Competency-Based Training for Young Men with Suicide Risk: A Randomized Waitlist-Controlled Trial

Abstract

Purpose: Traditional masculine norms of self-reliance and emotional restraint deter help-seeking, contributing to higher suicide rates in men. Young men online adhering to these norms face elevated risk, worsened by negative digital experiences. Interventions emphasizing masculine-valued physical competency may aid suicide prevention. Methods: A two-arm, four-wave randomized waitlist-controlled trial recruited men aged 17–30 at suicide risk from online forums. Participants received either online social work (OSW) alone or OSW with a three-month competency-based physical training module (CbM) involving high-intensity circuit training. Outcomes were tracked for five months. Results: The CbM group showed significant, lasting gains in self-esteem, physical self-perception, and sport engagement. Suicidal ideation stabilized, with a 95% higher likelihood of improvement versus controls. Perceived physical mastery, not objective fitness, appeared key to mental health benefits. Competency-based physical training module also showed higher engagement. Conclusions: Combining competency-based physical training with OSW provides a scalable, gender-sensitive approach to reducing suicide risk among young men.

Keywords

physical competency societal masculinity young men suicide ideation online social work

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References

Aiken

(2017). The cyber effect: A pioneering cyber-psychologist explains how human behavior changes online. Spiegel & Grau.

Babiss

L. A.

Gangwisch

J. E.

(2009). Sports participation as a protective factor against depression and suicidal ideation in adolescents as mediated by self-esteem and social support. Journal of Developmental & Behavioral Pediatrics, 30(5), 376–384. https://doi.org/10.1097/DBP.0b013e3181b33659

Centre for Suicide Research and Prevention. (2025). Statistics of suicide data in Hong Kong (by year). CSRP, The University of Hong Kong.

Chan

T. M. H.

Law

Y. W.

Wong

P. W. C.

Chau

Cheng

K. W.

Bacon-Shone

Cheng

Q. E.

Yip

P. S. F.

(2017). Engagement of vulnerable youths using internet platforms. PLoS One, 12(12), Article e0189023. https://doi.org/10.1371/journal.pone.0189023

Chang

Yip

P. S.

Chen

Y. Y.

(2019). Gender inequality and suicide gender ratios in the world. Journal of Affective Disorders, 243, 297–304. https://doi.org/10.1016/j.jad.2018.09.032

Chen

C. Y.

Yeh

H. H.

Huang

Lin

Y. C.

(2014). Socioeconomic and clinical characteristics associated with repeat suicide attempts among young people. Journal of Adolescent Health, 54(5), 550–557. https://doi.org/10.1016/j.jadohealth.2013.10.008

Cheung

Y. T.

Wong

P. W.

Lee

A. M.

Lam

T. H.

Fan

Y. S.

Yip

P. S.

(2013). Non-suicidal self-injury and suicidal behavior: Prevalence, co-occurrence, and correlates of suicide among adolescents in Hong Kong. Social Psychiatry & Psychiatric Epidemiology, 48, 1133–1144. https://doi.org/10.1007/s00127-012-0640-4

Chou

K. L.

(2000). Assessing Chinese adolescents’ social support: The Multidimensional Scale of Perceived Social Support. Personality & Individual Differences, 28(2), 299–307. https://doi.org/10.1016/S0191-8869(99)00098-7

Cleary

(2012). Suicidal action, emotional expression, and the performance of masculinities. Social Science & Medicine, 74(4), 498–505. https://doi.org/10.1016/j.socscimed.2011.08.002

10.

Cohen

(1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum.

11.

Connell

R. W.

Messerschmidt

J. W.

(2005). Hegemonic masculinity: Rethinking the concept. Gender & Society, 19(6), 829–859. https://doi.org/10.1177/0891243205278639

12.

de Vries

J. D.

van Hooff

M. L. M.

Geurts

S. A. E.

Kompier

M. A. J.

(2018). Trajectories of well-being during an exercise randomized controlled trial: The role of exposure and exercise experiences. Stress and Health, 34(1), 24–35. https://doi.org/10.1002/smi.2758

13.

Donker

de Boer

Kostons

Dignath-van Ewijk

van der Werf

(2014). Effectiveness of learning strategy instruction on academic performance: A meta-analysis. Educational Research Review, 11, 1–26. https://doi.org/10.1016/j.edurev.2013.11.002

14.

