ʻO ke kino pilikino a me kona hui pūʻana me ka mea pili i ka pūnaewele a me kaʻike pūnaewele i ka manaʻo suicidal i nā'ōpio. (2016)

Hana ʻoki hōʻino (SH) kahi huaʻōlelo i wehewehe i nā hana a pau e hōʻino pono ʻole ai a hōʻeha paha iā ia iho ma nā ʻāina he nui o ʻEulopa, me ka manaʻo ʻole o ka manaʻo e hoʻopiʻi. He mea koʻikoʻi kēia ʻano ʻike no ka mea pinepine ka hoʻāʻo ʻana o SH a he kumu kūʻokoʻa kūʻokoʻa no ka makehewa, ʻoiai ʻo ia nā hana he nui o SH i ka wā ʻōpiopio e hoʻomaka me nā manaʻo nonsuicidal.¹ Ua ʻike ʻia nā haʻawina lōʻihi ma hope o ka SH i nā keiki ʻōpio he kanaka nui ka make o ka nui o ka nui o ka make i like me ka helu i kali ʻia (ʻo ka makeʻe ke kumu nui o kēia mahuahua).² a me ka mahuahua o ka loaʻa ʻana o ka maʻi psychiatric i ka wā ʻōpio.³

ʻO nā mea pilikia no ka SH i ka wā ʻōpio he multifactorial a pinepine i waena o ka intercorrelated. Ua hōʻike kahi loiloi ʻōnaehana pili i ka mea pili i nā ʻōpio SH me nā ʻōpiopio me nā nonfatal SH i kahi like like ʻole o nā ʻōpio i hoʻopau i ka make.⁴ I waena o nā mea i ʻike ʻia, ʻike ʻia i ka make ʻana (ʻo ka clustering o nā suicides / contagion o ka hana suicidal a i ʻole ka mana o ka media) i manaʻo ʻia i nā mea ʻōpio ma mua o nā pākeke.^{5, 6} ʻO ka hōʻike ʻana i nā ʻano suicidal nonfatal ma ka ʻohana a me nā hoaaloha i ʻike ʻia he wānana ʻo SH i nā ʻōpio.⁷ Eia nō naʻe, ʻike iki ʻia e pili ana i ka pilina ma waena o ka hōʻike ʻana i nā manaʻo suicidal i haʻi ʻia e nā poʻe ʻē aʻe, keu hoʻi i ka pōʻaiapili like ʻole i hoʻokumu ʻia e ka pūnaewele, a me ka hana hoʻopōʻino a kahi ʻōpio i ka pae kaiāulu.

Hoʻohālikelike ka hoʻohui ʻana pūnaewele ma kahi ʻano he pono ʻole o ka hoʻohana ʻana i ka pūnaewele e alakaʻi i ka hōʻeha kino ʻana a i ʻole ka pilikia.⁸ Nui ia i kahi preoccupation me nā hana pūnaewele, ka hoʻokau hou ʻole ʻana e pale aku i ka hoʻonāukiuki e hoʻohana i ka pūnaewele, ka hoʻomanawanui, ka hoʻihoʻi ʻana, hoʻohana ʻana i ka pūnaewele no kahi manawa he lōʻihi ka lōʻihi ma mua o ka makemake, hoʻomau a makemake ʻole a i ʻole i hoʻopaʻa ʻole ʻia i nā hoʻāʻo ʻana e hōʻoki a hoʻemi paha i ka hoʻohana pūnaewele. , ka nui o ka manawa ma ka hana pūnaewele a me ka haʻalele ʻana i ka Pūnaewele, nui ka hana i hoʻolilo ʻia i nā hana e pono ai ke kiʻi i ka pūnaewele, a hoʻomau i ka hoʻohana ʻana i ka pūnaewele kaumaha ʻoiai ua ʻike ka loaʻa ʻana o kahi pilikia olakino a hoʻomau ʻia a i ʻole ke kumu a he kumu paha a hoʻopilikia ʻia paha e Pūnaewele.⁹ ʻO nā haʻawina mua ua ʻike nā mea ʻōpio me ka loaʻa ʻana o ka pūnaewele i kiʻekiʻe kiʻekiʻe o ka mālamaʻana i nā maʻi maʻi hyperactivity deficit, depression, a me ka huhū, a me ka nui o ka hopohopo e komo i nā ʻano kūwaho.^{10, 11} Akā, ʻike liʻiliʻi ʻia e pili ana i ka pilina ma waena o ka hoʻohui ʻana ma ka pūnaewele a me SH i nā ʻōpio. Pono hou noiʻi e pili ana i kēia pilina a me nā ʻoihana lalo e pono ai e hoʻomaopopo pono a me ka mālama ʻana i ka SH i nā ʻōpio.

