大学生故意自伤行为与自杀行为的相关性研究

Relationship between deliberate self-harm and suicidal behaviors in college students

目的了解大学生故意白伤行为和自杀行为的发生情况，并分析其相关性。方法整群选取某医科大学4063名一、二年级在校生为研究对象，采用X^2检验比较不同性别大学生故意自伤行为、自杀行为检出率差异，建立多因素logistic回归模型拟合多种研究变量对故意自伤行为一自杀行为的影响。结果4063名大学生最近1年故意自伤行为检出率为13．4％，其中单次自伤检出率为3．7％，多次白伤检出率为9．6％，男生高于女生；最近1年自杀意念、自杀计划、自杀未遂和自杀行为的检出率分别为4．5％、1．4％、0．6％和4．9％，性别间差异无统计学意义（P〉0．05）。采用多元logistic回归分析，以有自伤无自杀组为参考，有自伤有自杀组表现为积极应对程度低（0R=0．5，95％ci：0-3-0．8）、伙伴个数相对较少（3-5个VS≤2个：OR=0．6，95％CI：0-3-0．9；≥6个vs．≤2个：0R=0．4，95％CI：0．2-0．8）；消极应对（DR=2．1，95％CI：1．2-3．7）、抑郁症状（OR=2．9。95％CI：1．6-5．2）、焦虑症状（OR=2．2，95％CI：1-2-3．8）、睡眠问题（OR=1．7，95％CI：1．1-2．8）、自评体型偏胖（偏胖vs正常：OR：2．0，95％CI：1．1-3．6）较为常见。logistic回归分析发现，大学生故意自伤行为者中自杀行为的发生风险显著增加（0R=4．7，95％CI：3．5-6．4），而抑郁、应对方式、自评体型等社会心理因素会减弱两者的关联程度（OR=3.3，95％CI：2．4-4．5）。自杀行为发生的风险随自伤次数的增加而增加（0R=3．1-10．0），社会心理因素也会减弱两者的关联（OR=2．4-5．9）。结论自伤行为虽然不是个体自杀行为发生的信号，但有必要在自伤者中开展自杀行为发生可能性的评估。

Objective To describe the prevalence of deliberate self-harm （DSH） and suicidal behaviors （SIB） as well as the relationship between them in a college student population. Methods A total of 4063 medical students were selected under the cluster sampling method in Anhui province. Data were analyzed by Pearson Chi-square and logistic regression. Results A total of 4063 （13.4%） students reported that they had deliberately harmed themselves during the past 12 months. The acts of DSH with 1 and more than or equal to 2 times occurrence accounted for 3.7% and 9.6% among all the respondents. The act of DSH was significantly higher among boys than that among girls. Rates of suicide ideation, suicide plan, attempted suicide and SIB in the last year were 4.5%, 1.4%, 0.6% and 4.9%, respectively. However no statistically significant difference was found in different sex. Students in the DSH group that with SIB were found to have lower positive coping levels （OR=0.5,95%CI： 0.3-0.8）, getting less support from friends （3-5 vs. less than or equal to 2： OR=0.6,95%CI： 0.3-0.9; more than or equal to 6 vs. less than or equal to 2： 0R=0.4,95%CI：0.2-0.8）,with higher negative coping levels （OR=2.1,95%CI： 1.2-3.7）, having more serious depressive symptoms （0R= 2.9, 95% CI： 1.6-5.2） and anxiety symptoms （OR=2.2, 95% CI： 1.2-3.8） , having more serious sleeping problems （OR= 1.7,95%CI： 1.1-2.8） and perceived fat （fat vs. moderate： OR=2.0,95%CI： 1.1-3.6） than the DSH group without SIB. The rates of SIB in students with DSH behavior were significantly higher than those in students without those behaviors （OR=4.7, 95% CI： 3.5-6.4）.Psychosocial variables could attenuate the relationship between the DSH status and suicidal events （OR= 3.3,95% CI： 2.4-4.5）. The DSH frequency exhibited a curvilinear relationship to SIB （OR= 3.1-10.0） and psychosocial variables also attenuated this relationship （0R=2.4-5.9）. Conclusion It was well known that SIB was not a suicidal gesture but our findings suggested that the presence of DSH might trigger the suicidal attempts.