Self-injury and suicidal ideation among Chinese adolescents involved in different subtypes of aggression: The role of gender.

BACKGROUND: Although aggression associated self-injury and suicidal ideation, but the specific impact of different subtypes of aggression is unclear. Therefore, the current study aims to quantify the associations between five subtypes of aggression, self-injury, and suicidal ideation in Chinese adolescents. METHOD: A total of 18,532 students were recruited in grades 7 to 12 using a stratified cluster sampling across five representative provinces in China. The Functional Assessment of Self-Mutilation (CH-FASM) and Buss and Warren's Aggression Questionnaire (BWAQ) assess self-injury and aggression, respectively. RESULTS: During the last year, the proportion of self-injury, suicidal ideation, and self-injury plus suicidal ideation (SSI) were 13.4 %, 10.0 %, 12.4 %, respectively. Multivariate logistic regression indicated that hostility was associated with self-injury-only (OR = 1.033, 95 % CI = 1.021-1.044), suicidal ideation-only (OR = 1.075, 95 % CI = 1.061-1.088), and SSI (OR = 1.100, 95 % CI = 1.087-1.114) (all P < 0.001) across five subtypes of aggression. In gender stratification, physical aggression was risk factor for self-injury-only, suicidal ideation-only, and SSI (OR = 1.028, 95 % CI = 1.018-1.037, P < 0.001) in females. While anger was association with self-injury-only and suicidal ideation-only in males (P < 0.05). LIMITATIONS: This study was a cross-sectional design and self-reported questionnaire. CONCLUSION: Hostility is a strong predictor of self-injury and suicidal ideation across five subtypes of aggression. There are gender differences in relationships. Prevention programs for adolescents' self-injury and suicidal ideation should consider different subtypes of aggression and gender differences.

Mobile phone addiction and suicide behaviors among Chinese adolescents: The mediation of poor sleep quality.

Background and aims: Mobile phone addiction (MPA) is emerging among adolescents, especially during the COVID-19 pandemic. Nevertheless, there is a dearth of knowledge regarding the correlation between MPA and suicide behaviors and its mechanism. The objective of the current study is exploring the direct effect of MPA on suicide behaviors and the indirect effect through poor sleep quality. Methods: A total of 18,900 Chinese adolescents aged 12 to 18 were recruited via a multi-stage cluster sampling method. Results: The prevalence of MPA and poor sleep quality was 26.2 and 23.1%, respectively. During the past year, 24.4% participants were involved in suicide behaviors. Specifically, suicide ideators, suicide planners, and suicide attempters were 10.7, 8.4, and 5.3%, respectively. Particularly, rural females had the highest prevalence of suicide behaviors, MPA, and poor sleep quality. Logistic regression analysis showed that MPA was significantly associated with suicide ideators (OR = 1.22, 95% CI: 1.09-1.37, p < 0.001) and planners (OR = 1.18, 95% CI: 1.04-1.34, p < 0.05), but not for suicide attempters (p > 0.05). Structural equation modelling demonstrated that MPA had direct effect on suicide behaviors (ß = 0.145, 95% CI = 0.127-0.160), and poor sleep quality partially mediated the relationship (the mediating ratio was 46.7%). The mediating ratio of poor sleep quality was the highest in urban males. Conclusions: MPA has both direct and indirect effects on suicide behaviors. For suicide prevention, limited mobile phone use and improvement sleep quality may be practical for adolescents. Additionally, more efforts of intervention could give priority to rural girls.

Specific and cumulative effects of childhood maltreatment on nonsuicidal self-injury in Chinese adolescents: The moderating effect of sleep disturbance.