Ma kēia noiʻi ʻana, ʻo kā mākou pahuhopu e nānā i ka pilina o SH i nā ʻōpio i ka ʻike ʻana i ka pūnaewele i ʻike ʻia i kahi manaʻo suicidal mai nā poʻe ʻē aʻe. Ua hoʻāʻo nō mākou e hoʻomaʻamaʻa i ka pili ʻana o ka hoʻohui ʻana o ka pūnaewele iā SH i ka wā ʻōpiopio, ma ka kāohi ʻana i nā hopena o ke kaumaha, a me ka pepehi ʻia ʻana o ka manaʻo, ʻike ʻia i nā manaʻo kuhihewa kuhi, mea hoʻohana, nā mea pili i ka ʻohana, ʻike ʻia i ke kākoʻo kaiāulu, a me ka manaʻo ponoʻī.^{4, 12} No ka poʻe i hōʻino iā lākou iho, ua nānā hou mākou i nā ʻokoʻa ʻana o ka nui o nā hana a me ka makehewa, a inā paha ua ʻimi nā ʻano o SH ma ka pūnaewele ma waena o ka poʻe ʻōpio he lawena a me nā ʻōpiopio ʻole. Kuhi ʻia nā hiʻohiʻona o nā ʻike pili i SH ma ke nānā ʻana i ka hoʻolaha ʻana o ka pūnaewele i nā manaʻo suicidal.

ʻO kēia noiʻi he hoʻokele cross-section i mālama ʻia ma Taipei City a me Taipei County mai ʻOkakopa 2008 a i Ianuali 2009. Aia ka poʻe 13 e hele nei i nā kula kiʻekiʻe (8 kauhale, kūlanakauhale ʻo 3, a me 2 mau kula kaiaulu e like me ka Hōʻikeʻike a ʻIka-Fukien Demographic Fact Book.¹³). Ua lako ʻia nā kula āpau i komo pū ʻia me nā pono lawelawe waihona papa, i hoʻohana nā haumāna no ka hoʻokō pono ʻana i nā nīnau nīnau pūnaewele.

Ua mālama ʻia ka hoʻolimalima e ka mea noiʻi noiʻi pae kiʻekiʻe o ka haku, me ka ʻole o ke komo ʻana o nā limahana o ke kula, i mea e hōʻalo ai i ka pilikia o ka coercion. Ua wehewehe pono ka mea noiʻi noiʻi i nā pahuhopu a me nā kaʻina hana o kēia noi ʻana, ua koʻikoʻi i nā pilikia pilikino, a loaʻa i nā ʻae i kākau ʻia e ka poʻe i komo. Ua hāʻawi ʻia kahi leka i nā mākua e noi ana i kā lākou ʻae a hoʻihoʻi ʻia kā lākou pane palapala e nā haumāna e komo ana. Ua loaʻa ka ʻae kūpono o kēia aʻo ʻana mai ka Board Review Board o MacKay Memorial Hospital ma mua o ka hoʻolālā ʻana.

