Motivations for Online Expression, Willingness of Online Help-Seeking, and the Risk of Suicide among Hong Kong Youths: A Mixed-Methods Study

Despite widespread interest in social media use, little is known about the heterogeneity of underlying motivations for online engagement among at-risk adolescents. This study adopted a mixed-methods approach to evaluate the motives of online expression among Hong Kong youths aged 15-19, as well as their relationships to online help-seeking willingness and suicide risks. In total, 6 focus groups and 12 individual interviews were conducted (N = 40) to elicit information regarding online expression purposes and to construct questionnaire items. The cross-sectional survey (N = 1,676) was undertaken subsequently to determine the prevalence of motives, and their correlations with online help-seeking willingness and suicide risks. Qualitative interviews revealed two key themes: major motivations for online expression, and features of online expression and help-seeking among suicidal youths. Quantitative analyses demonstrated the prevalence of each online expression purpose, with most reporting on "emotional expression"and "life sharing and documentation,"but variations identified by gender, school academic banding, and suicide-related experience. Notably, an ordinal logistic regression model revealed that motives of "emotional expression"and "image building"were associated with increased suicide risks, while the purpose of "life sharing"was associated with decreased suicide risks. Those who expressed online for "self-expression"and "friend making"showed a stronger willingness for online help-seeking. These findings provide a more holistic overview of the purposes of online expression, which suggested the likelihood of mental health issues and the need for support. Such insight may facilitate the development of more effective suicide prevention strategies and online intervention services.