BACKGROUND: Numerous studies have examined the relationship between childhood maltreatment (CM) and nonsuicidal self-injury (NSSI). However, few studies have explored both the specific and cumulative effects of CM on NSSI. Additionally, the impact of sleep disturbance on the association between CM and NSSI remains unclear. OBJECTIVES: To comprehensively explore the effects of CM on NSSI, and to determine whether these effects are moderated by sleep disturbance. PARTICIPANTS AND SETTING: A retrospective study was conducted in April 2021 among a representative sample of 21,340 students aged 11-20 years in China. METHODS: All participants completed questionnaires assessing CM, sleep disturbance, and NSSI. Adjusted multivariate logistic regression models were utilized to evaluate the associations between CM and NSSI, as well as the impact of sleep disturbance. RESULTS: The findings revealed that 13.0 % of adolescents reported occasional NSSI, while 25.2 % reported repetitive NSSI. Except for sexual abuse, all subtypes of CM were significantly associated with increased odds of both occasional and repetitive NSSI. A significant dose-response relationship was observed between cumulative CM and repetitive NSSI. Stratification analyses by sleep disturbance indicated that adolescents reporting sleep disturbance had a higher risk of developing repetitive NSSI, irrespective of the type of CM experienced. Furthermore, a dose-response relationship was identified between cumulative CM and repetitive NSSI among adolescents reporting sleep disturbance. CONCLUSION: This study demonstrated that CM increases the risk of NSSI among Chinese adolescents, and sleep disturbance plays a moderating role. Interventions targeting sleep disturbance may hold significance in reducing NSSI.

Specific effects of five subtypes of childhood maltreatment on suicide behaviours in Chinese adolescents: the moderating effect of sex and residence.

AIMS: Although childhood maltreatment has been widely supported to be a robust predictor of suicide behaviours, the effects of different childhood maltreatment subtypes remain controversial and inconclusive. Moreover, whether the effects differ by sex in urban and rural adolescents is still unknown. This study aimed to quantify the associations between five subtypes of childhood maltreatment and different suicide behaviour involvement. METHODS: A multistage cluster sampling method was adopted from April to December 2021 for adolescents aged 12 to 18 across five representative provinces of China. The Childhood Trauma Questionnaire-Short Form was used to measure childhood maltreatment subtypes. Suicide behaviour involvement was classified as none group, suicide ideator, suicide planner and suicide attempter. Confounding variables include demographic characteristics, smoking, drinking alcohol, depression and anxiety. RESULTS: Among a total of 18,980 adolescents, 2021 (10.6%) were suicide ideator, 1595 (8.4%) were suicide planner and 1014 (5.3%) were suicide attempter. Rural females had the highest proportion of suicide ideator (13.8%) and suicide planner (11.5%). Multinomial logistic regression analysis indicated that five childhood maltreatment subtypes were independently associated with suicide behaviours, except for associations between sexual abuse and suicide ideator as well as suicide planner (p > 0.05). Moreover, these associations differ by sex and residence. After adjusted for interactions of different subtypes, structural equation model indicated that the direct effects of childhood maltreatment subtypes on suicide behaviours from high to low were emotional abuse (ß = 0.363, p < 0.001), physical abuse (ß = 0.100, p < 0.001) and sexual abuse (ß = 0.033, p = 0.003), while the effects of physical neglect and emotional neglect were not significant (p > 0.05). CONCLUSIONS: Five subtypes of childhood maltreatment have specific and non-equivalence associations with suicide behaviours. Emotional abuse may have the strongest effect, and sexual abuse have an acute effect on suicide behaviours. Suicide prevention programs for Chinese adolescents could focus on those who experienced emotional, physical and sexual abuse. Furthermore, strategies should be tailored by sex and residence, and rural females deserve more attention.

Association between problematic smartphone use, chronotype and nonsuicidal self-injury among adolescents: A large-scale study in China.

