Professional help seeking for suicidal ideation among Chinese and Australian university students

Abstract

Introduction: Suicide is a leading cause of death among the university-aged population. Alarmingly, a large proportion of students with suicidal ideation or behaviour do not seek help from health services. This thesis aims to identify the factors associated with professional help seeking for suicidal ideation among Chinese and Australian university students and to develop a trial online program to facilitate help seeking. Methods: A systematic review was conducted to identify factors that may influence professional help seeking for suicidal ideation and behaviour. Two hundred and eight Chinese university students and 128 Australian university students were subsequently recruited to complete an online cross-sectional survey to further test the influence of the identified factors on professional help seeking for suicidal ideation. The results of this survey were then used to guide the development of a two-module online psychoeducational program (ProHelp). The effectiveness of this program was evaluated through a pilot randomised controlled study of 156 Chinese university students and 101 Australian university students. Results: Low perceived need for treatment, great self-reliance, low suicide literacy, and stigmatising attitudes were identified as important barriers to professional help seeking in both the systematic review and the cross-sectional surveys. In particular, greater self-reliance was significantly associated with negative help-seeking attitudes for suicidal ideation in both China and Australia. Attribution of suicidal individuals to isolation (p = .035) was negatively associated with help-seeking attitudes in China, while glorification (p = .008) and stigmatising attitudes (p = .025) of suicidal individuals were negatively associated with help-seeking beliefs and attitudes respectively in Australia. Limited suicide prevention knowledge (p = .042) in China and less supportive family relationship (p = .006) in Australia were associated with lower help-seeking beliefs. Two self-recognised barriers, “I prefer to deal with issues on my own” and “I question how serious my needs are” were identified in both China and Australia. Self-reliance, suicide literacy, suicide attitudes and social support were found to influence help-seeking and thus formed the basis of the ProHelp intervention. Although no significant effect of the intervention on professional help-seeking beliefs or intentions was found, both groups’ help-seeking attitudes increased during the study (p = .003 for the post-test survey, and p = .008 for the follow-up survey). The experimental group in both countries demonstrated a significant improvement in suicide literacy at the post-test survey (p = .015). Qualitative feedback indicated that the ProHelp program was generally user-friendly, clear, and helpful. Conclusion: The current thesis identified and tested the impact of self-reliance, suicide literacy, suicide attitudes, and social support on professional help-seeking for suicidal ideation among university students. It also provided initial evidence that a brief online psychoeducational program could enhance university students’ suicide literacy in both China and Australia. Although increasing suicide literacy was not sufficient to improve students’ help seeking, effect sizes indicated that this low-intensity online approach showed promise in encouraging more positive beliefs towards help seeking among young people.