Coping with peer suicidality, help-seeking intentions, and suicidal attitudes among Asian adolescents: a mixed-methods study in Hong Kong

Background: Adaptive responses to peer suicidality and the involvement of professional help are crucial for adolescent suicide prevention and may be influenced by suicidal attitudes. This study aimed to explore Hong Kong adolescents' responses to and help-seeking intentions for suicidal peers and to examine the influence of suicidal attitudes. Method: This study used an exploratory sequential mixed-methods approach targeting Hong Kong adolescents aged 15–19 between September 2018 and October 2019. Adolescents' reactions to peer suicidality, suicidal attitudes, and willingness to help were examined through six focus groups and 12 individual interviews (N = 40). A cross-sectional survey (N = 1676) was subsequently conducted to investigate the prevalence of different responses to peer suicidality, help-seeking intentions, differences by background characteristics, and the impacts of suicidal attitudes. Results: Qualitative findings revealed three major themes: attitudes toward suicide, reactions to peer distress and suicidality, and willingness to help suicidal individuals. Most survey respondents reported actively responding and seeking informal help, but not professional support. Differences were observed based on sex, academic performance, and self-suicidality. Notably, a stigmatizing attitude was positively associated with both response types and informal help-seeking intentions. The belief that suicide is unpreventable was positively associated with passive responses but negatively associated with active responses and informal help-seeking intentions. Conclusions: Our findings highlight variability in adolescents' responses to peer suicidality and help-seeking intentions, underscoring the need for attitude-tailored courses and more systematic, action-based gatekeeper training. Recommendations are provided to enhance the effectiveness of mental health first aid programs through public education, school interventions, and media campaigns.