The stigmatization of suicide: A study of stories told by college students in China

Suicide-related stigma and its relationship with help-seeking, mental health, suicidality and grief: scoping review

BACKGROUND

Suicide-related stigma (i.e. negative attitudes towards people with suicidal thoughts and/or behaviours as well as those bereaved by suicide) is a potential risk factor for suicide and mental health problems. To date, there has been no scoping review investigating the association between suicide-related stigma and mental health, help-seeking, suicide and grief across several groups affected by suicide.

AIMS

To determine the nature of the relationship between suicide-related stigma and mental health, help-seeking, grief (as a result of suicide bereavement) and suicide risk.

METHOD

This review was registered with PROSPERO (CRD42022327093). Five databases (Web of Science, APA PsycInfo, Embase, ASSIA and PubMed) were searched, with the final update in May 2024. Studies were included if they were published in English between 2000 and 2024 and assessed both suicide-related stigma AND one of the following: suicide, suicidal thoughts or suicidal behaviours, help-seeking, grief or other mental health variables. Following screening of 14 994 studies, 100 eligible studies were identified. Following data charting, cross-checking was conducted to ensure no relevant findings were missed.

RESULTS

Findings across the studies were mixed. However, most commonly, suicide-related stigma was associated with higher levels of suicide risk, poor mental health, lowered help-seeking and grief-related difficulties. A model of suicide-related stigma has been developed to display the directionality of these associations.

CONCLUSIONS

This review emphasises the importance of reducing the stigma associated with suicide and suicidal behaviour to improve outcomes for individuals affected by suicide. It also identifies gaps in our knowledge as well as providing suggestions for future research.

"I Want to Hold an Umbrella Over You Because I Have Been in the Rain": Exploring Patient Influencers' Motivations to Share Eating Disorders Experiences from a Self-Determination Theory Perspective

Patients can become educator-influencers in promoting the public's understanding of health and illness; however, the underlying motivations driving their engagement in this role remain unclear. Drawing from the Self-Determination Theory, this study explores the motivations of patients-turned-influencers in sharing eating disorders (ED) experiences and information on Chinese social media. Through semi-structured interviews with 33 patient influencers, this study examines the motivations associated with three psychological needs: autonomy, competence, and relatedness. In terms of autonomy, influencers shared their ED experiences as self-therapy, expression, and documentation of personal growth. Regarding competence, influencers felt that their medical training or personal experiences made them more knowledgeable about ED, and their communication skills and high self-esteem gave them more confidence and courage to share their ED experiences. Finally, in terms of relatedness, altruism, community building, and peer influence are the driving forces behind their sharing behaviors. With the rise of ED cases in China, misunderstandings about the condition remain prevalent. As the first study of ED social media influencers in a Chinese context, this research highlights the unique cultural and social factors influencing the motivations behind sharing ED-related experiences on social media. The theoretical and practical implications of the study are also discussed.

Support-Seeking Strategies, Family Communication Patterns, and Received Support Among Chinese Women with Postpartum Depression: A Content Analysis of Zhihu Posts

The incidence of postpartum depression (PPD) among Chinese women surpasses the global average, and this disparity is closely associated with the level of social support they receive. Using Sensitive Interaction Systems Theory and Family Communication Patterns Theory as guiding frameworks, we conducted a content analysis of 705 posts gathered from the hashtag #PPD (chanhou yiyu) on Zhihu, a popular Chinese social media platform. Our findings reveal that postpartum women primarily seek social support from their husbands and mothers-in-law through indirect nonverbal and direct verbal communication strategies. They tend to receive more problem-focused support than emotion-focused solace. Moreover, the use of direct verbal communication strategies promotes potential support providers' problem-solving behaviors, while the use of indirect nonverbal strategies elicits their avoidance behaviors. In addition, the conversation-oriented family communication pattern strengthens the positive association between direct verbal communication and support-providing behaviors, whereas the conformity-oriented family communication pattern weakens this relationship. This study contributes to the applicability of the abovementioned theories in the Chinese context and provides insights for future interventions aimed at addressing PPD among women.

Depression and suicidal ideation among Chinese college students during the COVID-19 pandemic: the mediating roles of chronotype and sleep quality

BACKGROUND

This study was intended to investigate the correlation between depression and suicidal ideation among Chinese college students during the COVID-19 pandemic and the potential mediating roles of chronotype and sleep quality in this relationship .