BACKGROUND: Nonsuicidal self-injury (NSSI) is a serious public health and clinical problem, particularly for adolescents, and may link to problematic smartphone use (PSU) and chronotype. This study examines the independent and interaction effects of PSU and chronotype on NSSI among adolescents and identified gender differences in these associations. METHODS: A total of 21,357 students aged 11-19 were recruited using stratified cluster sampling across five representative provinces in China and completed standard questionnaires to record details of PSU, chronotype, and NSSI. RESULTS: A total of 38.1 % of students reported having engaged in NSSI and 17.7 % had PSU. PSU and chronotype were significantly associated with NSSI among adolescents, and this relationship was stronger in females. Interaction analysis indicated that E-type and PSU were interactively associated with increased risks of NSSI. CONCLUSION: The findings suggest that E-type and PSU can increase the risk of NSSI both independently and interactively. Therefore, they should be considered in intervention programs for NSSI, especially for females.

Psychometric properties and normative data of the childhood trauma questionnaire-short form in Chinese adolescents.

Background: The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a widely utilized instrument of childhood maltreatment (CM). However, psychometric properties and normative data of the CTQ-SF for Chinese adolescents are still unknown. Objective: To examine psychometric properties and normative data of Chinese version CTQ-SF in a nationally representative sample of Chinese adolescents, including internal consistency reliability, test-retest reliability, structural validity, and convergent validity. Method: A total of 20,951 adolescents aged 12 to 18 years were recruited from five provinces across China. Item analysis was used for 25 clinical items of the CTQ-SF. Confirmatory factor analysis was performed to examine fit indices of the factor structure. The Adverse Childhood Experiences Scale (ACEs) was used to evaluate convergent validity. The percentile ranks for scores of the CTQ-SF and each subscales were presented. Results: According to the results of three methods in Item analysis, Item 4 should be dropped. The remaining 24 clinical items achieved satisfactory fits in an alternative four-factor model. The alternative CTQ-SF showed acceptable internal consistency and the Cronbach's α of the four subscales was 0.824 (Neglect), 0.755 (Sexual Abuse), 0.713 (Physical Abuse), and 0.666 (Emotional Abuse), respectively. Besides, test-retest reliability and convergent validity of the alternative CTQ-SF were also acceptable. Conclusion: The alternative four-factor model CTQ-SF exhibits good reliability and validity among Chinese adolescents. Additionally, the normative information of the CTQ-SF could provide practical support for determining severity of different subtypes of CM.

Association between sexual orientation and high risk sexual behaviors among college students in Hubei Province / 中国学校卫生

Objective@#To examine the association between sexual orientation and high risk sexual behaviors and its sex differences among college students, so as to provide a theoretical basis for intervention and controlling of high risk sexual behaviors of the college students.@*Methods@#From November 2020 to May 2021, 1 920 college students among four universities in Hubei Province were recruited by multi stage stratified random cluster sampling, and their sexual orientation and the frequency of high risk sexual behaviors were investigated by a self designed questionnaire. And then analyzed the association between sexual orientation and high risk sexual behaviors and its sex differences by using Chi square test and Logistic regression analysis method.@*Results@#The prevalence of sexual behaviors was 18.2%, the prevalence of high risk sexual behaviors was 7.2%, and the prevalence of high risk sexual behaviors was higher among non heterosexuals(13.5%) than among heterosexuals (6.7%),the prevalence of high risk sexual behaviors was higher among males (9.2%) than among females(5.3%)，and the differences were statistically significant( χ 2=9.40, 10.77, P <0.01). Logistic regression analysis showed that the association between sexual orientation and high risk sexual behaviors was not statistically significant( OR=1.52, 95%CI=0.83-2.80, P >0.05). However, stratified analysis by sex revealed that among male students, the risk of high risk sexual behaviors was 3.57 times higher among non heterosexuals than among heterosexuals( OR= 3.57 , 95%CI=1.52-8.41, P <0.01), while among female students, the association between sexual orientation and high risk sexual behaviors was not statistically significant( OR=0.48, 95%CI=0.15-1.57, P >0.05).@*Conclusion@#There are sex differences in the relationship between sexual orientation and high risk sexual behaviors among college students. Male non-heterosexuals are at higher risk for high risk sexual behaviors than male heterosexuals. Therefore, prevention and interventions for high risk sexual behaviors among college students should focus on gay and bisexual men so as to reduce the occurance rate of their high risk sexual behaviors.