Pākuʻi ʻia kēia i ka papa aʻo (aia nā mea āpau i ka papa mua o ke kula kiʻekiʻe ma kēia noi), ka makahiki, ke kāne, ka haipule, ke kūlana kālā ʻohana i ʻike ʻia e ka nīnau ʻana "He paʻakikī paha i kou ʻohana ke mālama i nā pono maʻamau (e laʻa, nā meaʻai, nā lole, nā hale. , etc.?) ", ka poʻe a lākou e noho pū ai (" Noho ʻoe i kēia manawa me kāu mau mākua ola? "), a me ka launa ʻohana (" Manaʻo ʻoe he nui ka hakakā i nā pilina o kou ʻohana? ").

Ua hōʻiliʻili ʻia ka ʻike, e hoʻohana ana i nā nīnau maʻamau, i ke kū ʻana o ka manaʻo suicidal, nā hoʻolālā pepehi kanaka, a me ke ʻano SH ma loko o ka makahiki i hala, me ka helu o nā hana SH, inā lākou i nīnau i kekahi pūnaewele e pili ana i nā hana SH, inā aia ka manaʻo hoʻomake i ka wā a lākou e ʻike ai. ua hoʻāʻo e hana ʻino iā lākou iho ("I loko o kekahi o kēia mau ʻāpana āu i makemake ai e pepehi iā ʻoe iho?"), a inā paha ua hōʻike ʻia lākou i nā manaʻo suicidal o haʻi i ka honua maoli ("Ua haʻi a kamaʻilio paha kekahi iā ʻoe e pili ana i nā manaʻo e pili ana pepehi iā lākou iho me ʻoe? ") a ma ka pūnaewele (" Ua hala paha ʻoe i kahi hanana kahi kanaka āu i launa wale ai ma ka pūnaewele e kūkākūkā i nā manaʻo e pili ana i ka pepehi ʻana iā lākou iho me ʻoe? ") i loko o ka makahiki i hala. Ua nīnau ʻia nā nīnau āpau e like me kā mākou hoihoi noiʻi, a ua hōʻoia ʻia ma o ke kaʻina hana o ka pūʻulu.

Ua hoʻohana ʻia ke kime 26-kumuhana Chen Internet Addiction Scale (CIAS) i ka nānā ʻana i ka loaʻa ʻana o ka ʻike pūnaewele ma ka loiloi ma kahi ʻehā ʻehā helu, me ka huina helu mai 26 a 104. Ua nānā ʻia nā hiʻohiʻona psychometric o ke pākuʻi a ʻike ʻia ka hilinaʻi kūloko mai 0.79 a 0.93.¹⁴ Koho ʻO nā Kānāwai Diagnostic o ka Hoʻohui pūnaewele no nā ʻōpio,⁹ ʻānō i nā ʻōpiopio o 64 a i ʻole i ka CIAS i hōʻike ʻia ka loaʻa ʻana o ka hoʻohui honua. ʻO ka pololei diagnostic ʻo 87.6%.¹⁵

ʻO ka nīnau nīnau ʻ Healthlelo Pilikino (PHQ-9) he ʻikepili a me ka hōʻike ponoʻī ʻatikala e pili ana i ka palapala ʻo Diagnostic and Statistical Manual of Mental Disriers-Fourth Edition (DSM-IV) no ka hōʻike ʻana i ke kaumaha, ka loiloi ʻana i ka hōʻeha a me ka nānā ʻana i ka pane lapaʻau.¹⁶ ʻO ka mana Kina o ka PHQ-9 he kūlike kūloko (alpha = 0.84) a me ka hilinaʻi e hoʻāʻo hou ʻia (ICC = 0.80) i nā heluna ʻōpio.¹⁷ Ke hoʻohana nei i ka papa kuhikuhi Kiddie-for Affective Disorder a me Schizophrenia (Epidemiological Version) ma ke ʻano he pae hoʻohālikelike, ua loaʻa kahi helu PHQ-9 ≥ 15 i ka 0.72 a me kahi kikoʻī o 0.95 no ka ʻike ʻana i kahi maʻi depressive nui i nā ʻōpio.¹⁷