METHODS

A sample of 4,768 college students was selected from four institutions in Anhui Province, China, and the study was conducted during the COVID-19 pandemic (November to December 2020) using a stratified, cluster, multi-stage sampling method. This study used the two-item Patient Health Questionnaire (PHQ-2) to assess depressive symptoms, the Morningness-Eveningness Questionnaire 19 (MEQ-19) to determine individual sleep chronotypes (i.e., morning or evening preference), and the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. Participants were asked about suicidal ideation. MPLUS 8.3 software was used to analyze the mediating effect of chronotype and sleep quality on the relationship between depression and suicidal ideation.

RESULTS

During the COVID-19 pandemic, the prevalence of suicidal ideation among Chinese college students was 5.4%. Depression was inversely correlated with chronotype (beta = - 0.346, P < 0.01) and positively correlated with sleep quality (beta = 0.846, P < 0.001), indicating that students experiencing depressive symptoms were more likely to have a later chronotype and poor sleep quality. A later chronotype (beta = - 0.019, P < 0.05) and poor sleep quality (beta = 0.066, P < 0.01) predicted suicidal ideation. Depression emerged as a direct and significant risk factor for suicidal ideation (effect value = 0.535, 95% confidence interval: 0.449 ~ 0.622). Chronotype and sleep quality were found to have potential mediating effects on the relationship between depression and suicidal ideation; however, the chain-mediating effect of chronotype and sleep quality was not statistically significant.

CONCLUSIONS

Our findings suggest that during the COVID-19 pandemic, depression can precipitate suicidal ideation through its influence on sleep chronotype and quality. These compelling findings highlight the urgency of early intervention strategies intended to mitigate suicidal thoughts, particularly among students exhibiting depressive symptoms, who experience disrupted sleep patterns and poor sleep quality.

My Story of Depression: A Content Analysis of Autobiographic Videos on Douyin

Autobiographical accounts on social media could play an essential role in shaping the public's understanding of illnesses and dispelling illness-related stigma. This study examined how people living with depression describe their illness experiences on Douyin, China's leading video-sharing platform, through content analysis. It finds that most videos were created by young women who have lived with the illness for over three years. The top three topics were patient psychology, experience sharing, and knowledge and medical advice. These videos provided an overall non-stigmatizing portrayal of depression, with more than 80% of the influencers using challenge cues. However, stigma cues contributed to the virality of the videos. The theoretical and practical implications of the study were discussed.

How to survive the long night? Longitudinal relationship between sleep problems and suicidal behavior among adolescents: The serial mediating roles of negative emotion, self-control, and nonsuicidal self-injury

OBJECTIVE

Sleep problems are a significant risk factor for identifying and preventing suicidal involvement among adolescents. However, there is limited evidence to assess the underlying mechanisms between them. This study investigated the longitudinal relationship between sleep problems and suicidal behavior and examined whether this relationship was moderated by negative emotions, low self-control, and nonsuicidal self-injury (NSSI).

METHODS

From December 2020 onward, we assessed 1214 Chinese secondary school adolescents (60.7% were boys, aged 13-19 years) three times, 6 months apart.

RESULTS

In the direct effects model, sleep problems were found to have a positive impact on adolescent suicidal behavior. In the indirect effects model, we observed that sleep problems were associated with an elevated risk of suicidal behavior through several pathways: one-mediator path of negative emotions, low self-control, and NSSI, respectively; two-mediator path of negative emotions via low self-control, negative emotions via NSSI, and low self-control via NSSI, and three-mediator path from negative emotions to NSSI via low self-control.

CONCLUSIONS

This longitudinal study provides evidence that sleep problems in adolescents may increase suicidal behavior by exacerbating negative emotions, weakening self-control, and promoting NSSI. The findings suggest sleep problems should be addressed in suicide prevention and intervention efforts for adolescents.

Breaking Taboos in Women's Reproductive Health: The Communication Strategies Used by Top OB/GYN Influencers in Chinese Social Media

Numerous women struggling with health issues dare not go to the hospital due to the stigmatization of obstetric and gynecological diseases in traditional Chinese culture. Social media provide a platform for women to access health information from experts easily. Guided by the doctor-patient communication model, attribution theory, and destigmatization framework, we sought to understand the topics/diseases covered by top OB/GYN influencers on Weibo and the prevalent functions, language style, responsibility attribution, and destigmatization cues used by them. We also examined how these communication strategies predicted followers' engagement behavior. The results showed that women's childbirth-related issues received the highest exposure in the leading OB/GYN influencers' Weibo posts. Influencers' emphasis on building psychological connectedness with their followers was exhibited in the following communication strategies: avoiding using complex medical terminology, drawing equivalences between the outgroup and ingroup, and providing health information. However, using everyday language, responding to emotions, and removing blame served as the three most influential predictors of followers' engagement. Theoretical and practical implications are also discussed.

