Tim M. H. Li

Evaluation of a Web-Based Social Network Electronic Game in Enhancing Mental Health Literacy for Young People

Background Internet-based learning programs provide people with massive health care information and self-help guidelines on improving their health. The advent of Web 2.0 and social networks renders significant flexibility to embedding highly interactive components, such as games, to foster learning processes. The effectiveness of game-based learning on social networks has not yet been fully evaluated. Objectives The aim of this study was to assess the effectiveness of a fully automated, Web-based, social network electronic game on enhancing mental health knowledge and problem-solving skills of young people. We investigated potential motivational constructs directly affecting the learning outcome. Gender differences in learning outcome and motivation were also examined. Methods A pre/posttest design was used to evaluate the fully automated Web-based intervention. Participants, recruited from a closed online user group, self-assessed their mental health literacy and motivational constructs before and after completing the game within a 3-week period. The electronic game was designed according to cognitive-behavioral approaches. Completers and intent-to-treat analyses, using multiple imputation for missing data, were performed. Regression analysis with backward selection was employed when examining the relationship between knowledge enhancement and motivational constructs. Results The sample included 73 undergraduates (42 females) for completers analysis. The gaming approach was effective in enhancing young people’s mental health literacy (d=0.65). The finding was also consistent with the intent-to-treat analysis, which included 127 undergraduates (75 females). No gender differences were found in learning outcome (P=.97). Intrinsic goal orientation was the primary factor in learning motivation, whereas test anxiety was successfully alleviated in the game setting. No gender differences were found on any learning motivation subscales (P>.10). We also found that participants’ self-efficacy for learning and performance, as well as test anxiety, significantly affected their learning outcomes, whereas other motivational subscales were statistically nonsignificant. Conclusions Electronic games implemented through social networking sites appear to effectively enhance users’ mental health literacy.

Youth social withdrawal behavior (hikikomori): A systematic review of qualitative and quantitative studies:

Objective: Acute and/or severe social withdrawal behavior among youth was seen as a culture-bound psychiatric syndrome in Japan, but more youth social withdrawal cases in different countries have been discovered recently. However, due to the lack of a formal definition and diagnostic tool for youth social withdrawal, cross-cultural observational and intervention studies are limited. We aimed to consolidate existing knowledge in order to understand youth social withdrawal from diverse perspectives and suggest different interventions for different trajectories of youth social withdrawal. Method: This review examined the current available scientific information on youth social withdrawal in the academic databases: ProQuest, ScienceDirect, Web of Science and PubMed. We included quantitative and qualitative studies of socially withdrawn youths published in English and academic peer-reviewed journals. Results: We synthesized the information into the following categories: (1) definitions of youth social withdrawal, (2) developmental theories, (3) factors associated with youth social withdrawal and (4) interventions for socially withdrawn youths. Accordingly, there are diverse and controversial definitions for youth social withdrawal. Studies of youth social withdrawal are based on models that lead to quite different conclusions. Researchers with an attachment perspective view youth social withdrawal as a negative phenomenon, whereas those who adopt Erikson’s developmental theory view it more positively as a process of seeking self-knowledge. Different interventions for socially withdrawn youths have been developed, mainly in Japan, but evidence-based practice is almost non-existent. Conclusion: We propose a theoretical framework that views youth social withdrawal as resulting from the interplay between psychological, social and behavioral factors. Future validation of the framework will help drive forward advances in theory and interventions for youth social withdrawal as an emerging issue in developed countries.

The prevalence and correlates of severe social withdrawal (hikikomori) in Hong Kong: A cross-sectional telephone-based survey study

Background: Severe social withdrawal behaviors among young people have been a subject of public and clinical concerns. Aims: This study aimed to explore the prevalence of social withdrawal behaviors among young people aged 12–29 years in Hong Kong. Methods: A cross-sectional telephone-based survey was conducted with 1,010 young individuals. Social withdrawal behaviors were measured with the proposed research diagnostic criteria for hikikomori and were categorized according to the (a) international proposed duration criterion (more than 6 months), (b) local proposed criterion (less than 6 months) and (c) with withdrawal behaviors but self-perceived as non-problematic. The correlates of social withdrawal among the three groups were examined using multinomial and ordinal logistic regression analyses. Results: The prevalence rates of more than 6 months, less than 6 months and self-perceived non-problematic social withdrawal were 1.9%, 2.5% and 2.6%, respectively. In terms of the correlates, the internationally and locally defined socially withdrawn youths are similar, while the self-perceived non-problematic group is comparable to the comparison group. Conclusions: The study finds that the prevalence of severe social withdrawal in Hong Kong is comparable to that in Japan. Both groups with withdrawal behaviors for more or less than 6 months share similar characteristics and are related to other contemporary youth issues, for example, compensated dating and self-injury behavior. The self-perceived non-problematic group appears to be a distinct group and the withdrawal behaviors of its members may be discretionary.

