School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Shaanxi Medical Association, Xi'an, China.
Front Public Health. 2023 Jun 15;11:1199882. doi: 10.3389/fpubh.2023.1199882. eCollection 2023.
Nonsuicidal self-injury (NSSI) is a serious public health problem. The role of adverse childhood experiences (ACEs) and lifestyle on the risk for NSSI is still underexplored, especially among college students. We aimed to investigate the association of ACEs with the risk of NSSI, and effect modifications by lifestyle among college students.
A total of 18,723 college students from six universities were recruited through a multistage, random cluster sampling method in Shaanxi province, China. The Adverse Childhood Experiences International Questionnaire was used to assess ACEs for each participant, and the Chinese version of the Ottawa Self-injury Inventory was used to assess the presence or absence of NSSI behaviors. Information about lifestyle was collected by a self-designed questionnaire. The associations of NSSI with ACEs and lifestyle were analyzed using logistic regression models. Furthermore, we constructed a combination score of multiple lifestyles and evaluated whether lifestyle modified the effect of ACEs on the risk of NSSI.
The prevalence of NSSI for the past 1 month, 6 months, and 12 months was 3.8, 5.3, and 6.5%, respectively. 82.6% of participants have reported experiencing at least one type of ACEs, and participants with higher levels of ACEs (≥4) were more likely to have higher odds of developing NSSI during the past 1 month (OR, 4.10; 95%CI, 3.38-4.97), 6 months (OR, 4.76; 95%CI, 4.03-5.62), and 12 months (OR, 5.62; 95%CI, 4.83-6.55), as compared with participants with low levels of ACEs (0-1). There were additive interactions between ACEs and lifestyle. Compared with participants with low levels of ACEs and healthy lifestyle, participants with high levels of ACEs and unhealthy lifestyle had the highest odds of NSSI during the past 1 month (OR, 5.56; 95%CI, 3.80-8.31), 6 months (OR, 6.62; 95%CI, 4.73-9.42), and 12 months (OR, 7.62; 95%CI, 5.59-10.52).
These results suggest that ACEs play an important role in the occurrence of NSSI among college students, especially in those with unhealthy lifestyle. Our findings may help develop targeted intervention strategies for the prevention of NSSI.
非自杀性自伤（NSSI）是一个严重的公共卫生问题。不良童年经历（ACEs）和生活方式对 NSSI 风险的影响仍未得到充分探索，尤其是在大学生群体中。我们旨在研究 ACEs 与大学生 NSSI 风险之间的关联，以及生活方式在其中的调节作用。
本研究采用多阶段、随机聚类抽样方法，在陕西省六所大学共招募了 18723 名大学生。使用不良童年经历国际问卷（ACEs）对每位参与者进行 ACEs 评估，使用中文版渥太华自伤量表评估 NSSI 行为的有无。通过自行设计的问卷收集生活方式信息。使用逻辑回归模型分析 NSSI 与 ACEs 和生活方式之间的关联。此外，我们构建了多个生活方式的组合评分，并评估生活方式是否改变了 ACEs 对 NSSI 风险的影响。
过去 1 个月、6 个月和 12 个月的 NSSI 发生率分别为 3.8%、5.3%和 6.5%。82.6%的参与者报告至少经历过一种 ACEs，经历 ACEs 水平较高（≥4）的参与者在过去 1 个月（OR，4.10；95%CI，3.38-4.97）、6 个月（OR，4.76；95%CI，4.03-5.62）和 12 个月（OR，5.62；95%CI，4.83-6.55）时更有可能发生 NSSI，而 ACEs 水平较低（0-1）的参与者发生 NSSI 的风险较低。ACEs 与生活方式之间存在相加交互作用。与 ACEs 水平较低且生活方式健康的参与者相比，ACEs 水平较高且生活方式不健康的参与者在过去 1 个月（OR，5.56；95%CI，3.80-8.31）、6 个月（OR，6.62；95%CI，4.73-9.42）和 12 个月（OR，7.62；95%CI，5.59-10.52）时发生 NSSI 的可能性最高。
这些结果表明 ACEs 在大学生 NSSI 的发生中起重要作用，尤其是在生活方式不健康的大学生中。我们的研究结果可能有助于制定针对 NSSI 的预防的有针对性的干预策略。
