METHODS: This two-arm cluster-randomised controlled trial was implemented between January 2018 and November 2018. Six schools were selected using stratified random sampling, whereby students were purposively selected and invited. The criteria of inclusion to the programme were secondary school students (aged 13 years old-17 years old) who smoked conventional cigarettes (CC) and electronic cigarettes (EC).
RESULTS: A total of 422 students from six schools participated in this study. Three schools were designated as intervention (n = 250) and the other three as control schools (n = 172). Formative evaluation of participants in the FSSCP using the logic model showed that participants were satisfied with the overall programme (91.5%), were motivated to stop smoking (90.4%) and were prevented from relapse (89.2%). The quit rate at a 3-month follow-up was 41.8%.
CONCLUSION: The logic model supported the development of the programme, with details on the processes, dissemination activities, identification of barriers, evaluation criteria and outcomes provided.
METHODS: The Question, Persuade, Refer program materials were translated and adapted for implementation in the hospital setting for nonpsychiatric health professionals. There were 159 (mean age = 35.75 years; SD = 12.26) participants in this study. Most participants were female (84.9%), staff/community nurses (52.2%), who worked in the general medical department (30.2%) and had no experience managing suicidal patients (64.2%). Intervention participants (n = 53) completed a survey questionnaire at pretraining, immediately after training, and after three months. Control participants (n = 106) were not exposed to the training program and completed the same questionnaire at baseline and three months later.
RESULTS: Significant improvement occurred among intervention participants in terms of perceived knowledge, self-efficacy, and understanding of/willingness to help suicidal patients immediately after training and when compared with the control participants 3 months later. Improvements in declarative knowledge were not maintained at the 3-month follow-up.
DISCUSSION: This study confirmed the short-term effectiveness of the gatekeeper training program. Gatekeeper suicide training is recommended for implementation for nonpsychiatric health professionals nationwide.
OBJECTIVE: To examine the risk and protective factors contributing to suicidality among undergraduate college students in seven provinces in China.
METHODS: We conducted a cross-sectional study involving 13,387 college students from seven universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, Shaanxi, and Xinjiang. Data were collected using self-report questionnaires.
RESULTS: Higher scores in the psychological strain, depression, anxiety, stress, and psychache (psychological risk factors for suicidality) and lower scores in self-esteem and purpose in life (psychological protective factors against suicidality) were associated with increased suicidality among undergraduate students in China. Demographic factors which were associated with higher risks of suicidality were female gender, younger age, bad academic results, were an only child, non-participation in school associations, and had an urban household registration. Perceived good health was protective against suicidality.
CONCLUSIONS: Knowing the common risk and protective factors for suicidality among Chinese undergraduate students is useful in developing interventions targeted at this population and to guide public health policies on suicide in China.
OBJECTIVE: The current study examines the association between religious affiliation and suicidality among college students in six provinces in China.
METHODS: We conducted a cross-sectional study involving 11,407 college students from six universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, and Shaanxi. We collected the data between October 2017 and March 2018 using self-report questionnaires. They included self-report measures of depression, psychache, hopelessness, self-esteem, social support, and life purpose.
RESULTS: Participants with a Christian affiliation had 1.5 times (95% CI: 1.14, 1.99, p = 0.004) higher odds of indicating an elevated suicide risk, 3.1 times (95% CI: 1.90, 5.04, p<0.001) higher odds of indicating a previous suicide attempt, and increased overall suicidality (B = 0.105, p < 0.001) after accounting for demographic and risk/protective factors. Christians also scored the highest in depression, psychache, hopelessness, and the lowest social support, self-esteem, and purpose in life. Muslims reported decreased suicidality (B = -0.034, p = 0.031). Buddhism/Daoism yielded non-significant results in the multivariate analyses.
CONCLUSIONS: Christian college students reported increased suicidality levels, perhaps due to public policies on religion. The decreased suicidality levels among Muslims may be attributed to higher perceived social support. The associations between religious affiliation and suicidality, depression, and hopelessness contrast sharply with US samples. This finding may be influenced by interactions between the religious denomination, individual, and social/political factors. This conclusion includes the possibility of anti-religious discrimination, which this paper did not investigate as a possible mediator and therefore remains a conjecture worthy of future investigation.
AIMS: To determine levels of work engagement and to identify psychological and work-related characteristics predicting work engagement in employees in Malaysia.
METHODS: We recruited 5235 employees from 47 public and private organizations in Malaysia who responded to an online health survey. We assessed work engagement with the 9-item Utrecht Work Engagement Scale (UWES-9) and psychological distress using the 6-item Kessler scale. We performed multiple linear regression to determine predictors of work engagement.