Temporal and computerized psycholinguistic analysis of the blog of a Chinese adolescent suicide

BACKGROUND Text analysis of personal documents provides insight into the cognition of those who complete suicide. Many personal documents are digitalized and easily found on the Internet, which can be used to advance suicide research. AIMS (1) To examine the temporal relationships between posting intensity and language use to sketch the suicidal process of a young man on the basis of his blog entries. (2) To investigate whether digitalized personal documents and paper documents of suicide cases have similar or different language patterns. METHOD Firstly, 193 blog entries of a 13-year-old boy posted during the year prior to his suicide were analyzed using the Chinese Linguistic Inquiry and Word Count (CLIWC) program. The temporal relationships between posting intensity and language use were illustrated by time series visualization. Secondly, the findings of this case study were compared with previous case studies from a systematic search of three Ovid databases. RESULTS Posting frequency and language use in the blog helped sketch the suicidal process of the young boy. In this case study, the ratio of positive to negative emotion words was associated with the posting trend. Progressive self-referencing appeared to be a primary predictive sign of suicide. However, the comparison did not show other clearly consistent patterns. CONCLUSION Digitalized personal documents, when interpreted with other information of the individual, provide insight into the suicidal process of completed suicides. This study extends the findings of psycholinguistic analyses of suicides to the Chinese social context and online document form.

Assessing Suicide Risk and Emotional Distress in Chinese Social Media: A Text Mining and Machine Learning Study

Background Early identification and intervention are imperative for suicide prevention. However, at-risk people often neither seek help nor take professional assessment. A tool to automatically assess their risk levels in natural settings can increase the opportunity for early intervention. Objective The aim of this study was to explore whether computerized language analysis methods can be utilized to assess one’s suicide risk and emotional distress in Chinese social media. Methods A Web-based survey of Chinese social media (ie, Weibo) users was conducted to measure their suicide risk factors including suicide probability, Weibo suicide communication (WSC), depression, anxiety, and stress levels. Participants’ Weibo posts published in the public domain were also downloaded with their consent. The Weibo posts were parsed and fitted into Simplified Chinese-Linguistic Inquiry and Word Count (SC-LIWC) categories. The associations between SC-LIWC features and the 5 suicide risk factors were examined by logistic regression. Furthermore, the support vector machine (SVM) model was applied based on the language features to automatically classify whether a Weibo user exhibited any of the 5 risk factors. Results A total of 974 Weibo users participated in the survey. Those with high suicide probability were marked by a higher usage of pronoun (odds ratio, OR=1.18, P=.001), prepend words (OR=1.49, P=.02), multifunction words (OR=1.12, P=.04), a lower usage of verb (OR=0.78, P<.001), and a greater total word count (OR=1.007, P=.008). Second-person plural was positively associated with severe depression (OR=8.36, P=.01) and stress (OR=11, P=.005), whereas work-related words were negatively associated with WSC (OR=0.71, P=.008), severe depression (OR=0.56, P=.005), and anxiety (OR=0.77, P=.02). Inconsistently, third-person plural was found to be negatively associated with WSC (OR=0.02, P=.047) but positively with severe stress (OR=41.3, P=.04). Achievement-related words were positively associated with depression (OR=1.68, P=.003), whereas health- (OR=2.36, P=.004) and death-related (OR=2.60, P=.01) words positively associated with stress. The machine classifiers did not achieve satisfying performance in the full sample set but could classify high suicide probability (area under the curve, AUC=0.61, P=.04) and severe anxiety (AUC=0.75, P<.001) among those who have exhibited WSC. Conclusions SC-LIWC is useful to examine language markers of suicide risk and emotional distress in Chinese social media and can identify characteristics different from previous findings in the English literature. Some findings are leading to new hypotheses for future verification. Machine classifiers based on SC-LIWC features are promising but still require further optimization for application in real life.

