key: cord-0840004-5wsrhev6 authors: Li, Tim M. H.; Leung, Cassie S. Y. title: Exploring student mental health and intention to use online counselling in Hong Kong during the COVID‐19 pandemic date: 2020-07-20 journal: Psychiatry Clin Neurosci DOI: 10.1111/pcn.13117 sha: 2460134c0db63ec623718252d929e16f14e97d7a doc_id: 840004 cord_uid: 5wsrhev6 nan The worldwide outbreak of coronavirus disease (COVID-19) has exacerbated pre-existing student mental health problems, due to academic disruption, restricted social contact, loss of routine, and health-related fear. 1 A recent study has found that one-fourth of the student participants exhibited anxiety symptoms in China under COVID-19. 2 Student mental health has always been a serious concern in Hong Kong. A review has summarized that, in Hong Kong, before the COVID-19 outbreak, the prevalence rates of depression and anxiety in adolescents were 2.2% and 2.6%, respectively. 3 It is speculated that the mental health conditions of young people have worsened during this period. In Hong Kong, classes of all schools have been suspended since late January 2020. Online counselling becomes one of the very few possible ways to engage and intervene students who are facing emotional and mental well-being challenges. 4 However, a previous study has reported that only 25% of the youth participants were willing to be approached online by helping professionals. 5 While digital mental health services have been widely implemented in China during the outbreak of COVID-19, 4 it is important to explore the feasibility of conducting online counselling to address student mental health issues in Hong Kong. The current study investigates (1) student mental health conditions in Hong Kong under COVID-19, (2) whether students had intention to use online counselling service, and (3) the factors associating with students' intention to use online counselling, namely benefits of online counselling, preferred online channels for counselling, and past counselling experience. This study adopted snowball sampling and online survey due to territory-wide class suspension and other social distancing measures. It is expected that the sample collected would not be representative. All parents and students in the study were informed about the voluntary This article is protected by copyright. All rights reserved. basis of participation and gave informed consent. 300 secondary school students (64% female) were investigated between April and May 2020. The results reveal that one-third of them were classified as having mental distress. Form 6 students preparing for public exams were at increased risk of mental distress. It is suspected that the uncertainty surrounding the assessment arrangement under COVID-19 had caused the students to feel more stressed about the public exams. On the other hand, over 40% of the student participants had intention to use online counselling service. The findings confirm that online counselling is in need as many people cannot access mental health care during the outbreak. The methods and results of this study is reported in Appendix S1. The factors affecting students to use online counselling service are shown in Table 1 . Students without mental distress who regarded online counselling as secure were more likely to use it via instant message and video chat. Nowadays, the use of advanced Internet technology expands the variety of online platforms in delivering counselling service, including instant messaging and videoconferencing. Online communication platform also gives clients a sense of security to share sensitive information during counselling sessions. 5 Young people may be more willing to explore and address topics that they feel ashamed to talk in real-life settings. It is expected that online counselling can reach a much wider user community including those who feel uncomfortable to meet in person for mental health prevention. Nevertheless, the anonymity and convenience of online counselling conventionally believed to be appealing to clients were not significant factors motivating students to use online counselling service. Distressed students who perceived their previous counselling experience effective would be more probable to use online counselling service. Instead of benefits and channels of This article is protected by copyright. All rights reserved. online counselling, distressed students were more concerned about the effectiveness of counselling, comparing to those without mental distress. With the successful counselling experience, distressed students may feel more comfortable to try online service. In fact, some previous studies have shown the effectiveness of online counselling. For instance, it was found that young people engaged and intervened online had a significant alleviation in emotional distress and social withdrawal symptoms. 6 Another study has also demonstrated that online counseling reduced suicidal thinking among medical students. 7 The information may further reinforce distressed student to use online counselling service. While more students are willing to utilize online counselling service, it is meaningful to advocate online counselling so it can be incorporated when developing student-centered support programs. 1 In fact, some non-governmental organizations have pioneered to provide online counselling service in Hong Kong. 5, 6, 8 Practitioners will inevitably encounter new technological challenges and ethical issues. 8, 9 Further research is needed to consolidate the experience and steer the counselling field in new directions. As the demand of mental health service has been growing in Hong Kong, online counselling will be a new alternative to meet the mental health needs in the future. Student mental health in the midst of the COVID-19 pandemic: A call for further research and immediate solutions The psychological impact of the COVID-19 epidemic on college students in China Adolescent mental health problems in Hong Kong: a critical review on prevalence, psychosocial correlates, and prevention Online mental health services in China during the COVID-19 outbreak Engagement of vulnerable youths using internet platforms Online social work engagement and empowerment for young internet users: A quasi-experiment Online therapy reduces suicide ideation in medical interns Finding People with Emotional Distress in Online Social Media: A Design Combining Machine Learning and Rule-Based Classification Ethical issues in online psychotherapy: A narrative review We would like to thank all the participants for sharing their experiences with us during the COVID-19 pandemic.This article is protected by copyright. All rights reserved. The authors declare no conflict of interest.This article is protected by copyright. All rights reserved. Appendix S1. The methods and results of this study.This article is protected by copyright. All rights reserved. .48) * .032 † Participants who had no intention to use online counselling served as the reference group in multiple binary logistics regression; adjusted odds ratio (OR) was controlled by gender, age, and grade; *p < .05; **p < .01. ‡ The item was measured using a yes/no format. Participants who opted for "no" served as the reference group.