Detection of Suicidal Ideation in Clinical Interviews for Depression Using Natural Language Processing and Machine Learning: Cross-Sectional Study

Background

Assessing patients' suicide risk is challenging, especially among those who deny suicidal ideation. Primary care providers have poor agreement in screening suicide risk. Patients' speech may provide more objective, language-based clues about their underlying suicidal ideation. Text analysis to detect suicide risk in depression is lacking in the literature.

Objective

This study aimed to determine whether suicidal ideation can be detected via language features in clinical interviews for depression using natural language processing (NLP) and machine learning (ML).

Methods

This cross-sectional study recruited 305 participants between October 2020 and May 2022 (mean age 53.0, SD 11.77 years; female: n=176, 57%), of which 197 had lifetime depression and 108 were healthy. This study was part of ongoing research on characterizing depression with a case-control design. In this study, 236 participants were nonsuicidal, while 56 and 13 had low and high suicide risks, respectively. The structured interview guide for the Hamilton Depression Rating Scale (HAMD) was adopted to assess suicide risk and depression severity. Suicide risk was clinician rated based on a suicide-related question (H11). The interviews were transcribed and the words in participants' verbal responses were translated into psychologically meaningful categories using Linguistic Inquiry and Word Count (LIWC).

Results

Ordinal logistic regression revealed significant suicide-related language features in participants' responses to the HAMD questions. Increased use of anger words when talking about work and activities posed the highest suicide risk (odds ratio [OR] 2.91, 95% CI 1.22-8.55; P=.02). Random forest models demonstrated that text analysis of the direct responses to H11 was effective in identifying individuals with high suicide risk (AUC 0.76-0.89; P<.001) and detecting suicide risk in general, including both low and high suicide risk (AUC 0.83-0.92; P<.001). More importantly, suicide risk can be detected with satisfactory performance even without patients' disclosure of suicidal ideation. Based on the response to the question on hypochondriasis, ML models were trained to identify individuals with high suicide risk (AUC 0.76; P<.001).

Conclusions

This study examined the perspective of using NLP and ML to analyze the texts from clinical interviews for suicidality detection, which has the potential to provide more accurate and specific markers for suicidal ideation detection. The findings may pave the way for developing high-performance assessment of suicide risk for automated detection, including online chatbot-based interviews for universal screening.

Prevalence, psychosocial correlates of youths’ suicidal behaviors and perspectives on the phenomena at Zagazig University: a mixed-methods study

Background

Suicidal behaviors are major public health concerns that affect large numbers of youth, leaving not only the youth but also their parents, family, friends, and peers in constant wailing. This study aimed to investigate the prevalence, psychosocial correlates, and perspectives of youths’ suicidal behaviors. A concurrent mixed-methods descriptive study was used in carrying out this study. This study was conducted at Zagazig University, Al Sharkia Governorate. A stratified multi-stage cluster sampling technique was used to enroll 364 youths. Four tools were used to collect quantitative data. They were as follows: The Youth Profile Questionnaire, composed of two parts (socio-demographic data and youth characteristics), the Suicide Behaviors Questionnaire-Revised (SBQ-R), Social Problem-Solving Inventory-Revised Short Form (SPSI-R-SF), and the Short Version of the World Health Organization Quality of Life (WHOQOL-BREF). For the qualitative part, focus group discussions were conducted to explore youths’ perspectives on the phenomenon of suicidal behaviors.

Results

Quantitative findings revealed that 25% of the youth participants had a significant risk for suicidal behaviors. Being female, in the first years of practical faculties and having no friends are significantly correlated with suicidal behaviors. Further, the quality of life had a statistically significant negative correlation with suicidal behaviors. Qualitative findings were discussed under one main category: youths’ perspectives about suicidal behaviors (pressure/escaping tool, seeking help/ending pain, attention-grabbing behavior, and stain for life).

Conclusions

According to this mixed-methods study, youths’ suicidal behaviors are prevalent multifaceted phenomena that certain factors have been correlated with. It is suggested that female sex, having no friends, and academic stressors are risk factors for suicidal behaviors. Also, the quality of life was introduced as a protective factor against suicidal behaviors. Therefore, it is recommended to implement prevention and management approaches to realize the complexity of the phenomena of suicidal behaviors among youth; these approaches target the youths themselves (mental health promotion and strategies for coping with stress) and the population (careful media coverage, limit access to suicidal methods, and raise the awareness about mental illness).