自杀行为暴露与青少年非自杀性自伤关系的纵向研究

Non-suicidal self-injury and exposure to suicidal behaviors among Chinese adolescents:a longitudinal study

目的青少年群体中,非自杀性自伤(non-suicidal self-injury,NSSI)行为较为普遍且受多种因素影响。本研究旨在探究中国青少年自杀行为暴露与其自身NSSI之间的关系。方法研究对象来自山东省青少年行为与健康队列研究。选取参与了2015年基线调查和2016年第一次随访调查,并且基线调查中不存在NSSI行为史的5154名学生为研究对象。研究内容通过自填式问卷收集,包括基本人口学信息、社会心理学信息、终生及过去一年NSSI情况、自杀行为暴露史等。采用多因素logistic回归模型分析基线自杀行为暴露与一年后NSSI间的关系。结果5154名研究对象的基线年龄为(14.49±1.48)岁,女性占48.5%。9.0%的青少年报告曾暴露于自杀行为,其中6.0%暴露于自杀未遂,4.9%暴露于自杀死亡,7.3%暴露于朋友/熟人的自杀行为,3.1%暴露于亲属的自杀行为。自杀行为暴露组的过去一年NSSI发生率高于非暴露组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,与非暴露组相比,暴露于自杀死亡(OR=1.91,95%CI:1.22~3.01)和暴露于亲属自杀行为(OR=1.79,95%CI:1.02~3.12)与NSSI风险增加有关。结论暴露于自杀死亡或亲属自杀行为可能会增加青少年NSSI行为风险。自杀事件发生后,针对高危人群进行心理疏导和健康教育可促进青少年身心健康、预防自我伤害。

Objective Non-suicidal self-injury(NSSI)in adolescents appeared prevalent and multifactorial.This study was to examine the associations between exposure to suicidal behaviors and NSSI in the Chinese adolescents.Methods Participants included for analyses were 5154 adolescent students who participated in the baseline survey in 2015 and the first follow-up survey in 2016 of the Shandong Adolescent Behavior and Health Cohort,but with no history of NSSI at the baseline survey.A self-administered structured questionnaire was used to collect data on demographics,behavioral and emotional problems,lifetime and last-year NSSI.Data on the history of exposure to suicide attempt or death of a family member,friend,or close acquaintance were also collected.Multivariate logistic regression methods were used to examine the associations between exposure to suicidal behaviors and NSSI.Results In the baseline survey,mean age of the 5154 participants was(14.49±1.48)years,with 48.5%of the participants as girls.Of the participants,9.0%reported having been exposed to suicidal behaviors,including 6.0%reported to suicide attempt,4.9%to suicide death,7.3%to suicidal behaviors of friends/close acquaintances,and 3.1%to suicidal behaviors of relatives.The prevalence rates of NSSI in the last year were significantly higher in adolescents who had been exposed to suicidal behaviors than those who had not(P<0.05).Results from the multivariate logistic regressions showed that exposure to suicide death(OR=1.91,95%CI:1.22-3.01)or to suicidal behaviors of relatives(OR=1.79,95%CI:1.02-3.12)were both significantly associated with the increased risk of NSSI.Conclusions Experiences related to exposure to suicide-death or suicidal behaviors of relatives were associated with increased risk of NSSI in adolescents.After the suicide events,psychological counseling and health education programs set for high-risk groups were helpful in promoting physical and mental health and preventing the attempt of self-injury in teenagers.