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Wu J, Zhang R, Zhao L, Yin Y, Min J, Ge Y, Luo Y, Li P, Li L, Tong Y. Risk factors for subsequent suicidal acts among 12-25-year-old high-risk callers to a suicide prevention hotline in China: a longitudinal study. Child Adolesc Psychiatry Ment Health 2024; 18:73. [PMID: 38898519 PMCID: PMC11188529 DOI: 10.1186/s13034-024-00765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND A few previous cross-sectional studies investigated correlated factors of suicidal ideation or suicide attempts among suicide prevention hotline callers; however, scarcely any evidence was from a longitudinal study. In addition, it is still unclear whether improvements in some suicide risk factors could reduce the occurrence of subsequent suicidal acts. This longitudinal study focusing on the risk factors for subsequent suicidal acts among adolescent and young adult callers with high suicide risk aims to fill this gap. METHODS This study recruited 12-25-year-old high-risk callers to a China nationwide suicide prevention hotline. Potential risk factors, including hopefulness, psychological distress, depression, history of suicide attempts, alcohol or substance misuse, and acute life events, were examined during the index calls, and improvements in hopefulness, psychological distress, and suicide intent were assessed before ending the index calls. The recruited callers were followed up 12 months after their index calls. The primary outcome was the occurrence of suicidal acts (suicide attempts or suicide death) during follow-up. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards model were used. RESULTS During the follow-up period, 271 of 1656 high-risk adolescent and young adult callers attempted suicide, and seven callers died by suicide. After adjusting for demographic variables, low hopefulness (Hazard Ratio [HR] = 2.03, 95% Confidence Interval [CI]=[1.47, 2.80]) at the beginning of the index call was associated with a higher risk for subsequent suicidal acts, whereas improvements in psychological distress (HR = 0.61, 95%CI [0.41, 0.89]) and suicidal intent (HR = 0.56, 95%CI [0.38, 0.84]) during the index call reduced the risk of subsequent suicidal acts. In addition, alcohol or substance misuse (Model 2, HR = 1.65, 95%CI [1.11, 2.46]) and suicide attempt history(Model 1: one episode, HR = 1.96, 95%CI=[1.05, 3.66]; two or more episodes, HR = 2.81, 95%CI [1.59, 4.96]. Model 2: one episode, HR = 2.26, 95%CI [1.06, 4.82]; two or more episodes: HR = 3.28, 95%CI [1.63, 6.60]) were risk factors for subsequent suicidal acts. CONCLUSIONS While suicide prevention hotline operators deliver brief psychological interventions to high-risk adolescent and young adult callers, priority should be given to callers with low hopefulness and to the alleviation of callers' high psychological distress and suicide intent.
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Affiliation(s)
- Jianlan Wu
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Ruoyun Zhang
- Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
| | - Liting Zhao
- Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
| | - Yi Yin
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Jing Min
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yiming Ge
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yang Luo
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Peiyao Li
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Lingling Li
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yongsheng Tong
- Peking University Huilongguan Clinical Medical School, Beijing, China, 7 Nan Dian Road, Changping, 100096.
- WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.
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Wei Y, Song H. Adult female callers' characteristics and mental health status: a retrospective study based on the psychological assistance hotline in Hangzhou. BMC Public Health 2023; 23:2295. [PMID: 37986069 PMCID: PMC10662539 DOI: 10.1186/s12889-023-17085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE This study aims to analyze the basic characteristics and mental health status of adult female callers to the psychological assistance helpline in Hangzhou City, in order to provide targeted services for effectively intervening in the psychological crises of this group. METHODS Data from adult female callers to a helpline in Hangzhou City were collected between 2019 and 2022, encompassing demographic information and discussed issues. The data were analyzed according to age groups, marital status, and call times. The mental health status of the adult female population was measured by two indicators-mood status and suicide risk. RESULTS The study included 15,580 adult female callers. Among them, 52.2% were aged 30 and below, 62.1% were unmarried, and 42.6% were from other provinces. The primary types of calls were related to mental health (56.5%), romantic relationships (11%), and marriage/family issues (13%). Adults aged 30 and below had more consultations about romantic relationships, work, and study-related issues compared to those over 30. Those over 30 sought more advice on marriage/family and child education. Younger callers displayed higher levels of depression and suicide risk compared to older callers. Unmarried callers had a higher proportion of moderate depression and suicide risk than married callers. Higher education levels were associated with lower depression levels (OR = 0.631,95%CI:0.439-0.906, P = 0.013) and high-risk proportions (OR = 0.328,95%CI:0.147-0.733, P = 0.007). Late evening callers had a higher high-risk proportion (OR = 5.326,95%CI:2.633-10.775, P < 0.001), and employed individuals had lower high-risk proportions compared to unemployed callers (OR = 0.536,95%CI:0.320-0.897, P = 0.018). CONCLUSION The mental health status of female callers aged 30 and below, unemployed individuals, and those calling in the latter part of the night have relatively poorer mental health and are more likely to be at risk for suicide, which needs to be taken seriously, and more professional and targeted intervention services need to be enhanced in the hotline.