Relationship between adolescent parent attachment and attempted suicide among middle school students / 中国学校卫生

Objective@#To understand the current situation of suicide attempts in middle school students and to explore its relation with adolescent parent attachment, to provide a basis for the prevention and control of middle school students suicidal behavior.@*Methods@#A total of 4 419 students from grades 7 to 12 in Ezhou City and Xiaogan City, Hubei Province were selected by stratified cluster random sampling. The Inventory of Parent and Peer Attachment, Rosenberg Self Esteem Scale, Kessler Psychological Distress Scale were used to conduct a questionnaire Survey, and evaluated the suicide attempts of middle school students.@*Results@#The detection rate of attempted suicide among middle school students was 6.8%. The detection rate of attempted suicide varies among different grades, family types, parental relation, parenting style, family income, self esteem level, and psychological distress( χ 2/ t =3.88, 10.12, 18.00, 52.54, 13.90 , 2.37, 8.99, P <0.05). The scores of paternal attachment and maternal attachment ( 14.64 ±13.45, 14.77±12.26) in the group with attempted suicide were lower than those without attempted suicide(22.05±16.08, 23.79±14.93)( t =-9.07, -12.11, P <0.05). Logistic regression analysis showed that both paternal attachment and maternal attachment were associated with lower rate of suicide attempts among middle school students(paternal attachment, OR=0.99, 95%CI = 0.98 -0.99; maternal attachment OR=0.97, 95%CI =0.96-0.98), with paternal attachment for girls only( OR=0.98, 95%CI= 0.97 -0.99)(P <0.05).@*Conclusion@#Adolescent parent attachment may be a protective factor for middle school students suicide attempts. Sex specific effects are observed in adolescent father attachment in girls. Parents should pay attention to cultivating a good attachment relationship with their children and promote the healthy growth of middle school students.

Association between childhood physical abuse and suicidal behaviors among Chinese adolescents: The mediation of aggression.

BACKGROUND: Although previous studies have examined many predictors of suicidal behaviors. However, little is known for childhood physical abuse (CPA) and aggression, which are prevalent among adolescents. This study aimed to explore association between CPA and suicidal behaviors, and the potential mediating role of aggression. METHOD: A total of 16,111 students graded 7 to 12 were recruited using a stratified cluster sampling across five representative provinces in China. Conflict Tactics Scale-Parents to Child (CTS-PC) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure CPA and aggression, respectively. RESULTS: During the last year, 16.0 % of adolescents reported suicidal behaviors. Specifically, 7.9 % were suicide ideators, 4.6 % were planners, and 3.5 % were attempters. The prevalence of CPA in mild, moderate, and severe was 15.7 %, 26.9 %, and 4.4 %, respectively. Multinomial logistic regression indicated that moderate and severe CPA and overall aggression were associated with suicide ideators, planners, and attempters. In five sub-types of aggression, only hostility was significantly associated with all three suicidal behaviors. Structural equation modelling showed that aggression partially mediate the relationship between CPA and suicidal behaviors. The mediation proportion of overall aggression, physical aggression, verbal aggression, anger, hostility, and indirect aggression were 27.2 %, 22.4 %, 5.2 %, 14.2 %, 23.5 %, and 12.1 %, respectively. LIMITATIONS: Cross-sectional design, self-reported questionnaire, and no other forms of childhood maltreatment. CONCLUSIONS: CPA is a critical risk factor of suicidal behaviors among Chinese adolescents and aggression is a mediator between CPA and suicidal behaviors. Targeted suicide prevention should focus on those adolescents who report CPA and aggression, especially for hostility.

Sex differences in association between Internet addiction and aggression among adolescents aged 12 to 18 in mainland of China.