Duncanson

(2015). Hegemonic masculinity and the possibility of change in gender relations. Men & Masculinities, 18(2), 231–248. https://doi.org/10.1177/1097184X15584912

15.

K. W.

Liu

K. Y.

Yip

P. S.

(2007). Predictive validity of the Chinese version of the Adult Suicidal Ideation Questionnaire: Psychometric properties and its short version. Psychological Assessment, 19(4), 422–429. https://doi.org/10.1037/1040-3590.19.4.422

16.

Griffin

Hosking

Gill

P. R.

Shearson

Ivey

Sharples

(2022). The gender paradox: Understanding the role of masculinity in suicidal ideation. American Journal of Men’s Health, 16(5). https://doi.org/10.1177/15579883221123853

17.

Griffith

D. M.

Gunter

Watkins

D. C.

(2012). Measuring masculinity in research on Men of Color: Findings and future directions. American Journal of Public Health, 102(Suppl.2), S187–S194. https://doi.org/10.2105/AJPH.2012.300715

18.

Haagsma

J. A.

Graetz

Bolliger

Naghavi

Higashi

Mullany

E. C.

Ameh

E. A.

(2016). The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013. Injury Prevention, 22(1), 3–18. https://doi.org/10.1136/injuryprev-2015-041616

19.

P. S. Y.

Jackson

Lam

J. R.

(2018). Talking politics, performing masculinities: Stories of Hong Kong men before and after the Umbrella movement. Sex Roles, 79(9), 533–548. https://doi.org/10.1007/s11199-017-0887-z

20.

Hong Kong Census and Statistics Department. (2024). Thematic household survey report no . 80: Internet and Personal Computer Penetration . Retrieved March 24, 2026, from https://www.censtatd.gov.hk/en/wbr.html?ecode=B11302012024XX02&scode=590

21.

Iwamoto

D. K.

Brady

Kaya

Park

(2018). Masculinity and depression: A longitudinal investigation of multidimensional masculine norms among college men. American Journal of Men’s Health, 12(6), 1873–1881. https://doi.org/10.1177/1557988318785549

22.

Jordan

Chandler

(2019). Crisis, what crisis? A feminist analysis of discourse on masculinities and suicide. Journal of Gender Studies, 28(4), 462–474. https://doi.org/10.1080/09589236.2018.1510306

23.

Klika

Jordan

(2013). High-intensity circuit training using body weight: Maximum results with minimal investment. ACSM’s Health & Fitness Journal, 17(3), 8–13. https://doi.org/10.1249/FIT.0b013e31828cb1e8

24.

Knipe

Padmanathan

Newton-Howes

Chan

L. F.

Kapur

N. K.

(2022). Suicide and self-harm. The Lancet, 399(10338), 1903–1916. https://doi.org/10.1016/S0140-6736(22)00173-8

25.

Law

Y. W.

Kwok

C. L.

Chan

P. Y.

Chan

Yip

(2019). Online social work engagement and empowerment for young internet users: A quasi-experiment. Journal of Affective Disorders, 250, 99–107. https://doi.org/10.1016/j.jad.2019.02.061

26.

Daniel

Fujioka

Umashanker

(2023). Obesity among Asian American people in the United States: A review. Obesity, 31(2), 316–328. https://doi.org/10.1002/oby.23639

27.

Lok

R. H. T.

Law

Y. W.

(2025). Men's mental health service engagement amidst the masculinity crisis: Towards a reconstruction of traditional masculinity. SSM – Qualitative Research in Health, 8, Article 100596. https://doi.org/10.1016/j.ssmqr.2025.100596

28.

Lundin

Hallgren

Theobald

Hellgren

Torgén

(2016). Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population. Public Health, 136, 66–74. https://doi.org/10.1016/j.puhe.2016.03.005

29.

Mann

J. J.

Michel

C. A.

Auerbach

R. P.

(2021). Improving suicide prevention through evidence-based strategies: A systematic review. American Journal of Psychiatry, 178(7), 611–624. https://doi.org/10.1176/appi.ajp.2020.20060864

30.

Marques de Miranda

da Silva Athanasio

Sena Oliveira

A. C.

Simoes-E-Silva

A. C.

(2020). How is COVID 19 pandemic impacting mental health of children and adolescents? International Journal of Disaster Risk Reduction, 51, Article 101845. https://doi.org/10.1016/j.ijdrr.2020.101845

31.