ʻO Multi-Dimensional Support Scale (MDSS) kahi kumu hōʻike ponoʻī nona ka loaʻa ʻana a me ka lawa o ke kākoʻo kūloko mai nā ʻano like ʻole.¹⁸ Hiki ke hoʻonohonoho pono ʻia i nā pono kikoʻī o nā papahana noiʻi like ʻole. Ma ʻaneʻi ua hoʻokaʻawale mākou i ke kākoʻo kaiāulu o nā ʻōpio i ʻehā mau kumuwaiwai (ʻo ia hoʻi, nā mākua, ʻohana ʻē aʻe, nā hoaaloha, a me nā kumu). ʻAʻole i loaʻa ka mana Chinese o kēia pālākiō i ka manawa o kēia aʻo ʻana; ua unuhi ʻia i ka ʻōlelo Haole e ka mea kākau, me ke unuhi kūʻokoʻa kūʻokoʻa e kahi psychiatrist ʻōlelo ʻelua. Kuhi ka helu kiʻekiʻe ma luna o ka MDSS i ke kākoʻo kaiāulu ʻike ʻia

ʻO Rosenberg Self-Esteem Scale (RSES) kahi mea pono pilikino hōʻike he 10 mau mea e ana ana i ka hilinaʻi o ke kanaka iā ia iho.¹⁹ Ua hoʻokūpaʻa ʻia ka pololei a me ka hilinaʻi o ka China Kina no nā RSES.²⁰ ʻO kahi helu kiʻekiʻe ma nā RSES e hōʻike i kahi kiʻekiʻe o ko lākou mau manaʻo ponoi.

ʻĀina Hōʻea Pio Lizki Hoʻomoe Hōʻike Hoʻohālikelike-ʻĀina (AUDIT-C) i nā mea mua ʻekolu o ka AUDIT no ka hoʻomaopopo ʻana i ka inu ʻona.^{21, 22} Ua hōʻoia ʻia ka hana ʻana o ka hana Kina me kēia mea hana ʻimi kino waiʻona.²³ Loaʻa i kahi helu AUDIT-C ≥ 4 ka noʻonoʻo o 0.90 a me kahi kikoʻī o 0.92 no ka ʻike ʻana i ka hoʻohana ʻana i ka wai ʻona weliweli.²³

Ua hōʻuluʻulu mākou i nā haumāna o ke kula kiʻekiʻe he 3994 mai nā kula i hoʻokokoke ʻia. Ua hāʻawi aku nā haumāna he 2479 i kā lākou ponoʻī a me kā lākou mau mākua i ʻae ʻia i ka ʻikepili a hoʻopau i ka nīnau nīnau (pane pane = 62.1%). ʻO ko lākou makahiki he 15.44 mau makahiki (mai ka makahiki 14-19; ka hoʻololi maʻamau 0.61); ʻo ka hapanui he wahine (n = 1494; 60.3%) a me ka pili ʻole o ka hoʻomana (n = 1344, 54.2%). ʻO ka laha o SH ma loko o ka makahiki i hala he 10.1% (n = 250). Ma waena o nā poʻe komo, 17.1% ka loaʻa ʻana o ka pūnaewele (n = 425) a me 3.3% i hōʻike ʻia i nā manaʻo suicidal ma ka pūnaewele (n = 82) i loko o ka makahiki i hala.