BACKGROUND: Previous studies have reported that Internet addiction (IA) is an important predictor of aggression. However, little is known whether aggression is a risk factor of IA. This study aims to explore whether IA can predict total and sub-types of aggression, whether aggression also can predict IA, and the potential sex difference. METHOD: A total of 15,977 adolescents aged 12 to 18 were recruited though a stratified cluster sampling across five representative provinces in mainland of China. Young's Internet Addiction Test (IAT) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure IA and aggression, respectively. RESULTS: The prevalence of IA and total aggression was 16.8 % and 25.0 %, respectively. Binary logistic regression analysis indicated that IAT score was significantly associated with total and five sub-types of aggression (P < 0.001). However, scores of physical aggression, hostility, and indirect aggression were positively associated with IA (P < 0.001), while verbal aggression and anger were not significant (P > 0.05). Moreover, the interaction of sex and IA was significant for aggression. Specifically, females with IA had higher risks of anger and indirect aggression but had lower risks of physical and verbal aggression compared to males with IA. LIMITATIONS: Cross-sectional design, self-reported information, and only Chinese rural adolescents. CONCLUSIONS: IA is a strong risk factor of total and five sub-types of aggression, while not all sub-types of aggression are predictors of IA. Prevention programs for adolescents' IA and aggression should consider different aggression sub-types and sex.

Interaction between Sirtuin 1 (SIRT1) polymorphisms and childhood maltreatment on aggression risk in Chinese male adolescents.

BACKGROUND: Aggressive behavior is a highly prevalent and serious public health problem among adolescents. However, the etiology and pathogenesis of aggressive behavior remain unclear. Childhood maltreatment is an acknowledged factor for aggressive behavior. SIRT1 is closely related to the occurrence and development of psychiatric disorders. We aimed to reveal the interactive effect between SIRT1 and childhood maltreatment on aggressive behavior among Chinese adolescents. METHODS: Aggressive behavior and childhood maltreatment were evaluated by the Buss and Warren's Aggression Questionnaire (BWAQ) and short form Childhood Trauma Questionnaire (CTQ-SF), respectively. This study comprised 436 aggression cases and 435 controls. Four SIRT1 tagSNPs were selected for genotyping. Interaction between SIRT1 and childhood maltreatment was estimated by logistic regression models. RESULTS: Individuals carrying SIRT1 rs4746720 minor allele and TAAC haplotype derived from SIRT1 variants was associated with reduced aggression risk when childhood maltreatment occurred (all P < 0.01). An antagonistic additive interaction between SIRT1 rs4746720 and childhood maltreatment on aggressive behavior (S = 0.421; 95%CI: 0.234 to 0.758) was further testified. No main effect of the SIRT1 SNPs or the haplotype block was observed (all P > 0.05). LIMITATIONS: Since participants were only males, our findings were unable to be directly extended to females. Cross-sectional design, self-reported measurements and limited sample size were adopted. CONCLUSION: This study provides the first evidence of SIRT1 × childhood maltreatment interaction on aggressive behavior in male adolescents. The minor allele of SIRT1 rs4746720 presents a protective effect on combination with childhood maltreatment on the risk of aggressive behavior.

Specific effects of neglect and physical abuse on adolescent aggressive behaviors by gender: A multicenter study in rural China.

BACKGROUND: Neglect and physical abuse may be typical risk factors for aggressive behavior in adolescents. However, findings on their specific effects and sex differences are still unclear. This study aimed to examine the specific effects of neglect and physical abuse on adolescent aggressive behaviors and to further explore the potential sex-specific effect. METHODS: A multicenter school-based survey was conducted in rural China. A total of 15,957 students aged 11-20 years completed self-report questionnaires to record aggressive behaviors, neglect and physical abuse, and other related information. Participants were grouped into those who experienced none, one of, or both neglect and physical abuse for statistical analyses. RESULTS: Of the participants, 37.0% experienced both neglect and physical abuse, 30.0% experienced neglect only, and 9.8% experienced physical abuse only. Higher risk for physical aggression (OR=1.24, 95% CI=1.06-1.45), and lower risk for verbal aggression (OR=0.83, 95% CI=0.72-0.94) and hostility (OR=0.81, 95% CI=0.69-0.94) were found in the physical abuse only group as compared to the neglect only group. No sex difference was found between neglect or physical abuse and general aggressive behaviors (P>0.05), except that females were more likely to exert physical aggression than males when exposed to neglect and physical abuse (P<0.05). LIMITATIONS: Cross-sectional design, retrospective self-report data, and not including other maltreatment subtypes. CONCLUSIONS: Neglect and physical abuse may each have distinct sensitivity for different subtypes of aggression. Targeted treatment for diverse aggressive symptoms is suggested, and strategies to prevent both neglect and physical abuse across gender would yield comprehensive benefits.