RESULTS: Employee mean age was 33.8 years (standard deviation [SD] ± 8.8). The mean work engagement score on the UWES-9 was 3.53 (SD ± 0.94). Eleven of 18 variables on multiple regression predicted work engagement, F(18, 4925) = 69.02, P < 0.001, R2 = 0.201. Factors that predicted higher work engagement were age, marital status, education level, job type, job permanency, longer sleep duration, lower psychological distress and no history of workplace bullying.
CONCLUSIONS: Key factors associated with poorer work engagement in Malaysian employees include inadequate sleep, psychological distress and a history of workplace bullying. These are modifiable factors that individuals and employers can target to improve work engagement, ideally tailored according to occupational type.
Materials and Methods: A total of 11,356 working adults (≥18 years) were recruited from a cross-sectional online health and work survey. Sleep duration was self-reported and was categorised as insufficient sleep (<7 h) and sufficient sleep (≥7 h) based on the National Sleep Guidelines' daily sleep time recommendation for adults. The 10-item Kessler scale was used to assess psychological distress levels (cutoff score ≥20). Bivariate and multivariable regression analyses were performed to examine the factors associated with insufficient sleep.
Results: The mean age of the participants was 35.7 years (standard deviation, SD±9.2). There were more female (n=6613; 58.2%) respondents. The mean sleep duration was 6.49 h (SD±1.10). A total of 6212 individuals (54.7%) reported getting <7 h of sleep daily. After adjusting for gender, marital status and educational attainment, older age (odds ratio, OR=2.22, 95% confidence interval, 95% CI: 1.72-2.86), ever smoking (OR=1.38, 95% CI: 1.25-1.53), and high psychological distress (OR=1.33, 95% CI: 1.17-1.53) were found to be associated with insufficient sleep. Factors associated with sleep duration of <7 h per night included having children (OR=1.35, 95% CI: 1.21-1.50), lifestyle factors (OR=1.38, 95% CI: 1.25-1.53), poor sleeping conditions (OR=1.21, 95% CI: 1.07-1.36), and mental health issues (OR=1.32, 95% CI: 1.12-1.54).
Discussion and Conclusion: More than half of the participants reported sleep insufficiency. Older age, ever smoking, and high levels of psychological distress were significantly associated with insufficient sleep. Our findings recognise sleep as an emerging public health issue. Smoking cessation programmes and addressing high psychological distress may be beneficial to improve sleep.
AIMS: This study aims to explore qualitatively the influence of religious/spiritual beliefs on healthcare workers' attitudes towards suicide and suicidal patients in the culturally heterogeneous Malaysian population.
METHODS: Thirty-one healthcare workers from diverse religious backgrounds, professions and medical disciplines were interviewed. Thematic analysis revealed the centrality of religion in determining healthcare workers' acceptability of suicide, specific religious beliefs that influenced their views on the right-to-die issue, perceptions of the suicidal patient's religiousness/spirituality, and the aspects and extent of religious relevance in professional philosophy and practice.
RESULTS: Healthcare workers who could perceive the multifactorial nature of suicide causation had a more empathetic response. There were high levels of paternalism in the care of suicidal patients, involving unsolicited religious/spiritual advice practised as a form of suicide deterrent and social support.
CONCLUSIONS: The formal integration of religious/spiritual practices into the professional care of suicidal patients was indicated.
METHODS: 6,305 college students (39.3% men; 60.7% women) from six Chinese provincial-level jurisdictions completed a paper-and-pencil survey with Psychological Strain Scales (PSS-40) and Depression, Anxiety, and Stress Scales-21 (DASS-21), both validated in Chinese populations.
RESULTS: Both PSS-40 and DASS-21 have high internal consistency reliabilities, and are highly correlated with each other. Hence, Chinese college students with greater psychological strains (value, aspiration, deprivation, or coping) have greater depression, anxiety, and stress. These results still held after controlling for relevant socio-demographic variables in the multiple regression models.
LIMITATIONS: This was a cross-sectional study, and the sample only included several provinces in mainland China, not a representative sample of all of them.
CONCLUSIONS: Mood disorders and psychopathologies are linked to suicidal thoughts and behaviors. The results of this study extend the Strain Theory of Suicide from explaining the risk factors of suicidality to mood disorders and psychopathologies. Hence, these findings can inform prevention measures among college students, and possibly the general population.
METHOD: This study involved a total of 3,185 college students aged between 18 to 24 years (1,185 US college students, and 2,000 Chinese students who were randomly selected from a large sample of 11,806 Chinese college students). Participants filled out the 4-item SBQ-R.
RESULTS: Participants' responses were compared by country and sex. There was a higher overall risk of suicide-related behaviors among US students (24.3%) compared to Chinese students (17.0%). US students also reported higher lifetime attempt, past-year ideation, and lifetime threat. US female college students reported the highest suicide-related behaviors compared to other sub-groups.
CONCLUSIONS: There is a need to tailor specific interventions to alleviate college students' suicide-related behaviors in the US and China, with a particular focus on US females.