Hōʻike ʻia nā hiʻohiʻona o nā poʻe i ʻole a i ʻole SH 1 Pūnaewele. ʻAʻole nui ka makahiki, no ka mea, ʻo nā haumāna wale nō i ka makahiki mua o ke kula kiʻekiʻe i kiʻi ʻia. Hoʻokahi wale nō haumāna i hōʻike i ka hoʻohana ʻana i nā lāʻau lapaʻau kūpono ʻole no laila ʻaʻole hiki ke hoʻokomo ʻia kēia mea i ka loiloi. ʻO ka poʻe ʻōpio me SH i loko o ka makahiki i hala aku nei he wahine paha lākou, ʻaʻole e noho pū ana me ko lākou mau mākua ola ʻelua, a e hōʻike i ke kūpaʻa o ka ʻohana. E pili ana i ka suicidality, ua mālama nā haumāna me SH i ka manaʻo suicidal a me nā hoʻolālā hoʻomake no lākou iho, a ua hōʻike ʻia i nā manaʻo suicidal o haʻi i ka honua maoli a ma ka pūnaewele. Hoʻohui ʻia, loaʻa paha iā lākou ke kaumaha a me kahi pae haʻahaʻa o ke kākoʻo kaiāulu a me ka hilinaʻi iā lākou iho, a me ka puhipaka, hōʻino ʻana i ka ʻalekohola, a me ka hoʻopili ʻana i ka pūnaewele.

Hōʻike ʻia nā hualoaʻa o ka loiloi loiloi reivariate logistic 2 Pūnaewele. ^ E Ha yM. Hoʻonui ka pae o ke kākoʻo kaiāulu ʻike a me ka manaʻo ponoʻī e pili ana i ka hoʻemi ʻana o ka hopena o ka SH i ka wā ʻōpiopio. Ua hōʻike ʻia kēia mau mea ʻelua i ke ʻano he mea palekana ia; kau mākou iā lākou ma hope i loko o ka loiloi loiloi loekele a hierarchical (3 Pūnaewele). E like me ia i hōʻikeʻia 3 Pūnaewele, ka pili pūnaewele a me ka hōʻike ʻana i nā manaʻo suicidal ma ka pūnaewele i pili nui i ka nui o ka makaʻu o SH, ma hope o ke kaohi ʻana no ke kāne, a me nā mea pili ʻohana, ka hōʻike ʻana i nā manaʻo suicidal i ke ola maoli, nā pilikino pilikino kikoʻī, a me ka suicidality like (Models I –IV). Ke hoʻololi nei no ka pae o ke kākoʻo kaiāulu i ʻike ʻia, ua noho mau nā loli ʻelua i mau pilikia nui no SH (Model V). Eia nō naʻe, nāwaliwali ka pilina ma waena o ka hoʻoweliweli pūnaewele a me SH a lilo i mea ʻole ma hope o ka hoʻoponopono ʻana no ka pae o ka hilinaʻi iā ʻoe iho (Model VI), ʻoiai ka pili ʻana o ka pūnaewele me nā manaʻo suicidal i pili nui i ka hoʻonui ʻia o ka pilikia o SH i nā ʻōpio (odds odds = 1.96; 95% manawa hilinaʻi: 1.06-3.64).

I ka hoʻohālikelike hou ʻana o nā pūʻulu o nā poʻe me SH e ʻike i nā ʻano o ka pili o ka SH e pili ana i nā mea hoʻohana pūnaewele ʻelua, ʻike mākou i ʻike nā haumāna e pili ana i nā manaʻo suicidal e pili ana i nā hana hou a SH a loaʻa iā lākou ka manaʻo hoʻomalu i ka manawa SH (4 Pūnaewele). Hoʻohālikelike ʻia me ko lākou mau hoa pili, ua nui aʻe nā haumāna me ka ʻikepili pūnaewele me ka manaʻo e make a manaʻo nei me ka kūkākūkā ʻana i nā pūnaewele pūnaewele e pili ana i nā ala hana (4 Pūnaewele).

