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.
AikenM. (2017). The cyber effect: A pioneering cyber-psychologist explains how human behavior changes online. Spiegel & Grau.
2.
BabissL. A.GangwischJ. 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
3.
Centre for Suicide Research and Prevention. (2025). Statistics of suicide data in Hong Kong (by year). CSRP, The University of Hong Kong.
4.
ChanM.LiT. M. H.LawY. W.WongP. W. C.ChauM.ChengC.FuK. W.Bacon-ShoneJ.ChengQ. E.YipP. S. F. (2017). Engagement of vulnerable youths using internet platforms. PLoS One, 12(12), Article e0189023. https://doi.org/10.1371/journal.pone.0189023
5.
ChangQ.YipP. S.ChenY. 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
6.
ChenC. Y.YehH. H.HuangN.LinY. 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
7.
CheungY. T.WongP. W.LeeA. M.LamT. H.FanY. S.YipP. 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
8.
ChouK. 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
CohenJ. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum.
11.
ConnellR. W.MesserschmidtJ. W. (2005). Hegemonic masculinity: Rethinking the concept. Gender & Society, 19(6), 829–859. https://doi.org/10.1177/0891243205278639
12.
de VriesJ. D.van HooffM. L. M.GeurtsS. A. E.KompierM. 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.
DonkerA.de BoerH.KostonsD.Dignath-van EwijkC.van der WerfM. (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.
DuncansonC. (2015). Hegemonic masculinity and the possibility of change in gender relations. Men & Masculinities, 18(2), 231–248. https://doi.org/10.1177/1097184X15584912
15.
FuK. W.LiuK. Y.YipP. 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.
GriffinL.HoskingW.GillP. R.ShearsonK.IveyG.SharplesJ. (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.
GriffithD. M.GunterK.WatkinsD. 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.
HaagsmaJ. A.GraetzN.BolligerI.NaghaviM.HigashiH.MullanyE. C.AmehE. 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.
HoP. S. Y.JacksonS.LamJ. 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
IwamotoD. K.BradyJ.KayaA.ParkA. (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.
JordanA.ChandlerA. (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.
KlikaB.JordanC. (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
LawY. W.KwokC. L.ChanP. Y.ChanM.YipP. (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.
LiZ.DanielS.FujiokaK.UmashankerD. (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.
LokR. H. T.LawY. 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.
LundinA.HallgrenM.TheobaldH.HellgrenC.TorgénM. (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.
MannJ. J.MichelC. A.AuerbachR. 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 MirandaD.da Silva AthanasioB.Sena OliveiraA. C.Simoes-E-SilvaA. 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.
MifflinM. D.St JeorS. T.HillL. A.ScottB. J.DaughertyS. A.KohY. 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
Miranda-MendizabalA.CastellvíP.Parés-BadellO.AlayoI.AlmenaraJ.AlonsoI.BlascoM. J.CebriàA.GabilondoA.GiliM.LagaresC.PiquerasJ. A.Rodríguez-JiménezT.Rodríguez-MarínJ.RocaM.Soto-SanzV.VilagutG.AlonsoJ. (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-LeimkühlerA. 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-LeimkühlerA. 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.
MonteiroA. G.AlvenoD. A.PradoM.MonteiroG. D. A.UgrinowitschC.AokiM. S.PiçarroI. D. C. (2008). Acute physiological responses to different circuit training protocols. Journal of Sports Medicine & Physical Fitness, 48(4), Article 438.
37.
PirkisJ.SpittalM. J.KeoghL.MousaferiadisT.CurrierD. (2017). Masculinity and suicidal thinking. Social Psychiatry & Psychiatric Epidemiology, 52, 319–327. https://doi.org/10.1007/s00127-016-1324-2
38.
RadovicA.GmelinT.SteinB. D.MillerE. (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.
RajkumarR. 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
RhodesA. E.BoyleM. H.BridgeJ. A.SinyorM.LinksP. S.TonmyrL.SkinnerR.BethellJ. M.CarlisleC.GooddayS.HottesT. S.NewtonA.BennettK.SundarP.CheungA. H.SzatmariP. (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.
RiceS.OliffeJ.SeidlerZ.BorschmannR.PirkisJ.ReavleyN.PattonG. (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.
RochelleT. 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.
RochelleT. L.YimK. 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.
RyanR. M.DeciE. 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.
SchlichthorstM.KingK.ReifelsL.PhelpsA.PirkisJ. (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.
ShelefL. (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
TamH. C.KwanC. (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.
TangS.ReilyN. M.ArenaA. F.SheanodaV.HanJ.DraperB.BatterhamP. J.MackinnonA. J.ChristensenH. (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
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.
TsangG. 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.
TylerR. E.WilliamsS. (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.
VancampfortD.HallgrenM.FirthJ.RosenbaumS.SchuchF. B.MugishaJ.ProbstM.Van DammeT.CarvalhoA. F.StubbsB. (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.
WangC. K. J.SunY.LiuW. C.YaoJ. (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
WongD. F. K.CheungY. C. H.HuangY.-T.TamC. H. L.ChanW. M. H.YeungK. 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
YipP. S. F.CheungY. 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.
ZhangY.YipP. S. F.ChangS. S.WongP. W. C.LawF. 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.
ZhongB. (2009). How to calculate sample size in randomized controlled trial?Journal of Thoracic Disease, 1(1), 51–54.
