This study found that although the hotline is based in Hangzhou, callers from the Young and middle-aged unemployed or jobless callers are spread across the country, indicating that the sample in this study can represent the situation of hotline callers nationwide. From the data in Table 1, we found that 62.8% of male callers are from other provinces, while the proportion of female callers from the local area (40%) is significantly higher than that of males (19.2%). This indirectly reflects the effective promotion and high visibility of the psychological assistance hotline in Hangzhou. Taking into account Hangzhou's economic and cultural development level, the overall living standards and level of education among women in Hangzhou are relatively higher compared to those from other provinces. Consequently, they are more likely to prioritize psychological issues and seek help at a relatively higher rate when faced with such problems. This study sheds light on another advantage of hotline telephone consultation from a different perspective, as it is not constrained by geographical or time limitations. It enables individuals in need to access psychological services remotely, promptly identifying potential callers with psychological issues and providing referral services to facilitate timely professional diagnosis and treatment.
Mental and psychological issues are the main topics of consultation for young and middle-aged unemployed individuals, similar to research findings abroad[8]. Studies have shown that unemployed individuals experience higher levels of distress and lower levels of happiness compared to those who are employed, significantly increasing the suffering of unemployed individuals[9]. In fact, mental and psychological disorders have ranked first in the overall burden of disease in China, accounting for approximately 20% and showing a growing trend. This demonstrates that as social competition intensifies, not only limited to the unemployed population, the psychological burden on humanity is increasing, and untreated psychological disorders can develop into serious mental illnesses. Considering that current hotline counselors in China are not medical professionals and most of them do not have qualifications in psychiatry, there is a relatively high number of callers seeking support for mental illnesses and depressive emotions. Therefore, hotlines need to provide mental health training for hotline counselors, especially in the area of common psychological issues related to unemployment. This training would help hotline counselors acquire basic knowledge, enhance their ability to discern potential psychological problems in callers, and promptly refer them to specialized institutions for services.
From the data presented in Table 1, it can be observed that males tend to call during the evening while females tend to call during the daytime. Generally, people are more inclined to call a mental health hotline when they are alone. Once the feeling of loneliness is disrupted, the hotline also stops receiving calls. The difference in the number of calls made by males and females during night shifts and day shifts may be related to differences in their alone time. The difference in alone time between males and females also reflects gender role differences. Furthermore, an interesting phenomenon was discovered: among the callers, the proportion of married women (20.4%) was significantly higher than that of men (9.9%), and the overall educational level of women was higher than that of men – the proportion of women with moderate educational level (40%) and higher educational level (45.8%) was higher than that of men (30.7% and 42.9% respectively), while the proportion of men with low educational level (26.4%) was significantly higher than that of women (14.3%). By comparing the data in Table 3, we can boldly speculate that marital status and educational level influence the mental health status of men and women. In fact, many studies have also confirmed this speculation. As the level of education increases, callers' social functioning and identity recognition improve, indicating that they have higher mental health literacy and a lower risk and severity of psychological problems. Additionally, previous research has shown that individuals with higher educational attainment often have partners with similar educational backgrounds, meaning that highly educated individuals are more likely to understand and empathize with each other[10].
Based on the relevant data in Table 2, it can be observed that women (11.5%) make more hotline calls on marriage and family topics compared to men (5.4%). This corresponds to the traditional cultural views of men's family roles. Over time, women have increasingly emphasized marriage and family relationships, while men have shown a greater need for achieving higher social status through work. This may also be a contributing factor to why men (5.9%) are more likely than women (3.2%) to focus on work-related issues. On the whole, men have a higher proportion of consultations for mental and psychological problems, sexual issues, and work-related problems, while women have a higher proportion for dating issues, marriage and family problems, child education, and interpersonal relationship problems. These disparities are related to the distinct gender roles of men and women in society and the family. The findings of this study align with the current situation in our country and emphasize the need to provide tailored services based on the specific concerns of individuals of different genders.
The data in Table 3 deviate somewhat from foreign research results. In China, the proportion of men with severe depression, suicidal ideation, suicidal plans, and suicidal behaviors is higher than that of women. Among high-risk groups, men also have a significantly higher proportion than women. The role of gender in the relationship between unemployment and mental health has been discussed in classical literature (Jahoda, 1982)[11]. Thus far, the results have remained inconclusive, with even meta-analyses yielding different conclusions. For instance, McKee-Ryan et al. (2005) [12]found that the mental health status of unemployed women was poorer, whereas Pau and Moser (2009) [13]found that men were more affected by unemployment than women. From a theoretical standpoint, personal consequences of unemployment should not be determined solely by gender. Instead, it is necessary to understand the differences between men and women in the family, labor market, and society from a structural perspective[14]. In summary, hotline counseling services in our country should be tailored to our specific circumstances and must not simply replicate foreign experiences. They should be developed based on our country's socioeconomic, political, and cultural background to provide targeted services that are relevant to our actual situation.