Association between childhood maltreatment and suicide among rural adolescents / 中国学校卫生

Objective@#This study explored the relationship between childhood maltreatment and adolescent suicide provides a scientific basis for suicide prevention strategies.@*Methods@#A total of 16 271 middle and high school students from rural areas in Anhui, Guangdong, Yunnan, Heilongjiang and Hubei provinces were enrolled through multi stage stratified cluster random sampling. Structured questionnaires were used to collect information on participants general information, childhood neglect, abuse, suicide ideation, suicide plans and suicide attempts in the 12 months prior to the survey. Multivariate Logistic regression models were used to analyze the associations of childhood neglect and childhood maltreatment with suicide ideation, suicide plans and suicide attempts.@*Results@#The number of suicide ideations, suicide plans and suicide attempts among rural adolescents were 2 453( 15.1 %), 1 164(7.2%) and 572(3.5%), respectively. The number of cases of childhood neglect, moderate physical abuse and severe physical abuse were 10 756(66.1%), 4 311(26.5%) and 703(4.3%), respectively. Univariate analysis showed that childhood neglect and abuse were significantly associated with suicide ideation, suicide plans and suicide attempts( P <0.05). After controlling for age, gender, only children, parental education level, income, emotional management and social support, childhood neglect and abuse remained significantly correlated with suicide ideation, suicide plans and suicide attempts( OR =1.62-5.14, P <0.05); the OR(OR 95%CI) for severe physical abuse were 3.00(2.49-3.62), 3.52(2.81-4.40),5.14(3.87-6.83) respectively.@*Conclusion@#Childhood neglect and abuse may increase the risk of suicide among adolescents in rural China, and effective measures should be taken to reduce childhood neglect and abuse and prevent suicide.

Self-Harm, Suicidal Ideation, and Suicide Attempts in Chinese Adolescents Involved in Different Sub-types of Bullying: A Cross-Sectional Study.

Background: Bullying tends to peak during adolescence, and it is an important risk factor of self-harm and suicide. However, research on the specific effect of different sub-types of bullying is limited. Objective: The purpose of this study is to examine the associations between four common forms of bullying (verbal, physical, relational, and cyber) and self-harm, suicidal ideation (SI), and suicide attempts (SA). Method: This was a cross-sectional study of a sample including 4,241 Chinese students (55.8% boys) aged 11 to 18 years. Bullying involvement, self-harm, SI, and SA were measured via The Juvenile Campus Violence Questionnaire (JCVQ). The association was examined through multinomial logistic regression analysis, adjusted for demographic characteristics and psychological distress. Results: Bullying victimization and perpetration were reported by 18.0 and 10.7% of participants. The prevalence of self-harm, SI, and SA were 11.8, 11.8, and 7.1%, respectively. Relational bullying victimization and perpetration were significantly associated with SI only, SI plus self-harm, and SA. Physical bullying victimization and perpetration were risk factors of self-harm only and SA. Verbal victimization was significantly associated with SI only. Cyber perpetration was a risk factor of SA. Conclusions: The findings highlight the different effects of sub-types of bullying on self-harm and suicidal risk. Anti-bullying intervention and suicide prevention efforts should be prior to adolescents who are involved in physical and relational bullying.