Objectives:This study examines in what exchange patterns that three types of intergenerational support are associated with elderly parents' life satisfaction, and whether elderly parents' evaluation on parent-child relationship plays a mediation role on those associations. Method: Data were drawn from Hong Kong Panel Survey for Poverty Alleviation. Respondents aged 65 and over were included ( N=504). Three types of support, namely, daily-living, financial, and emotional support were examined in four patterns-the over-benefited , under-benefited , reciprocal and no flow of exchange. A multivariable linear regression was applied to investigate the association between pattern of intergenerational exchange and life satisfaction, and mediation analysis was employed to examine the mediating role of satisfaction with parent-child relationship on their associations. Results: Elderly parents were less satisfied with their lives when they had no flow of exchange in daily-living support, and more satisfied when they were under-benefited in financial support, and over-benefited or reciprocal in emotional support. Elderly parents’ satisfaction with parent–child relationship mediated the association between exchange of emotional support and life satisfaction; but not the association between daily-living or financial support and life satisfaction. Conclusion: Different types of intergenerational support are associated with elderly parents’ life satisfaction in different patterns.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: In Hong Kong, with an increasing number of children experiencing mental health issues, there is a need to develop not only innovative but also comprehensive prevention interventions to reduce their anxiety symptoms and enhance their emotional management and interpersonal relationships. Objective: This study was conducted to determine the effectiveness of “The Adventures of DoReMiFa”, an integration model of cognitive behavioral approach and positive psychology by using digital game-based and school-based mental health enhancement intervention to magnify the social and emotional health and well-being of children in Hong Kong aged 9 to 11. Methods: A quasi-experimental design method was used to evaluate this digital game and school-based intervention. “The Adventures of DoReMiFa” was piloted in 4 primary schools where students were allocated to either an intervention or a control group. Participants were assessed pre-and post-intervention with a 6-month follow-up, measuring their mental health knowledge, level of anxiety symptoms, positive and negative thinking, perspective-taking and self-esteem. Results: A total of 459 primary school students participated in the study. The intervention group was found to have significant association with improved mental health knowledge and perspective-taking. The intervention, however, was not found to be effective in reducing the rates of anxiety symptoms and negative thinking among the participating students. Conclusions: “The Adventures of DoReMiFa”, an integration of digital game-based and school-based mental health enhancement intervention was shown to be effective in elevating the knowledge of mental health and promoting perspective-taking of primary school students in Hong Kong. While there was insufficient evidence to support a reduction in symptoms of anxiety and negative automatic thoughts, the overall results were encouraging in that a preventive effect was found, indicating that “The Adventures of DoReMiFa” has potential to enhance the mental well-being of schoolchildren. The implications and limitations of this study and suggestions for future research were also discussed.

The decreasing suicide rate in China has been regarded as a major contributor to the decline of global suicide rate in the past decade. However, previous estimations on China’s suicide rates might not be accurate, since often they were based on the data from the Ministry of Health’s Vital Registration (“MOH-VR”) System, which is biased towards the better-off population. This study aims to compare suicide data extracted from the MOH-VR System with a more representative mortality surveillance system, namely the Center for Disease Control and Prevention’s Disease Surveillance Points (“CDC-DSP”) System, and update China’s national and subnational suicide rates in the period of 2004–2014. The CDC-DSP data are obtained from the National Cause-of-Death Surveillance Dataset (2004–2014) and the MOH-VR data are from the Chinese Health Statistics Yearbooks (2005–2012) and the China Health and Family Planning Statistics Yearbooks (2013–2015). First, a negative binomial regression model was used to test the associations between the source of data (CDC-DSP/MOH-VR) and suicide rates in 2004–2014. Joinpoint regression analyses and Kitagawa’s decomposition method are then applied to analyze the trends of the crude suicide rates. Both systems indicated China’s suicide rates decreased over the study period. However, before the two systems merged in 2013, the CDC-DSP System reported significantly higher national suicide rates (IRR = 1.18, 95% Confidence Interval [CI]: 1.13–1.24) and rural suicide rates (IRR = 1.29, 95% CI: 1.21–1.38) than the MOH-VR System. The CDC-DSP System also showed significant reversing points in 2011 (95% CI: 2006–2012) and 2006 (95% CI: 2006–2008) on the rural and urban suicide trends. Moreover, the suicide rates in the east and central urban regions were reversed in 2011 and 2008. The biased MOH-VR System underestimated China’s national and rural suicide rates. Although not widely appreciated in the field of suicide research, the CDC-DSP System provides more accurate estimations on China’s suicide rates and is recommended for future studies to monitor the reversing trends of suicide rates in China’s more developed areas.

Considerable attention has been focused on the study of suicides among those who have received help from healthcare providers. However, little is known about the profiles of suicide deceased who had psychiatric illnesses but made no contact with psychiatric services prior to their death. Behavioural model of health service use is applied to identify factors associated with the utilization of psychiatric service among the suicide deceased.

Background: Digital game-based learning (DGBL) makes use of the entertaining power of digital games for educational purposes. Effectiveness assessment of DGBL programs has been underexplored and no attempt has been made to simultaneously model both important components of DGBL: learning attainment (ie, educational purposes of DGBL) and engagement of users (ie, entertaining power of DGBL) in evaluating program effectiveness.Objective: This study aimed to describe and evaluate an Internet-based DGBL program, Professor Gooley and the Flame of Mind, which promotes mental health to adolescents in a positive youth development approach. In particular, we investigated whether user engagement in the DGBL program could enhance their attainment on each of the learning constructs per DGBL module and subsequently enhance their mental health as measured by psychological well-being.Methods: Users were assessed on their attainment on each learning construct, psychological well-being, and engagement in each of the modules. One structural equation model was constructed for each DGBL module to model the effect of users' engagement and attainment on the learning construct on their psychological well-being.Results: Of the 498 secondary school students that registered and participated from the first module of the DGBL program, 192 completed all 8 modules of the program. Results from structural equation modeling suggested that a higher extent of engagement in the program activities facilitated users’ attainment on the learning constructs on most of the modules and in turn enhanced their psychological well-being after controlling for users’ initial psychological well-being and initial attainment on the constructs.Conclusions: This study provided evidence that Internet intervention for mental health, implemented with the technologies and digital innovations of DGBL, could enhance youth mental health. Structural equation modeling is a promising approach in evaluating the effectiveness of DGBL programs.

We present the opportunities and challenges of Open Up, a free, 24/7 online text-based counselling service to support youth in Hong Kong. The number of youths served more than doubled within the first three years since its inception in 2018 in response to increasing youth suicidality and mental health needs. Good practice models are being developed in order to sustain and further scale up the service. We discuss the structure of the operation, usage pattern and its effectiveness, the use of AI to improve users experience, and the role of volunteer in the operation. We also present the challenges in further enhancing the operation, calling for more research, especially on the identification of the optimal number of users that can be concurrently served by a counsellor, the effective approach to respond to a small percentage of repeated users who has taken up a disproportional volume of service, and the way to optimize the use of big data analytics and AI technology to enhance the service. These advancements will benefit not only Open Up but also similar services across the globe.