ʻO kēia kahi o nā noiʻi kaiāulu mua i nā ʻōpio e noiʻi i ka hui ma waena o ka hōʻike ʻana i ka manaʻo suicidal i haʻi ʻia e nā poʻe ʻē aʻe, a me SH. Ua hōʻike ʻia nā hopena i hōʻike ʻia i ka hōʻike ʻana i nā manaʻo suicidal o haʻi i hoʻonui i ka likelika o ka lawena SH a ʻo ka ʻike maka ʻole ʻana ma ka pūnaewele ka mea nui o ka pilikia no SH.

ʻO ka 10.1% ākea o SH ma waena o nā ʻōpio Taiwanese i loaʻa i loko o ka makahiki i hala, ua kū like ia me nā hōʻike i hala mua o ka malama 12-malama mua o SH i nā wā ʻōpio (3.2-9.5%).²⁴ ʻO ka helu panapo o ka hoʻohui ʻāina pūnaewele i kā mākou papa noi ʻana i 17.1%, kahi mea like pū me nā helu i hōʻike ʻia mua o 18.8% ma ke kūkulu hema o Taiwan.¹¹ No nā ʻōpiopio i noiʻi ʻia, ua ʻike ʻia ʻo 3.3% i nā manaʻo suicidal ma ka pūnaewele i ka makahiki i hala. Ma muli o ka nele o kahi aʻo like ʻana o ke kaiāulu, ʻaʻole hiki iā mākou ke hoʻohālikelike i ko mākou mau hopena me kēia hopena. Eia nō naʻe, ke hōʻike nei ka pae i kā mākou papa noiʻi ʻana i kēia ʻike ʻole i waena o nā mea hoʻohana pūnaewele ʻōpio. Hāʻawi ʻia i ka pili o ka hoʻohana pūnaewele i kā mākou ola o kēlā me kēia lā, ʻo ka nui maoli o ka poʻe'ōpio i hōʻike ʻia i kēia pilikia hiki ke nui. Hāʻawi ka hana o ka pūnaewele pili i nā ʻenehana i nā manawa no ka launa pū ʻana e paʻa ʻole ʻia e nā palena kino pilikino a nānā ʻia e nā pākeke.²⁵ Hiki i nā kamaʻilio pūnaewele me ke kākoʻo kaiāulu koʻikoʻi no nā ʻōpio kaʻawale, akā hiki nō iā lākou ke hoʻokaʻawale a paipai i ka ʻano o SH.²⁶

Ua ʻimi kahi noiʻi i hala i ke ʻano o ka hoʻohālikelike kaiāulu i ka lawe ʻana i ke suicidality ma o nā hoa. ʻ suggestedlelo lākou i ka hopena o nā kumuwaiwai pili ʻole ʻohana o ka hōʻike ʻana i ka lawena suicidal o kekahi kanaka ma ke ʻano he koʻikoʻi e like me ka hopena o nā kumu ʻohana.⁷ I kā mākou noi ʻana, ua hōʻoia mākou i kā lākou hopena a loaʻa pū i ka hōʻike ʻana i nā manaʻo suicidal ʻē aʻe i hiki ke hoʻonui i ka makaʻi o ka SH ma nā ʻōpio. Ma hope o ka kaohi ʻana i nā ʻano mea like ʻole, ka likelihood o SH i ka poʻe i hōʻike ʻia i ka manaʻo suicidal mai nā poʻe ʻē aʻe i ke ola maoli, a mai ka pūnaewele hoʻi, hoʻonui ʻia e hoʻokahi pālua hoʻohālikelike ʻia me ka poʻe i hōʻike ʻole ʻia i loko o ka makahiki i hala. ʻO ka ʻike o ka hōʻike ʻana he mea nui ia no ka hana SH a nā ʻōpio, kūʻokoʻa i nā nāwaliwali e like me ke kaumaha a me kā lākou iho manaʻo ponoʻī suicidal. ʻO kēia hanana o ka "contagion kaiaulu" kahi mea i ʻike pinepine ʻia akā loaʻa mau i kahi pilikia no ka hōʻeha pilikino nonsuicidal i waena o nā ʻōpio.²⁷ Hōʻike pinepine ʻia nā ʻike hou ʻia e pili ana i kēia, inā ma nā ʻano e hoʻemi ʻia ai kēia pilikia.