Our research has found that the proportion of phone calls made during the second half of the night is higher among young people compared to the other two groups. The proportion of high-risk incoming calls is also significantly higher during the second half of the night compared to daytime and the first half of the night. Callers making phone calls during the second half of the night tend to have poorer mental health, with higher levels of depressive symptoms and a higher likelihood of engaging in suicidal behaviors. Previous studies have suggested that during the early morning hours, individuals are more likely to feel a lack of social support, vulnerability, and despair. This can lead to catastrophic thinking and lower impulse control, increasing the risk of suicide[15]. Additionally, previous research has found a higher frequency of suicidal behavior during the early morning hours, which may be related to sleep disturbances as a risk factor for suicide. Insomnia can increase the risk of individuals waking up during a vulnerable time for suicide, thereby enhancing the overall suicide risk[16].
This study supports the aforementioned conclusions and further finds that young unemployed or jobless individuals who make phone calls during the second half of the night generally have poorer overall psychological well-being. They are more likely to experience severe depressive symptoms and a sense of hopelessness, both of which are high-risk factors for suicide. Moreover, the overall poor psychological well-being during the second half of the night prompts these individuals to seek support and assistance through hotlines during this time. The study suggests that interventions targeting sleep difficulties may help alleviate suicide risk, and it also highlights the need for hotline counselors to strengthen their assessment of the mental health status, particularly suicide risk, among late-night callers to prevent suicidal behavior.
In terms of educational attainment (Table 4), the majority of the youth group have higher education degrees (57.5%), while only 22.8% of the middle-aged group have high educational levels, with over 60% having a moderate education level. In the context of China's societal and cultural background, individuals with higher educational degrees often face greater expectations, consequently experiencing higher psychological pressures. Combined with the data in Table 6, the psychological well-being of the youth group and the young-middle-aged group is relatively poorer compared to the middle-aged group, indicating that adolescents and young adults subjectively perceive higher levels of stress than the middle-aged group. This could be attributed to their lack of social experience and poorer ability to regulate their mindset. It suggests that hotline counselors should provide guidance on simple and feasible psychological regulation skills when providing psychological support to this age group. Additionally, we found that the proportion of unmarried callers in the young-middle-aged group is as high as 61.4%. For the unemployed or jobless population, "marriage" serves as one of the sources of psychological stress.
This study also found that approximately 6.6% of young callers had a history of suicide attempts, and 0.5% of callers were engaged in suicidal behavior during the call. This indicates that young individuals (between 19 and 29 years old) in the unemployed or jobless population have a higher risk of suicide. This finding is consistent with research conducted on the Beijing Psychological Assistance Hotline, which showed that the suicide risk among the unemployed population was 1.46 times higher than the general population[17]. The higher suicide risk may be related to the suicide prevention function provided by the hotline[18]: Most callers reach out due to crisis situations. This underscores the importance of providing timely crisis intervention for young unemployed or jobless individuals who exhibit suicidal behavior. It is crucial for preventing and reducing suicides in this population. Currently, the hotline interventions in our country focus only on assessment and immediate emotional relief[19]. In the future, there is a need to expand the hotline's services to provide professional interventions specifically targeted at this group of young unemployed or jobless individuals.
In conclusion, unemployed or jobless young people are a high-risk group for mental health issues. Thus, ensuring appropriate services and support for this population should be a priority for policy-making, not only from an economic standpoint but also from a public health perspective.
The differences in counseling issues and mental health between different age groups primarily stem from economic and familial responsibilities and the roles played in identity development[20]. Overall, the psychological state of young unemployed or jobless individuals who contact hotlines is poor, particularly among those between 19 and 29 years old, males, and those who call during the late hours of the night. They exhibit higher levels of depression, lower levels of hope, and increased suicide risk. This study highlights the need to pay attention to the mental health of hotline callers from this group and to improve assessment and relevant interventions.
There are limitations in this study. Hotlines provide structured counseling services, which can limit the information collected and prevent the gathering of more individualized information about factors such as duration of unemployment, physical health status, and family economic status. Additionally, the study sample only included young unemployed or jobless callers to the hotline and may not represent the entire population of unemployed or jobless individuals.