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Affiliation(s)
- Yating Wei
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230032, China.
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310013, China.
| | - Haidong Song
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230032, China
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310013, China
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Tong Y, Yin Y, Conner KR, Zhao L, Wang Y, Wang X, Conwell Y. Predictive value of suicidal risk assessment using data from China's largest suicide prevention hotline. J Affect Disord 2023; 329:141-148. [PMID: 36842651 DOI: 10.1016/j.jad.2023.02.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Suicide hotlines are widely used, with potential for identification of callers at especially high risk. METHODS This prospective study was conducted at the largest psychological support hotline in China. From 2015 to 2017, all distressed callers were consecutively included and assessed, using a standardized scale consisting of 12 elements, yielding scores of high risk (8-16), moderate risk (4-7), and low risk (0-3) for suicidal act. All high-risk and half of moderate- and low-risk callers were scheduled for a 12-month follow-up. Main outcomes were suicidal acts (nonlethal attempt, death) over follow-up. RESULTS Of 21,346 fully assessed callers, 5822, 11,791, and 3733 were classified as high-, moderate-, or low-risk for suicidal acts, with 8869 callers (4076 high-, 3258 moderate-, and 1535 low-risk) followed up over 12 months. Over follow-up, 802 (9.0 %) callers attempted suicide or died by suicide. The high-risk callers (15.1 %) had 3-fold higher risk for subsequent suicidal acts than moderate- (5.1 %) and 12-fold higher risk than low-risk callers (1.3 %). The weighted sensitivity, specificity, and positive predictive value of high risk scores were 56.4 %, 74.9 %, and 14.4 %. LIMITATIONS Assessed callers with different risk levels were followed disproportionally. CONCLUSIONS Suicidal risk assessment during a hotline call is both feasible and predictive of risk, guiding resource allocation to higher risk callers.
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Affiliation(s)
- Yongsheng Tong
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China; Peking University Huilongguan Clinical Medical School, Beijing, China.
| | - Yi Yin
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China; Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Liting Zhao
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yuehua Wang
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Xuelian Wang
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China; WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China; Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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An J, Yin Y, Zhao L, Tong Y, Liu NH. Mental health problems among hotline callers during the early stage of COVID-19 pandemic. PeerJ 2022; 10:e13419. [PMID: 35646488 PMCID: PMC9135033 DOI: 10.7717/peerj.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/20/2022] [Indexed: 01/20/2023] Open
Abstract
Background The study aims to explore the mental health of the hotline callers during the COVID-19 pandemic in China. Methods Callers (N = 10,490) from the Beijing Psychological Support Hotline from January 21st to June 30th in 2019 and 2020 were enrolled and divided into two groups (during (2020) and before (2019) COVID-19 pandemic). The severity of depressive symptoms, psychological distress, hopefulness, and suicidal ideation (SI) was assessed. Demographic characteristics and major concerns were also collected. Mann-Whitney U and chi-square test were used to compare the differences in mental health conditions and major concerns between two years and between different age groups. The multivariable logistic regression was used to explore whether mental health conditions were associated with pandemic and demographic factors. Results Results from multivariable logistic regression analysis indicated that the change in suicidal ideation (OR = 1.52, 95% CI: 1.21-1.92) was significantly different across age groups. Callers during the pandemic reported a higher level of hopefulness (OR = 1.13, 95% CI [1.03-1.24]), a lower level of depressive symptoms (OR = 0.81, 95% CI [0.74-0.89]) and psychological distress (OR = 0.89, 95% CI [0.81-0.98]), and were less likely to report SI (OR = 0.69, 95% CI [0.61-0.77]) compared with callers before the pandemic. Conclusions Compared with callers before the pandemic, hotline callers during the early stage of COVID-19 pandemic did not present significant mental health problems. Younger callers during the pandemic were more vulnerable for the presence of suicidal ideation. Hotline-based crisis interventions might provide specific psychological support to cope with troubles during the pandemic.
