Xiao Qingqing, Song Xiaozhen, Huang Lijuan, Hou Dandan, Huang Xuehua
Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
West China School of Nursing, Sichuan University, Chengdu, China.
Front Psychiatry. 2022 Aug 10;13:912441. doi: 10.3389/fpsyt.2022.912441. eCollection 2022.
Adolescents with immature mind and unstable emotional control are high-risk groups of non-suicidal self-injury (NSSI) behavior. We meta-analyzed the global prevalence of NSSI and prevalence of NSSI characteristics in a non-clinical sample of adolescents between 2010 and 2021.
A systematic search for relevant articles published from January 1, 2010 to June 30, 2021 was performed within the scholarly database search engines of CBM, CNKI, VIP, Wanfang, PubMed, Web of Science, PsycINFO, and Embase. Eligibility criteria were as follows: provided cross-sectional data on the prevalence of NSSI; the subjects were non-clinical sample adolescents; and a clear definition of NSSI was reported. We used the following definiton of NSSI as our standard: the deliberate, self-inflicted destruction of body tissue, such as cutting, burning, and biting, without attempted suicide. The quality evaluation tool for cross-sectional studies recommended by the JBI was used. The global prevalence of NSSI was calculated based on the random-effects model by Comprehensive Meta-analysis version 3.0. Subgroup analyses were performed to compare the prevalence according to sex, living place, smoking or drinking history, and family structure.
Sixty-two studies involving 264,638 adolescents were included. The aggregate prevalence of NSSI among a non-clinical sample of adolescents was similar between over a lifetime (22.0%, 95% CI 17.9-26.6) and during a 12-month period (23.2%, 95% CI 20.2-26.5). Repetitive NSSI was more common than episodic NSSI (20.3% vs. 8.3%) but the frequency of mild injury (12.6%) was similar to that of moderate injury (11.6%). Multiple-method NSSI occurred slightly more often compared than one-method NSSI (16.0% vs. 11.1%). The top three types of NSSI in adolescents were banging/hitting (12.0%, 95% CI 8.9-15.9), pinching (10.0%, 95% CI 6.7-14.8), and pulling hair (9.8%, 95% CI 8.3-11.5), and the least common type was swallowing drugs/toxic substances/chemicals (1.0%, 95% CI 0.5-2.2). Subgroup analyses showed that being female, smoking, drinking, having siblings, and belonging to a single-parent family may be linked to higher prevalence of NSSI.
This meta-analysis found a high prevalence of NSSI in non-clinical sample of adolescents, but there are some changes in severity, methods, and reasons. Based on the current evidence, adolescents in modern society are more inclined to implement NSSI behavior by a variety of ways, which usually are repetitive, and moderate and severe injuries are gradually increasing. It is also worth noting that adolescents with siblings or in single-parent families are relatively more likely to implement NSSI behavior due to maladjustment to the new family model. Future research needs to continue to elucidate the features and risk factors of NSSI so as to intervene in a targeted way.
The limitation of this study is that the heterogeneity among the included studies is not low, and it is mainly related to Chinese and English studies. The results of this study should be used with caution.
[www.crd.york.ac.uk/prospero/], identifier [CRD42022283217].
心智不成熟且情绪控制不稳定的青少年是非自杀性自伤（NSSI）行为的高危人群。我们对2010年至2021年间非临床样本青少年中NSSI的全球患病率及NSSI特征患病率进行了荟萃分析。
在CBM、CNKI、VIP、万方、PubMed、Web of Science、PsycINFO和Embase等学术数据库搜索引擎中，对2010年1月1日至2021年6月30日发表的相关文章进行系统检索。纳入标准如下：提供NSSI患病率的横断面数据；研究对象为非临床样本青少年；报告了NSSI的明确定义。我们采用以下NSSI定义作为标准：故意自我造成身体组织破坏，如切割、灼烧和咬噬，且无自杀企图。使用了JBI推荐的横断面研究质量评估工具。基于随机效应模型，采用Comprehensive Meta-analysis 3.0软件计算NSSI的全球患病率。进行亚组分析以比较不同性别、居住地点、吸烟或饮酒史以及家庭结构的患病率。
纳入62项研究，涉及264,638名青少年。在非临床样本青少年中，NSSI的终生患病率（22.0%，95%CI 17.9 - 26.6）与12个月期间患病率（23.2%，95%CI 20.2 - 26.5）相似。重复性NSSI比偶发性NSSI更常见（20.3%对8.3%）但轻度损伤频率（12.6%）与中度损伤频率（11.6%）相似。多种方式的NSSI比单一方式的NSSI略多（16.0%对11.1%）。青少年中NSSI的前三种类型是撞击/击打（12.0%，95%CI 8.9 - 15.9）、掐捏（10.0%，95%CI 6.7 - 14.8）和拔头发（9.8%，95%CI 8.3 - 11.5），最不常见的类型是吞服药物/有毒物质/化学品（1.0%，95%CI 0.5 - 2.2）。亚组分析表明，女性、吸烟、饮酒、有兄弟姐妹以及属于单亲家庭可能与NSSI的较高患病率相关。
这项荟萃分析发现非临床样本青少年中NSSI患病率较高，但在严重程度、方式和原因方面存在一些变化。基于当前证据，现代社会的青少年更倾向于通过多种方式实施NSSI行为，这些行为通常具有重复性且中度和重度损伤逐渐增加。还值得注意的是，有兄弟姐妹或处于单亲家庭的青少年因对新家庭模式适应不良而相对更易实施NSSI行为。未来研究需要继续阐明NSSI的特征和危险因素，以便进行有针对性的干预。
本研究的局限性在于纳入研究间的异质性不低，且主要与中英文研究相关。本研究结果应谨慎使用。
