One in four HK pupils has ≥1 mental disorder

One-fourth of pupils in Hong Kong experienced ≥1 mental disorder in the past year, and 4 percent had suicidal ideation, according to a territory-wide study by the Chinese University of Hong Kong (CUHK).

Childhood and adolescence are critical developmental stages, with onset of half of all lifetime mental disorders reported to occur by the age of 14 years. [Arch Gen Psychiatry 2005;62:593-602] “However, representative epidemiological surveys targeting children and adolescents in Hong Kong are lacking,” said the researchers.

In the territory-wide WORK HEART study, the researchers interviewed 6,082 pupils aged 6─17 years and their parents between 1 September 2019 and 30 June 2023. “This is Asia’s largest child and adolescent mental health study, which included both Chinese and non–ethnic Chinese [NEC] respondents,” noted the researchers. All diagnostic assessments were based on the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5).

Results showed that 24.4 percent of pupils had ≥1 mental disorder in the past 12 months, with approximately half of them having ≥2 co-occurring mental disorders. “The findings are worrying as we are currently on the high end of the global trend,” commented Professor Sandra Chan of the Department of Psychiatry, CUHK.

Attention-deficit/hyperactivity disorder (10.2 percent), disruptive, impulse-control and conduct disorders (8.8 percent), anxiety disorders (6.1 percent), and depression (5.4 percent) were the four most common DSM-5 mental disorders identified in the study.

Parental emotional distress, school-related problems (eg, grade retention, school suspension and absenteeism), and sleep disorders were the most common risk factors for mental disorders identified in the survey. Parental emotional distress causes disruptions in a family environment, which can potentially result in adverse childhood experiences and eventually lead to development of childhood psychiatric disorders. “Parents in Hong Kong often have unrealistically high expectations of their children’s academic achievement that may exceed their children’s actual capability,” continued Chan.

Additionally, the study showed that 10.2 percent of pupils had clinically significant sleep problems, which is an early marker for underlying psychiatric problems.

Among the pupils surveyed, 12-month prevalence rates of suicidal ideation, plan, and attempt were 3.9 percent, 1.9 percent, and 1.1 percent, respectively. The rates were even higher among secondary school students, at 8.4 percent, 3.8 percent, and 2.3 percent, respectively. “The suicide data only represent the tip of the iceberg,” commented Mr Yan-Lung Wong of the Advisory Committee on Mental Health.

However, 28.2 percent and 80.2 percent of local Chinese and NEC parents, respectively, did not recognize their children’s mental health status. Even in parents who recognized their children’s mental health problems, approximately 50 percent were unwilling to seek professional support, with higher reluctance found among NEC parents. Fear of stigma, downplaying the problem, language barrier, and unawareness of access to professional support were key reasons for not seeking help.

“Psychological well-being and resilience should be prioritized and should not be a subsidiary to scholastic outcomes,” emphasized Wong. “A comprehensive and inclusive approach in health policy for school-aged children and adolescents should be rooted in integrated family support, holistic education, and understanding of the importance of sleep. Additional support should be provided to parents with high emotional distress, NEC parents, and high-risk youths showing signs of school or sleep problems.”