranted.

Politically Motivated Internet Addiction: Relationships among Online Information Exposure, Internet Addiction, FOMO, Psychological Well-being, and Radicalism in Massive Political Turbulence

This research examines the mediating role of the tendency for Internet addiction, fear of missing out (FOMO), and psychological well-being in the relationship between online exposure to movement-related information and support for radical actions. A questionnaire survey that targets tertiary students was conducted during the Anti-Extradition Law Amendment Bill (Anti-ELAB) Movement (N = 290). The findings reveal the mediating effect of Internet addiction and depression as the main relationship. These findings enrich the literature of political communication by addressing the political impact of Internet use beyond digital architecture. From the perspective of psychology, this research echoes the literature that concerns depression symptoms driven by a protest environment. Radical political attitudes driven by depression during protests should also be concerned based on the findings of this survey.

What predicts threat perceptions toward people opposing to the government? A population-based study following Umbrella Movement, Hong Kong

We examined the incidence and predictors of threat perceptions toward people who oppose government action (i.e., protestors) following the Umbrella Movement in Hong Kong (September 28th to December 15th, 2014). A population-representative sample of 1,208 citizens (mean age = 46.89 years; 52.4% female) was recruited two months after the conclusion of the Movement using random digit dialing. Upon giving their informed consent, respondents reported sociodemographics, perceived threats of protestors to the prospects of democracy, ways of life, and the economy, anxiety symptoms (STAI), and depressive symptoms (PHQ-9). More than half disagreed that protestors threatened the prospects of democracy (54.7%, 95% CI = .52, .57), ways of life (52.2%, 95% CI = .49, .55), and the economy (51.4%, 95% CI = .49, .54). Regression analyses revealed that male sex was associated with lower odds of perceiving threats to the prospects of democracy and ways of life. Being unmarried was associated with lower odds of perceiving threats to the economy. Secondary education level and depressive symptoms were associated with higher odds of perceiving threats to ways of life and the economy, respectively. This is one of the first population-based studies that measured socioeconomic and mental health correlates of political attitudes immediately following pro-democracy movements.

The epidemiology of current depression in Macau, China: towards a plan for mental health action

PURPOSE

Macau is a Special Administrative Region in China that has experienced tremendous development in its gambling industry during its post-colonial years. To inform mental health planning, this study presents the first population estimates and correlates of the current depression in Macau.

METHODS

A population-representative sample of 1068 Macau Chinese citizens aged 18 or above responded to a household telephone survey in January, 2015. The Patient Health Questionnaire-9 measured the current depression. Logistic regression models assessed the association between depression and potential correlates.

RESULTS

Overall, 8.0% (95% CI 6.3-9.7) of persons reported the current depression. A higher but non-significant proportion of women reported depression than men (9.3 vs. 6.6%) and older women reported higher prevalence (13.4%) than other demographic groups. Persons who were unemployed (OR = 4.9, 2.3-10.5), separated or divorced (OR = 3.1, 1.1-8.9), and reported poor self-rated health (OR = 5.0, 2.8-9.0), low quality of life (OR = 6.2, 3.1-12.7), lower social standing (OR = 2.4, 1.4-4.0), lower community trust (OR = 1.9, 1.2-3.1), lower perceived fairness (OR = 2.3, 1.4-3.8), lower social cohesion (OR = 3.8, 2.3-6.2), and lower social integration (OR = 3.0, 1.9-5.0) had greater odds of depression than their comparison group.

CONCLUSIONS

The current study demonstrated the burden of depression among Macau adults disproportionately affects women during emerging adolescence and old age, and men during middle adulthood. Key strategies to improve mental health services in Macau are discussed.