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Affiliation(s)
- Jing An
- Beijing Huilongguan Hospital, Beijing, Beijing, China,Peking University HuiLongGuan Clinical Medical School, Beijing, China,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yi Yin
- Beijing Huilongguan Hospital, Beijing, Beijing, China,Peking University HuiLongGuan Clinical Medical School, Beijing, China,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Liting Zhao
- Beijing Huilongguan Hospital, Beijing, Beijing, China,Peking University HuiLongGuan Clinical Medical School, Beijing, China,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yongsheng Tong
- Beijing Huilongguan Hospital, Beijing, Beijing, China,Peking University HuiLongGuan Clinical Medical School, Beijing, China,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Nancy H. Liu
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States of America
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Shen J, Zhang S, Tong Y, Dong X, Wang X, Fu G, Zhao L, Wu M, Yin Y, Wang Y, Liu NH, Wu J, Li J. Establishment and psychometric characteristics of emotional words list for suicidal risk assessment in speech emotion recognition. Front Psychiatry 2022; 13:1022036. [PMID: 36440401 PMCID: PMC9691664 DOI: 10.3389/fpsyt.2022.1022036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Emotional disturbance is an important risk factor of suicidal behaviors. To ensure speech emotion recognition (SER), a novel technique to evaluate emotional characteristics of speech, precision in labeling emotional words is a prerequisite. Currently, a list of suicide-related emotional word is absent. The aims of this study were to establish an Emotional Words List for Suicidal Risk Assessment (EWLSRA) and test the reliability and validity of the list in a suicide-related SER task. METHODS Suicide-related emotion words were nominated and discussed by 10 suicide prevention professionals. Sixty-five tape-recordings of calls to a large psychological support hotline in China were selected to test psychometric characteristics of the EWLSRA. RESULTS The results shows that the EWLSRA consists of 11 emotion words which were highly associated with suicide risk scores and suicide attempts. Results of exploratory factor analysis support one-factor model of this list. The Fleiss' Kappa value of 0.42 indicated good inter-rater reliability of the list. In terms of criteria validities, indices of despair (Spearman ρ = 0.54, P < 0.001), sadness (ρ = 0.37, P = 0.006), helplessness (ρ = 0.45, P = 0.001), and numbness (ρ = 0.35, P = 0.009) were significantly associated with suicidal risk scores. The index of the emotional word of numbness in callers with suicide attempt during the 12-month follow-up was significantly higher than that in callers without suicide attempt during the follow-up (P = 0.049). CONCLUSION This study demonstrated that the EWLSRA has adequate psychometric performance in identifying suicide-related emotional words of recording of hotline callers to a national wide suicide prevention line. This list can be useful for SER in future studies on suicide prevention.
