Exploring student mental health and intention to use online counseling in <scp>Hong Kong</scp> during the <scp>COVID</scp>‐19 pandemic

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 found that one-quarter of the student participants exhibited anxiety symptoms under COVID-19 in China.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 counseling has become one of the very few possible ways to engage and intervene with 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 counseling to address student mental health issues in Hong Kong. The current study investigated: (i) student mental health conditions in Hong Kong under COVID-19; (ii) whether students had intention to use online counseling services; and (iii) factors associated with students' intention to use online counseling, namely benefits of online counseling, preferred online channels for counseling, and past counseling experience. This study adopted snowball sampling and an 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 basis of participation and gave informed consent. Three hundred secondary school students (64% female) were surveyed 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 an intention to use online counseling services. The findings confirm that online counseling is in need as many people cannot access mental health care during the outbreak. The methods and results of this study are reported in Appendix S1. The factors affecting students' use of online counseling services are shown in Table 1. Students without mental distress who regarded online counseling 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 counseling services, including instant messaging and videoconferencing. Online communication platforms also give clients a sense of security to share sensitive information during counseling sessions.5 Young people may be more willing to explore and address topics that they feel ashamed to talk about in real-life settings. It is expected that online counseling can reach a much wider user community, including those who feel uncomfortable meeting in person, for mental illness prevention. Nevertheless, the anonymity and convenience of online counseling, which have been conventionally considered appealing to clients, were not significant factors motivating students to use online counseling services. Distressed students who perceived their previous counseling experience as effective would be more likely to use online counseling services. Instead of benefits and channels of online counseling, distressed students were more concerned about the effectiveness of counseling, compared to those without mental distress. With a successful counseling experience, distressed students may feel more comfortable to try online services. In fact, some previous studies have shown the effectiveness of online counseling. For instance, it was found that young people who 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 This information may further encourage distressed students to use online counseling services. While more students are willing to utilize online counseling services, it is meaningful to advocate online counseling so it can be incorporated when developing student-centered support programs.1 In fact, some nongovernmental organizations have pioneered providing online counseling services 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 counseling field in new directions. As the demand of mental health services has been growing in Hong Kong, online counseling will be a new alternative to meeting mental health needs in the future. We would like to thank all the participants for sharing their experiences with us during the COVID-19 pandemic. The authors declare no conflicts of interest. Appendix S1. The methods and results of this study. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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