Abstract
BACKGROUND: Suicide is a critical global public health issue that demands a better understanding of its complex causes and effective interventions. This study examines data from the Hangzhou Mental Health Hotline (2014-2023) to explore the relationship between consultation themes and suicidal ideation, with an emphasis on gender differences and how these associations changed during different phases of the COVID-19 pandemic. METHODS: This retrospective analysis covers 128,245 calls to the hotline over a decade. Chi-square tests identified differences in suicidal ideation across consultation themes and demographics. Multivariate logistic regression models were used to examine the relationship between specific themes and suicidal ideation, adjusting for confounders. The analysis was stratified by gender and pandemic phases to assess the interaction between gender and pandemic-related changes. RESULTS: The incidence of suicidal ideation was highest during the mid-pandemic phase (11.95%), compared to the pre-pandemic (7.68%) and post-pandemic phases (10.66%). Additionally, the rate was slightly higher among female callers (9.8%) than male callers (9.4%). Physical illness (OR = 4.70, 95% CI: 3.71-5.91) had the strongest association with suicidal ideation, followed by mental health issues (OR = 3.35, 95% CI: 3.03-3.70). Compared to male callers, female callers were more significantly affected by physical illness (OR = 6.86 vs. OR = 3.71, p < 0.001) and mental health issues (OR = 6.81 vs. OR = 2.11, p < 0.001). In the context of romantic relationship problems, female callers had a higher likelihood of suicidal ideation (OR = 4.13 vs. OR = 1.88, p < 0.001). Similarly, marital and family issues were more strongly associated with suicidal ideation in female callers (OR = 4.58 vs. OR = 1.21, p < 0.001). During the global COVID-19 pandemic, the association between suicidal ideation and consultation themes among male callers showed a sharp upward trend, which eased after the pandemic. In contrast, the association among female callers gradually accumulated and continued to worsen in the later stages of the pandemic. CONCLUSION: This study highlights the necessity of implementing gender-sensitive mental health interventions tailored to different gender groups during and after global crises such as the COVID-19 pandemic, to safeguard public mental health effectively.