A hybrid system for online detection of emotional distress

Nowadays, people are familiar with online communication and tend to express their deeper feelings on the Web. In the light of this situation, we present a hybrid system based on affect analysis for mining emotional distress tendencies from publicly available blogs to identify needy people in order to provide timely intervention and promote better public health. We describe the system architecture with a hand-crafted model at a fine level of detail. The model, which incorporates human judgment, enables the adjustment of prediction in machine learning on blog contents. The system blending supervised and unsupervised approaches will be examined and evaluated in lab experiments and practice.

Engagement of vulnerable youths using internet platforms

Aim The aim of this study was to explore the online distress and help-seeking behavior of youths in Hong Kong. Methods A cross-sectional telephone-based survey was conducted among 1,010 young people in Hong Kong. Logistic regression analysis was then performed to identify the factors associated with those who reported expressing emotional distress online and the differences in help-seeking behavior among four groups of youths: (1) the non-distressed (reference) group; (2) “Did not seek help” group; (3) “Seek informal help” group; and (4) “Seek formal help” group. Results The seeking of help and expression of distress online were found to be associated with a higher lifetime prevalence of suicidal ideation. The “Seek formal help” and “Did not seek help” groups had a similar risk profile, including a higher prevalence of suicidal ideation, non-suicidal self-injury, unsafe sex, and being bullied. The “Seek informal help” group was more likely to express distress online, which indicates that this population of youths may be accessible to professional identification. Approximately 20% of the distressed youths surveyed had not sought help despite expressing their distress online. Implication The study’s results indicate that helping professionals have opportunities to develop strategic engagement methods that make use of social media to help distressed youths.

Effectiveness of a Culturally Attuned Internet-based Depression Prevention Program for Chinese Adolescents: A Randomized Controlled Trial

Depression prevention among adolescents is crucial for reducing the global disease burden. Internet‐based depression prevention approaches are found to be effective but they were mostly evaluated in a Western context. Grasping the Opportunity is a Chinese Internet intervention, which was translated and modified from CATCH‐IT developed in the West. We aimed to evaluate the effectiveness of Grasp the Opportunity in reducing depressive symptoms in Chinese adolescents.

Efficacy of a Multicomponent Intervention with Animal-Assisted Therapy for Socially Withdrawn Youth in Hong Kong

This is an evaluation study of a pilot multicomponent program with animal-assisted therapy ( AAT ) for socially withdrawn youth with or without mental health problems in Hong Kong. There were fifty-six participants. Decreased level of social anxiety, and increased levels of perceived employability and self-esteem across two withdrawn groups were observed. When comparing those who did and did not receive the AAT component(s), however, AAT did not seem to have additional impacts on outcomes. The qualitative data collected through interviews with ten participants reflected that the AAT component was attractive because the nonhuman animals made them feel respected and loved. This pilot study showed that a multicomponent program with a case management model correlated with increased levels of self-esteem and perceived employability, and a decreased level of social interaction anxiety. In addition, using nonhuman animals in a social service setting appears to be a good strategy to engage difficult-to-engage young people.

Withdrawal experience and possible way-outs from withdrawal behavior in young people

The term NEET (not in employment, education, or training) has been increasingly applied to young people in Europe not engaged in the three systems mentioned. Young people who seclude themselves at home and progress to social withdrawal can be considered a NEET subgroup—the “disengaged.” This phenomenon was first identified in Japan, where such reclusive individuals are referred to as hikikomori, but youth social withdrawal has also been reported in other countries, including South Korea and Hong Kong. Research on youth social withdrawal has mainly focused on describing and identifying contributing factors to this withdrawal behavior. Very few studies have examined the transitional processes from the initial self-seclusion to later help-seeking. Examining the mechanisms behind the engagement process for helping professionals is important to guide social work services for this unique group of young people. We conducted a qualitative study involving semi-structured interviews with 30 socially withdrawn young people in Hong Kong. Thematic analysis conceptualized their social withdrawal processes into three subthemes: private status, de-friending spiral, and suspension of experiences. Three reasons for changing their withdrawal behavior were also identified: rebalancing one’s ideal self with reality, reconnecting with tuned-in people, and regaining momentum in life. This study provides practical implications for social workers to develop approaches to engage withdrawn young people.