童年不良经历和非自杀性自伤交互作用与初中生自杀相关行为的关联

Association of adverse childhood experiences and non-suicidal self-injurious interactions with suicide-related behaviors in junior high school students

目的探讨童年不良经历(ACEs)和非自杀性自伤行为(NSSI)与初中生自杀相关行为的关联,为预防初中生自杀行为的发生提供参考依据。方法于2023年5—6月,采用分层整群抽样与方便抽样相结合的方法,抽取重庆市3个区县7392名初中生,采用中文版儿童期创伤量表、青少年NSSI评定问卷、自杀相关行为问卷进行自填式问卷调查。采用χ^(2)检验和多因素Logistic回归模型进行统计分析,再进行相加交互分析,计算相对超危险度比(RERI)、归因比(AP)和交互作用指数(S)的估计值及95%CI。结果初中生NSSI报告率为38.03%,ACEs报告率为41.76%,自杀意念、自杀计划、自杀未遂报告率分别为27.99%,9.90%,4.75%。ACEs及其各维度和NSSI均是自杀相关行为的影响因素(OR=1.83~10.66,P值均<0.01)。相加交互作用分析结果显示,ACEs和NSSI、躯体忽视(PN)和NSSI、情感虐待(EA)和NSSI、情感忽视(EN)和NSSI对自杀相关行为均有相加交互作用(RERI=0.45~39.15,AP=0.10~1.09,S=1.02~13.92);同时存在ACEs和NSSI的初中生发生自杀意念、自杀计划和自杀未遂的风险是无ACEs且无NSSI的11.45,20.38,28.76倍(P值均<0.05)。结论ACEs和NSSI对初中生自杀相关行为具有相加交互作用。应减少ACEs和NSSI,以预防初中生自杀行为的发生。

Objective To explore the association between adverse childhood experiences(ACEs)and non-suicidal self-injury(NSSI)and suicide-related behaviors among junior high school students,so as to provide a reference basis for the prevention of junior high school students'suicide.Methods From May to June 2023,a total of 7392 junior high school students in three districts and counties of Chongqing were selected for self-administered questionnaire survey by stratified cluster sampling and convenience sampling methods.The questionnaire survey was conducted using the Chinese version of the Childhood Trauma Scale,Adolescent NSSI Assessment Questionnaire,and Suicide Related Behavior Questionnaire.Statistical analysis was performed by using χ^(2) test,multifactorial Logistic regression model,and additional interaction analysis was used to calculate the estimated relative excess risk due to interaction(RERI),attributable proportion(AP),and synergy index(S),as well as 95%CI.Results The detection rate of NSSI among junior high school students was 38.03%,the detection rate of ACEs was 41.76%,and the detection rates of suicidal ideation,suicide planning,and suicide attempt were 27.99%,9.90%,and 4.75%,respectively.ACEs and its dimensions,and NSSI were the influencing factors for suicide-related behaviors(OR=1.83-10.66,P<0.01).The result of the additive interaction showed that ACEs and NSSI,PN and NSSI,EA and NSSI,EN and NSSI all had additive interactions on suicide-related behaviors(RERI=0.45-39.15,AP=0.10-1.09,S=1.02-3.92).And ACEs and its dimensions had additive interactions with NSSI on suicide-related behaviors,for junior high school students with both ACEs and NSSI had 11.45,20.38,and 28.76 times the risk of suicidal ideation,suicidal planning,and suicidal attempts as compared to junior high school students without ACEs and without NSSI(P<0.05).Conclusions ACEs and NSSI among junior high school students have an additive interaction effect on suicide related behaviors.ACEs and NSSI should be reduced to prevent suicidal behavior among middle school students.