Ma kā mākou papa noiʻi, ʻike mākou ua pili pū ka hoʻohui hoʻohui pūnaewele me SH i ka wā ʻōpiopio ma hope o ka hoʻoponopono ʻana i nā mea e ʻike ʻia ka mea e hoʻohilahila ʻia, e kūleʻa ana i ka loaʻa ʻana o kahi noiʻi mua e nānā ana i ka hui ʻana ma waena o ka hoʻopili pūnaewele a me ka hōʻino kūʻē i ka wā ʻōpio.²⁸ a hiki i ka pae ʻana o ka manaʻo pono ʻole i hōʻemi ʻia i kēia hui. Ua hōʻike ʻia i waena o nā poʻe ʻōpio me ka nānāʻole-deficit / hyperactivity maʻi, haʻahaʻa haʻahaʻa iho nei ma ka ʻike pono ʻana ma ka RSES ua pili nui pū kekahi i nā hōʻailona hoʻokaumaha pūnaewele ʻoi aku.²⁹ Inā pololei paha kēia ʻaha kanaka i waena o nā ʻōpio me ka ʻano hanana SH, ka hopena o ka palupalu ma waena o ka hoʻohui honua ʻana a me SH, pono e noiʻi hou.

Ua ʻike ʻia nā noiʻi mua i kekahi mau bio-psycho-social correlates o SH i nā ʻōpio.^{30, 31} Ke hōʻike nei ka hoʻāʻo ʻana no ka hoʻāʻo ʻana i ka hana ʻōpiopio ma Hong Kong a me ʻAmelika Huipū ʻia i ke kaumaha, ka wā a me ka manaʻo hoʻohanohano suicidal, ka manaʻolana, ka pilina ʻole interpersonal, a me ka hōʻike ʻana i nā ho'āʻo hoʻoliʻi a me ka hoʻopiʻi i nā mea pili i ka hoʻāʻo ʻana i ka pepehi ʻana ma nā moʻomeheu ʻelua.³² I kā mākou papa noiʻi, ua hoʻohālikelike nā hiʻohiʻona pilikino (ʻo ia hoʻi, ke kaumaha, ka manaʻo o ka manaʻo suicidal a me nā hoʻolālā hoʻomalu, ka hoʻokaumaha ʻana iā ʻoe iho, ka ulaula a me ka hoʻohana ʻana i ka waiʻona weliweli) pili pū me ka ʻōpio SH. ʻO ka pale ʻana o ka nohona i pale aku ai i ka hana ʻōpiopio SH, e hōʻike ana i nā ʻike o nā hōʻike ma mua.^{33, 34} ʻO ka manaʻo nui o kekahi mau hiʻohiʻona ʻohana, e like me ka noho ʻole ʻana me nā mākua ola ʻelua a me ka hoʻohemo ʻohana, ua nalowale ma hope o ka pale ʻana no nā pilikino pilikino a me nā hopena ʻē aʻe i loko o kā mākou hoʻohālike. Hōʻike kēia hopena i nā ʻōpio, ʻike ʻia ke kōkua kaiāulu mai nā ʻano like ʻole e uku i ko lākou pilikia mua ʻohana. Ua ʻike hou kēia mau ʻike āpau i ka mea nui o kahi hoʻolālā multidisciplinary i ka wā e kū nei mākou i ke ʻano ʻōpio e hana ana ma SH.

