Duan Yinan, Xu Shicun, Wang Yinzhe, Zhang Yanwen, Wang Yuanyuan, Chen Runsen
Vanke School of Public Health, Tsinghua University, 100084 Beijing, China.
Northeast Asian Research Center, Jilin University, Changchun 130012, China.
EClinicalMedicine. 2022 Jul 18;51:101575. doi: 10.1016/j.eclinm.2022.101575. eCollection 2022 Sep.
Gambling appears to be an independent risk factor for suicide among the young population worldwide. Blind boxes are collectable toys packed randomly in the box, which share certain similarities with gambling and are popular among the young population. This is the first study that examined the association between blind box engagement and suicide risk in the young population, the leading consumption group of blind boxes.
This study is part of a large-scale, cross-sectional study using convenience sampling conducted Oct 26 to Nov 18, 2021, which covered all the university and college students in the Jilin province, China. A total of 73,206 participants completed the survey with valid data for the current study (male: = 28,762; female: = 44,444; Mean age = 19·59). Participants' blind box engagement, suicide risk, depression, anxiety, alcohol use, smoking habit, and sociodemographic characteristics were assessed. First, we used univariate and multivariable binary logistic regression models to examine the relationship between blind box engagement and suicide risk in all participants. Second, we tested whether depression and anxiety would mediate the association between blind box engagement and suicide risk. Third, we analysed the association between "Frequency (i.e., frequency of blind box engagement)," "Bet (i.e., expenditure on the blind box that exceeds affordability)," "Tolerance (i.e., level of addiction)," "Borrowed (i.e., the amount of money borrowed for blind box engagement)," and suicide risk in the group with blind box engagement history.
4,195 participants (5·73%) have engaged in blind boxes, with 3,255 females (77·59%) and 940 males (22·41%). In the univariate models, binary logistic regression showed that blind box engagement was associated with suicide risk in both male and female participants (male: OR = 2·21, 95% CI = 1·86-2·63; female: OR = 1·64, 95% CI = 1·50-1·78). In the multivariable models, after controlling age, subjective socioeconomic status, per capita disposable income, alcohol use, and smoking habit, blind box engagement still was associated with suicide risk across genders (male: OR = 2·25, 95% CI = 1·89-2·68; female: OR = 1·58, 95% CI = 1·45-1·73). Depression (male: indirect effect = 0·31, = 0·04, < 0·001; female: indirect effect = 0·20, = 0·02, < 0·001) and anxiety (male: indirect effect = 0·26, = 0·03, < 0·001; female: indirect effect = 0·13, = 0·02, < 0·001) mediate the association between blind box engagement and suicide risk. Within the blind box engagement group, forward binary logistic regression revealed that "Tolerance" was associated with participants' suicide risk in both males ( = 0·001) and females ( < 0·001); "Borrowed" ( = 0·019) alone was associated with the male participants' suicide risk.
Our findings showed that blind box over-engagement is positively associated with suicide risk in both young males and females, and this association persisted after adjusting for influencing factors. In spite of the limitations in this study (e.g., cross-sectional, convenience sampling), current findings can assist policymakers in developing regulations for such a prosperous youth-dominant consumption industry while protecting youth's mental health worldwide.
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赌博似乎是全球年轻人群自杀的一个独立风险因素。盲盒是随机装在盒子里的可收集玩具，与赌博有一定相似之处，且在年轻人群中很受欢迎。这是第一项研究盲盒参与度与年轻人群自杀风险之间关联的研究，而年轻人是盲盒的主要消费群体。
本研究是一项大规模横断面研究的一部分，采用便利抽样，于2021年10月26日至11月18日进行，涵盖了中国吉林省所有大学生。共有73206名参与者完成了调查，获得了本研究的有效数据（男性：=28762；女性：=44444；平均年龄=19.59）。评估了参与者的盲盒参与度、自杀风险、抑郁、焦虑、饮酒情况、吸烟习惯和社会人口学特征。首先，我们使用单变量和多变量二元逻辑回归模型来研究所有参与者中盲盒参与度与自杀风险之间的关系。其次，我们测试了抑郁和焦虑是否会介导盲盒参与度与自杀风险之间的关联。第三，我们分析了“频率（即盲盒参与频率）”、“赌注（即超出承受能力的盲盒支出）”、“耐受性（即成瘾程度）”、“借款（即为盲盒参与借入的金额）”与有盲盒参与史的人群中的自杀风险之间的关联。
4195名参与者（5.73%）参与过盲盒，其中女性3255名（77.59%），男性940名（22.41%）。在单变量模型中，二元逻辑回归显示，盲盒参与度与男性和女性参与者的自杀风险均相关（男性：OR=2.21，95%CI=1.86 - 2.63；女性：OR=1.64，95%CI=1.50 - 1.78）。在多变量模型中，在控制了年龄、主观社会经济地位、人均可支配收入、饮酒情况和吸烟习惯后，盲盒参与度在各性别中仍与自杀风险相关（男性：OR=2.25，95%CI=1.89 - 2.68；女性：OR=1.58，95%CI=1.45 - 1.73）。抑郁（男性：间接效应=0.31，=0.04，<0.001；女性：间接效应=0.20，=0.02，<0.001）和焦虑（男性：间接效应=0.26，=0.03，<0.001；女性：间接效应=0.13，=0.02，<0.001）介导了盲盒参与度与自杀风险之间的关联。在盲盒参与组中，向前二元逻辑回归显示，“耐受性”与男性（=0.001）和女性（<0.001）参与者的自杀风险均相关；仅“借款”（=0.019）与男性参与者的自杀风险相关。
我们的研究结果表明，过度参与盲盒与年轻男性和女性的自杀风险呈正相关，并且在调整影响因素后这种关联仍然存在。尽管本研究存在局限性（例如横断面研究、便利抽样），但目前的研究结果可以帮助政策制定者为这样一个以年轻人为主导的繁荣消费行业制定监管措施，同时保护全球年轻人的心理健康。
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