Mifflin

M. D.

St Jeor

S. T.

Hill

L. A.

Scott

B. J.

Daugherty

S. A.

Koh

Y. O.

(1990). A new predictive equation for resting energy expenditure in healthy individuals. The American Journal of Clinical Nutrition, 51(2), 241–247. https://doi.org/10.1093/ajcn/51.2.241

32.

Mikkelsen

Stojanovska

Polenakovic

Bosevski

Apostolopoulos

(2017). Exercise and mental health. Maturitas, 106, 48–56. https://doi.org/10.1016/j.maturitas.2017.09.003

33.

Miranda-Mendizabal

Castellví

Parés-Badell

Alayo

Almenara

Alonso

Blasco

M. J.

Cebrià

Gabilondo

Gili

Lagares

Piqueras

J. A.

Rodríguez-Jiménez

Rodríguez-Marín

Roca

Soto-Sanz

Vilagut

Alonso

(2019). Gender differences in suicidal behavior in adolescents and young adults: Systematic review and meta-analysis of longitudinal studies. International Journal of Public Health, 64(2), 265–283. https://doi.org/10.1007/s00038-018-1196-1

34.

Möller-Leimkühler

A. M.

(2002). Barriers to help-seeking by men: A review of sociocultural and clinical literature with particular reference to depression. Journal of Affective Disorders, 71(1–3), 1–9. https://doi.org/10.1016/S0165-0327(01)00379-2

35.

Möller-Leimkühler

A. M.

(2003). The gender gap in suicide and premature death or: Why are men so vulnerable? European Archives Psychiatry and Clinical Neuroscience, 253(1), 1–8. https://doi.org/10.1007/s00406-003-0397-6

36.

Monteiro

A. G.

Alveno

D. A.

Prado

Monteiro

G. D. A.

Ugrinowitsch

Aoki

M. S.

Piçarro

I. D. C.

(2008). Acute physiological responses to different circuit training protocols. Journal of Sports Medicine & Physical Fitness, 48(4), Article 438.

37.

Pirkis

Spittal

M. J.

Keogh

Mousaferiadis

Currier

(2017). Masculinity and suicidal thinking. Social Psychiatry & Psychiatric Epidemiology, 52, 319–327. https://doi.org/10.1007/s00127-016-1324-2

38.

Radovic

Gmelin

Stein

B. D.

Miller

(2017). Depressed adolescents’ positive and negative use of social media. Journal of Adolescence, 55(1), 5–15. https://doi.org/10.1016/j.adolescence.2016.12.002

39.

Rajkumar

R. P.

(2020). COVID-19 and mental health: A review of the existing literature. Asian Journal of Psychiatry, 52, Article 102066. https://doi.org/10.1016/j.ajp.2020.102066

40.

Raven

Pels

(2021). Why feeling competent matters. German Journal of Exercise and Sport Research, 51, 371–377. https://doi.org/10.1007/s12662-021-00731-9

41.

Rhodes

A. E.

Boyle

M. H.

Bridge

J. A.

Sinyor

Links

P. S.

Tonmyr

Skinner

Bethell

J. M.

Carlisle

Goodday

Hottes

T. S.

Newton

Bennett

Sundar

Cheung

A. H.

Szatmari

(2014). Antecedents and sex/gender differences in youth suicidal behavior. World Journal of Psychiatry, 4(4), Article 120. https://doi.org/10.5498/wjp.v4.i4.120

42.

Rice

Oliffe

Seidler

Borschmann

Pirkis

Reavley

Patton

(2021). Gender norms and the mental health of boys and young men. The Lancet Public Health, 6(8), e541–e544. https://doi.org/10.1016/S2468-2667(21)00138-9

43.

Rochelle

T. L.

(2019). Cross-cultural differences in the relationship between conformity to masculine norms and health behaviour among men in Hong Kong. British Journal of Health Psychology, 24(1), 159–174. https://doi.org/10.1111/bjhp.12345

44.

Rochelle

T. L.

Yim

K. H.

(2015). Assessing the factor structure of the Chinese Conformity to Masculine Norms Inventory. The Journal of Psychology, 149(1), 29–41. https://doi.org/10.1080/00223980.2013.837023

45.

Ryan

R. M.

Deci

E. L.

(2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68

46.