Ke hoʻonui ʻia i kahi ninaninau ʻana i nā ʻano o nā haumāna i hōʻike ʻia i nā manaʻo suicidal i hilinaʻi ʻia ma ka pūnaewele ma loko o ka papahana SH, ua ʻike kā mākou loiloi ua maʻalahi lākou i nā hana SH a makemake lākou e make. ʻOiai he ana mahele ʻāpana kēia, ʻaʻole hiki iā mākou ke hoʻoholo i ka pilina o ka hopena ma waena o ka hōʻike, ka nui o nā hana SH, a me ko lākou manaʻo hoʻomake. Ke hoʻomohala a hoʻoikaika nei paha nā ʻōpio i kā lākou manaʻo suicidal ma o ka hōʻike ʻana i nā manaʻo suicidal o haʻi, a hana i kā lākou SH ponoʻī. Eia kekahi, hiki i nā ʻōpio ke hoʻohana i ka pūnaewele ma nā ʻano ʻokoʻa i ka heluna lehulehu e pili ana i ka pepehi kanaka. Ua ana ʻia kahi noiʻi ma mua ma ka pūnaewele ʻenekini Google no nā huaʻōlelo pili i ke ola a ua hoʻopili ʻia i ka loaʻa a me ka ʻikepili hōʻeha ponoʻī. Ua ʻike lākou i ka hoʻopili maikaʻi ʻole ʻana o ka hana ʻimi pūnaewele me ka helu o ke ola ma ka lehulehu, ua hoʻopili maikaʻi ʻia me ka ʻehaʻeha ponoʻī a me ka hoʻopau ʻana i nā suicides i waena o nā ʻōpio.³⁵ I kā mākou noiʻi ʻana, ʻōpio nā ʻōpio me ka hoʻowalewale pūnaewele me ke kūkākūkā ʻana i ka pūnaewele me nā ʻano hana a lākou i hoʻohana ai iā SH. ʻO ka loaʻa o kēia mea hana ma ka lima hoʻokahi e hāʻawi i ke komo ʻana o ke kanaka i ka ʻikepili, akā, hiki nō paha iā ia ke kōkua i ka hoʻokō ʻana i ka make ʻana e nā ʻōpio ʻino.³⁶ Pono e nānā pono i nā ala o nā ʻōpio, nā mea hoʻohana pūnaewele hoʻohana pinepine ʻia i ka pūnaewele. Kau ʻia nā noi o nā kulekele media e pili ana i ka hoʻomake ʻana i ka pepehi ʻana i nā pūnaewele, no ka mea, e komo i nā pūnaewele kōkua pilikino no ka poʻe pepehi kanaka i manaʻo ʻia i nā mea hoʻohana ʻōpio.³⁶

E noʻonoʻo pono i kekahi mau palena o kā mākou aʻo ʻana. ʻAʻole maopopo i nā hōʻike i hāʻawi ʻia e kahi koleka hoʻolālā hoʻokaʻawale i ka loaʻa ʻana o kahi makemake. Hoʻokumu ʻia kā mākou ana unuhi i ka hōʻike ponoʻī ʻana iho, no laila he hanana hoʻokaʻina paha ka hōʻike. Hoʻokumu wale ʻia ka ʻike e pili ana i ka hana hōʻino hewa ʻana i hoʻokahi nīnau paʻa i kahi o kahi nīnau paʻa. ʻO ka hopena, ʻaʻole hiki ke hoʻohui ʻia kēia ʻano me ka ʻano o ka loiloi no ka hoʻoponopono ʻia. ʻOiai nā kaupalena, ko kā mākou aʻo ʻana ka mea mua e nānā ai i ka hui ʻana ma waena o ka hōʻike i ka manaʻo hoʻomanaki a me ka SH i kahi kaiāulu; ua hōʻoia nō mākou i ka hoʻouka pūnaewele a me ka ʻike pūnaewele ʻana o ka manaʻo suicidal i pili me SH i ka wā kamaliʻi; a e like me ka mea i kūkākūkā ʻia ma luna nei, ua kū like kā mākou mau ʻike i nā haʻawina mua ma ke ʻano.