Psychiatry. 2023 Winter;86(4):344-363. doi: 10.1080/00332747.2023.2238571. Epub 2023 Jul 31.
School-behavior-health difficulties (SBHDs) may alter physical/mental capabilities and consequently increase injury risk during daily activities. This study assessed the associations of potential SBHDs and their cumulative number (SBHDcn) with various injury types among younger adolescents. The study population included 1,559 middle-school adolescents in France (10-18 years, 98% under 16,778 boys and 781 girls). They completed a questionnaire at school-year end collecting socioeconomic features (nationality, family structure, parents' education/occupation/income), school/out-of-school injuries during the school-year (dependent variables), and SBHDs starting before the school-year (low academic performance, alcohol/tobacco/cannabis/other-illicit-drugs use, physical/verbal violence, sexual abuse, perpetrated violence, poor social support, poor general health status, sleep difficulty, depressive symptoms, and suicide attempt). Data were analyzed using logistic regression models and Kaplan-Meier estimates. Injuries were frequent during school-physical/sports-training (10.9%), other-school-training (4.7%), school-free-time (7.4%), out-of-school-sports-activity (16.5%), and traffic (2.2%). Single injury (one injury all injury types combined) and ≥2 injury types affected 23.3 and 7.9% of subjects, respectively. The proportion of adolescents without SBHDs decreased with age more quickly among those with each injury type than among those without injury. Various SBHDs were associated with most injury types, single injury, and ≥2 injury types (sex-age-adjusted odds/relative-risk ratios reaching 11, p < .001). A dose-effect association was found between SBHDcn 1-2/3-5/≥6 and both single injury and ≥2 injury types (sex-age adjusted relative risk ratios reaching 12.66, p < .001, vs. SBHDcn = 0). Socioeconomic features had a moderate confounding role in these associations. SBHDs strongly predict injuries among adolescents. Our findings may inform healthcare providers about their prominent role in detecting/reducing SBHDs and injuries.
学校行为健康困难（SBHD）可能会改变身体/心理能力，从而增加日常活动中的受伤风险。本研究评估了潜在的 SBHD 及其累积数量（SBHDcn）与青少年各种伤害类型之间的关联。 研究人群包括法国的 1559 名中学生（10-18 岁，98%年龄在 16 岁以下，778 名男孩和 81 名女孩）。他们在学年末完成了一份问卷，收集了社会经济特征（国籍、家庭结构、父母的教育/职业/收入）、学年期间的校内/校外伤害（因变量）以及学年前开始的 SBHD（学业成绩低、饮酒/吸烟/使用大麻/其他非法药物、身体/言语暴力、性虐待、实施暴力、社会支持差、一般健康状况差、睡眠困难、抑郁症状和自杀企图）。使用逻辑回归模型和 Kaplan-Meier 估计分析数据。 受伤在学校体育训练（10.9%）、其他学校训练（4.7%）、学校自由时间（7.4%）、校外体育活动（16.5%）和交通（2.2%）期间很常见。单一伤害（所有伤害类型的一次伤害）和≥2 种伤害类型分别影响 23.3%和 7.9%的受试者。在每种伤害类型中，没有 SBHD 的青少年比例随着年龄的增长下降得更快，而没有受伤的青少年则没有。各种 SBHD 与大多数伤害类型、单一伤害和≥2 种伤害类型相关（性别年龄调整后的优势/相对风险比达到 11，p<0.001）。发现 SBHDcn 1-2/3-5/≥6 与单一伤害和≥2 种伤害类型之间存在剂量-效应关联（性别年龄调整后的相对风险比达到 12.66，p<0.001，vs. SBHDcn=0）。社会经济特征在这些关联中具有中等的混杂作用。 SBHD 强烈预测青少年的受伤情况。我们的研究结果可能会让医疗保健提供者了解他们在发现/减少 SBHD 和伤害方面的重要作用。