Schlichthorst

King

Reifels

Phelps

Pirkis

(2019). Using social media networks to engage men in conversations on masculinity and suicide: Content analysis of Man Up Facebook Campaign Data. Social Media & Society, 5(4). https://doi.org/10.1177/2056305119880019

47.

Shelef

(2021). The gender paradox: Do men differ from women in suicidal behavior?. Journal of Men’s Health, 17(4), 22–29. https://doi.org/10.31083/jomh.2021.099

48.

Social Welfare Department. (2026). Cyber youth support teams. https://www.swd.gov.hk/en/pubsvc/young/cat_young/cyber_hotline/cyberyouth/

49.

Struszczyk

Galdas

P. M.

Tiffin

P. A.

(2019). Men and suicide prevention: A scoping review. Journal of Mental Health, 28(1), 80–88. https://doi.org/10.1080/09638237.2017.1370638

50.

Tam

H. C.

Kwan

(2024). What do we know about men and masculinities in Hong Kong? A scoping review and content analysis. The Journal of Men’s Studies, 32(3), 503–529. https://doi.org/10.1177/10608265241241445

51.

Tang

Reily

N. M.

Arena

A. F.

Sheanoda

Han

Draper

Batterham

P. J.

Mackinnon

A. J.

Christensen

(2022). Predictors of not receiving mental health services among people at risk of suicide: A systematic review. Journal of Affective Disorders, 301, 172–188. https://doi.org/10.1016/j.jad.2022.01.054

52.

Thapar

Eyre

Patel

Brent

(2022). Depression in young people. The Lancet, 400(10352), 617–631. https://doi.org/10.1016/S0140-6736(22)01012-1

53.

The Government of Hong Kong Special Administrative Region. (2022, December 29). Press release on Government adjusts local anti-epidemic measures. The Government of the Hong Kong Special Administrative Region. https://www.info.gov.hk/gia/general/202212/29/P2022122900035.htm

54.

Tsang

G. F.

(2020). Parochial apolitical formulation: Hong Kong internetization and the sexualizing cyberspace of the storytelling channels of the golden forum and the LIHKG forum. Sungkyun Journal of East Asian Studies, 20(1), 61–82.

55.

Tyler

R. E.

Williams

(2014). Masculinity in young men’s health: Exploring health, help-seeking and health service use in an online environment. Journal of Health Psychology, 19(4), 457–470. https://doi.org/10.1177/1359105312473784

56.

Vancampfort

Hallgren

Firth

Rosenbaum

Schuch

F. B.

Mugisha

Probst

Van Damme

Carvalho

A. F.

Stubbs

(2018). Physical activity and suicidal ideation: A systematic review and meta-analysis. Journal of Affective Disorders, 225, 438–448. https://doi.org/10.1016/j.jad.2017.08.070

57.

Wang

C. K. J.

Sun

Liu

W. C.

Yao

(2015). Latent profile analysis of the physical self-description among Chinese adolescents. Current Psychology, 34(2), 282–293. https://doi.org/10.1007/s12144-014-9257-y

58.

Wojnicka

(2021). Men and masculinities in times of crisis: Between care and protection. NORMA, 16(1), 1–5. https://doi.org/10.1080/18902138.2021.1885860

59.

Wong

D. F. K.

Cheung

Y. C. H.

Huang

Y.-T.

Tam

C. H. L.

Chan

W. M. H.

Yeung

K. K. W.

(2022). Quasi-experimental study comparing CBT, MBCT, activity-based supportive counselling for Hong Kong delinquent youth. Research on Social Work Practice, 32(5), 567–582. https://doi.org/10.1177/10497315221077651

60.

World Health Organization. (2021). Suicide worldwide in 2021: Global health estimates. https://www.who.int/publications/i/item/9789240110069

61.

Yip

P. S. F.

Cheung

Y. B.

(2006). Quick assessment of hopelessness: A cross-sectional study. Health & Quality of Life Outcomes, 4, Article 13. https://doi.org/10.1186/1477-7525-4-13

62.

Zhang

Yip

P. S. F.

Chang

S. S.

Wong

P. W. C.

Law

F. Y. W.

(2015). Association between changes in risk factor status and suicidal ideation incidence and recovery. Crisis, 36(6). https://doi.org/10.1027/0227-5910/a000343

63.

Zhong

(2009). How to calculate sample size in randomized controlled trial? Journal of Thoracic Disease, 1(1), 51–54.