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Affiliation(s)
- Juan Shen
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Shuo Zhang
- Faculty of Information Technology, Beijing University of Technology, Beijing, China
| | - Yongsheng Tong
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.,Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Xiangmin Dong
- Faculty of Information Technology, Beijing University of Technology, Beijing, China
| | - Xuelian Wang
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.,Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Guanghui Fu
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Liting Zhao
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Mengjie Wu
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.,Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yi Yin
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.,Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yuehua Wang
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Nancy H Liu
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Jianlan Wu
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.,Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Jianqiang Li
- Faculty of Information Technology, Beijing University of Technology, Beijing, China
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Suicide attempt risks among hotline callers with and without the coronavirus disease 2019 related psychological distress: a case-control study. BMC Psychiatry 2021; 21:363. [PMID: 34284741 PMCID: PMC8290867 DOI: 10.1186/s12888-021-03371-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/08/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic profoundly impacts on mental health, yet it is still unclear whether COVID-19 distress makes people more vulnerable to suicidal behavior. The present study aims to examine the association between COVID-19 related psychological distress and risk for suicide attempt, and moderators of this association, among hotline callers. METHODS This case-control study was conducted at the largest psychological support hotline in China. Hotline callers who sought help for psychological distress and reported whether or not they attempted suicide in the last 2 weeks (recent suicide attempt) were analyzed. The primary predictor of recent suicide attempt was the presence or absence of COVID-19 related psychological distress. Demographic variables and common risk and protective factors for suicidal behavior were also studied. Callers with COVID-19 related distress (COVID-19 callers) and those without such distress (non-COVID-19 callers) were compared on these variables. Recent suicide attempt was regressed on COVID-19 related distress and the other variables, and significant interaction terms of aforementioned predictors by COVID-19 related distress, to identify variables that moderate the association of COVID-19 related distress and recent suicide attempt. RESULTS Among 7337 included callers, there were 1252 COVID-19 callers (17.1%) and 6085 non-COVID-19 callers (82.9%). The COVID-19 callers were less likely to report recent suicide attempt (n = 73, 5.8%) than the non-COVID-19 callers (n = 498, 8.2%, P = 0.005). The COVID-19 callers were also less likely to have high scores on depressive symptoms (22.6% vs 26.3%, P < 0.001) and psychological distress (19.5% vs 27.3%, P < 0.001), and were more likely to have high hopefulness scores (46.5% vs 38.0%, P < 0.001). Tests of moderating effects showed that acute life events were associated with one-half lower risk (P = 0.021), and a trend that suicide attempt history was associated with two-thirds greater risk (P = 0.063) for recent suicide attempt, among COVID-19 callers than non-COVID-19 callers. CONCLUSIONS The COVID-19 calls are from individuals with lower suicide-related risk compared to more typical callers. Acute stressful life events provided a key context for suicide attempt in non-COVID-19 callers, i.e., more typical calls.
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Zhao L, Li Z, Tong Y, Wu M, Wang C, Wang Y, Liu NH. Comparisons of Characteristics Between Psychological Support Hotline Callers With and Without COVID-19 Related Psychological Problems in China. Front Psychiatry 2021; 12:648974. [PMID: 34054607 PMCID: PMC8149583 DOI: 10.3389/fpsyt.2021.648974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background: To compare the characteristics between hotline callers with and without the Coronavirus Disease 2019 (COVID-19) related psychological problems. Methods: From January 25 to March 31, 2020, 581 callers with COVID-19 related psychological problems (COVID-19 callers) and 695 callers without COVID-19 related psychological problems (non-COVID-19 callers) to the Beijing Psychological Support Hotline were recruited. The demographic characteristics, primary concerns, suicidal ideation, depression and other psychological problems were compared between the two groups of callers. Results: Both groups of the callers were predominantly female and highly educated. The primary concerns reported by the COVID-19 callers were depression (38.4%) and family relationship problems (26.0%). As compared to the non-COVID-19 callers, COVID-19 callers reported more financial (7.4%) and work related problems (4.1%), but revealed lower prevalence of suicidal ideation (47.9% v 71.3%), lower degrees of psychological distress (74.3 v 79.1), intensity of suicidal ideation (0 v 50), severity of depression (57.9 v 65.1), and higher degree of hopefulness (41.1 v 33.6) (all p values < 0.01). Additionally, a lower proportion of COVID-19 callers met the criteria of depressed mood (51.6% v 61.4%) and other 4 symptoms than the non-COVID-19 callers (p values < 0.01). Conclusions: Based on the content of the primary concerns and the relatively low level of depression of the COVID-19 callers, the psychological intervention for them during the pandemic should focus on "psychological supports." Coping strategies for daily life stressors and promotion of scientific knowledge about the pandemic should also be included in the hotline-related interventions.
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Affiliation(s)
- Liting Zhao
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Ziyang Li
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yongsheng Tong
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.,Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Mengjie Wu
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China.,Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Cuiling Wang
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yuehua Wang
- Beijing Suicide Research and Prevention Center, Beijing Huilongguan Hospital, Beijing, China.,World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Nancy H Liu
- Department of Psychology, University of California, Berkeley, Berkely, CA, United States
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