Association of interaction between mental health literacy and non-suicidal self-injury with suicidal behaviors among middle school students: a cross- sectional survey in three China cities
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摘要:
目的 探讨中学生心理健康素养和非自杀性自伤行为的交互作用与自杀相关行为的关联。 方法 于2020年10月 — 2021年6月,采用多阶段整群抽样方法,抽取北京、广东省阳江市、河南省郑州市3个城市16853名在校中学生,使用《青少年心理健康素养量表》、《青少年非自杀性自伤行为评定问卷》等进行自填式问卷调查,建立多因素logistic回归模型分析心理健康素养和非自杀性自伤行为与自杀相关行为的关联。 结果 中学生自杀意念、自杀计划和自杀未遂检出率分别为31.3 %、16.3 %和7.5 %,非自杀性自伤行为检出率为28.9 %。多因素logistic回归分析结果显示,不具备心理健康素养和非自杀性自伤行为是中学生自杀意念、自杀计划、自杀未遂的危险因素。并且心理健康素养和非自杀性自伤行为对自杀相关行为存在相加交互作用和相乘交互作用。 结论 中学生自杀相关行为检出率较高,不具备心理健康素养和非自杀性自伤行为是自杀相关行为的危险因素,两者联合作用时可显著增加自杀相关行为的发生。 Abstract:Objective To investigate the association of interaction between mental health literacy (MHL) and non-suicidal self-injury (NSSI) with suicidal behaviors among middle school students in China. Methods With multistage cluster sampling, totally 17 000 students were recruited from 39 middle schools in three China cities (Beijing, Zhengzhou of Henan province, and Yangjiang of Guangdong province) for self-administered anonymous survey during October 2020 – June 2021. Two scales compiled by Chinese researchers (Adolescent Mental Health Literacy Assessment Questionnaire [AMHLAQ] and Adolescent Non-suicidal Self-injury Assessment Questionnaire [ANSAQ] and a self- designed questionnaire were adopted in the survey. Multivariate logistic regression model was used to explore the association of interaction between MHL and NNSI with suicidal behavior in the students. Results Among the 16 853 students with valid responses, 31.3%, 16.3% and 7.5% reported ever having suicidal ideation, plan and attempt during past one year and the overall self-reported rate of NSSI was 28.9%. Multivariate logistic regression analyses revealed that inadequate MHL and NSSI are risk factors for suicidal ideation, plan and attempt. Furthermore, MHL and NSSI could exert an additive or multiplicative interactive effect on suicidal-related behaviors. Conclusion Among middle school students in China, suicidal-related behaviors is relatively prevalent and inadequate MHL and NSSI are risk factors for suicidal ideation, suicidal plan and suicidal attempt; the interaction between the two risk factors could increase the risk of suicide-related behaviors. -
表 1 不同特征中学生自杀相关行为检出率比较
特征 调查人数 自杀意念 自杀计划 自杀未遂 例数 % χ2 值 例数 % χ2 值 例数 % χ2 值 性别 171.79 a 80.63 a 49.63 a 男性 8 390 2 233 26.62 1 149 13.69 507 6.04 女性 8 463 3 045 35.98 1 591 18.80 753 8.90 年级 23.03 a 78.00 a 79.54 a 初中 9 235 3 036 32.87 1 712 18.54 842 9.12 高中 7 618 2 242 29.43 1 028 13.49 418 5.49 家庭所在地 0.40 1.39 2.98 农村 5 905 1 800 30.48 917 15.53 462 7.82 城市 11 048 3 478 31.48 1 823 16.50 798 7.22 独生子女 8.33 a 1.35 1.12 是 5 710 1 706 29.88 902 15.80 444 7.78 否 11 143 3 572 32.06 1 838 16.49 816 7.32 父亲文化程度 18.32 a 12.23 a 9.23 a 高中以下 8 041 2 647 32.92 1 391 17.30 653 8.12 高中及以上 8 812 2 631 29.86 1 349 15.31 607 6.89 母亲文化程度 2.42 3.23 3.29 高中以下 8 574 2 732 31.86 1 473 17.18 672 7.84 高中及以上 8 279 2 546 30.75 1 303 15.74 588 7.10 自评家庭经济状况 131.44 a 135.51 a 71.45 a 较差 2 119 892 42.10 527 24.87 252 11.89 一般 11 677 3 493 29.91 1 720 14.73 776 6.65 良好 3 057 893 29.21 493 16.13 232 7.59 自评学习成绩 197.48 a 203.02 a 137.41 a 较差 4 087 1 637 40.05 957 23.42 477 11.67 一般 10 316 2 993 29.01 1 440 13.96 628 6.09 良好 2 450 648 26.45 343 14.00 155 6.33 亲密伙伴个数 265.99 a 182.76 a 87.93 a ≤ 2 4 649 1 889 40.63 1 045 22.48 490 10.54 3~5个 6 949 1 997 28.74 977 14.06 425 6.12 ≥ 6 5 255 1 392 26.49 718 13.66 345 6.57 注:a P < 0.05。 表 2 中学生心理健康素养、NSSI与自杀相关行为的多因素logistic回归分析
变量 自杀意念 b 自杀计划 c 自杀未遂 c 例数 % OR 值 95 % CI 例数 % OR 值 95 % CI 例数 % OR 值 95 % CI 心理健康素养 具备 1 375 28.62 1.00 625 13.01 1.00 215 4.48 1.00 不具备 3 903 32.39 1.13 1.04~1.23 a 2 115 17.55 1.31 1.18~1.46 a 1 045 8.67 1.85 1.58~2.17 a NSSI 无 2 216 18.49 1.00 920 7.68 1.00 326 2.72 1.00 有 3 062 62.87 7.11 6.59~7.66 a 1 820 37.37 6.66 6.09~7.29 a 934 19.18 7.75 6.79~8.85 a 注:a P < 0.05;b 调整性别、年级、独生子女、父亲文化程度、家庭经济状况、自评学习成绩和亲密伙伴个数因素;c 调整性别、年级、父亲文化程度、家庭经济状况、自评学习成绩和亲密伙伴个数因素。 表 3 心理健康素养和NSSI交互作用与自杀相关行为的关联
模型 变量 自杀意念 b 自杀计划 c 自杀未遂 c β 值 OR 值 95 % CI β 值 OR 值 95 % CI β 值 OR 值 95 % CI 模型1 心理健康素养 × NSSI 具备 × 无 1.00 1.00 1.00 不具备 × 有 1.76 5.81 5.36~6.30 a 1.64 5.15 4.71~5.63 a 1.83 6.21 5.49~7.01 a 模型2 心理健康素养 NSSI 具备 无 1.00 1.00 1.00 有 1.98 7.26 6.30~8.36 a 2.13 8.40 6.98~10.10 a 2.55 12.76 9.05~17.99 a 不具备 无 0.13 1.14 1.03~1.27 a 0.45 1.58 1.34~1.86 a 1.05 2.87 2.07~3.97 a 有 2.15 8.60 7.70~9.61 a 2.38 10.76 9.18~12.62 a 3.11 22.32 16.30~30.57 a 注:a P < 0.05;b 调整性别、年级、独生子女、父亲文化程度、家庭经济状况、学习成绩和亲密伙伴个数因素;c 调整性别、年级、父亲文化程度、家庭经济状况、学习成绩和亲密伙伴个数因素;模型1 心理健康素养和NSSI相乘交互作用与自杀相关行为的关联;模型2 心理健康素养和NSSI相加交互作用与自杀相关行为的关联。 -
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