Li Yuan, Li Peiying, Yuan Mengyuan, Li Yonghan, Zhang Xueying, Chen Juan, Wang Gengfu, Su Puyu
Department of Maternal, Child and Adolescent Health, School of Public Health; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Anhui Medical University, Hefei, Anhui, China.
Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin Medical University, Tianjin, China.
Gen Psychiatr. 2024 Feb 1;37(1):e101317. doi: 10.1136/gpsych-2023-101317. eCollection 2024.
In early adolescence, youth are highly prone to suicidal behaviours. Identifying modifiable risk factors during this critical phase is a priority to inform effective suicide prevention strategies.
To explore the risk and protective factors of suicidal behaviours (ie, suicidal ideation, plans and attempts) in early adolescence in China using a social-ecological perspective.
Using data from the cross-sectional project 'Healthy and Risky Behaviours Among Middle School Students in Anhui Province, China', stratified random cluster sampling was used to select 5724 middle school students who had completed self-report questionnaires in November 2020. Network analysis was employed to examine the correlates of suicidal ideation, plans and attempts at four levels, namely individual (sex, academic performance, serious physical illness/disability, history of self-harm, depression, impulsivity, sleep problems, resilience), family (family economic status, relationship with mother, relationship with father, family violence, childhood abuse, parental mental illness), school (relationship with teachers, relationship with classmates, school-bullying victimisation and perpetration) and social (social support, satisfaction with society).
In total, 37.9%, 19.0% and 5.5% of the students reported suicidal ideation, plans and attempts in the past 6 months, respectively. The estimated network revealed that suicidal ideation, plans and attempts were collectively associated with a history of self-harm, sleep problems, childhood abuse, school bullying and victimisation. Centrality analysis indicated that the most influential nodes in the network were history of self-harm and childhood abuse. Notably, the network also showed unique correlates of suicidal ideation (sex, weight=0.60; impulsivity, weight=0.24; family violence, weight=0.17; relationship with teachers, weight=-0.03; school-bullying perpetration, weight=0.22), suicidal plans (social support, weight=-0.15) and suicidal attempts (relationship with mother, weight=-0.10; parental mental illness, weight=0.61).
This study identified the correlates of suicidal ideation, plans and attempts, and provided practical implications for suicide prevention for young adolescents in China. Firstly, this study highlighted the importance of joint interventions across multiple departments. Secondly, the common risk factors of suicidal ideation, plans and attempts were elucidated. Thirdly, this study proposed target interventions to address the unique influencing factors of suicidal ideation, plans and attempts.
在青春期早期，青少年极易出现自杀行为。在这一关键阶段识别可改变的风险因素是制定有效自杀预防策略的首要任务。
从社会生态视角探讨中国青春期早期自杀行为（即自杀意念、计划和未遂行为）的风险和保护因素。
利用“中国安徽省中学生健康与危险行为”横断面项目的数据，采用分层随机整群抽样方法，选取2020年11月完成自填问卷的5724名中学生。采用网络分析方法，从个体（性别、学业成绩、严重躯体疾病/残疾、自伤史、抑郁、冲动性、睡眠问题、心理韧性）、家庭（家庭经济状况、与母亲的关系、与父亲的关系、家庭暴力、童年期虐待、父母精神疾病）、学校（与教师的关系、与同学的关系、校园欺凌受害和欺凌行为）和社会（社会支持、对社会的满意度）四个层面，研究自杀意念、计划和未遂行为的相关因素。
在过去6个月中，分别有37.9%、19.0%和5.5%的学生报告有自杀意念、计划和未遂行为。估计的网络显示，自杀意念、计划和未遂行为与自伤史、睡眠问题、童年期虐待、校园欺凌受害和欺凌行为共同相关。中心性分析表明，网络中最具影响力的节点是自伤史和童年期虐待。值得注意的是，该网络还显示了自杀意念（性别，权重=0.60；冲动性，权重=0.24；家庭暴力，权重=0.17；与教师的关系，权重=-0.03；校园欺凌行为，权重=0.22）、自杀计划（社会支持，权重=-0.15）和自杀未遂行为（与母亲的关系，权重=-0.10；父母精神疾病，权重=0.61）的独特相关因素。
本研究确定了自杀意念、计划和未遂行为的相关因素，并为中国青少年自杀预防提供了实际启示。首先，本研究强调了多部门联合干预的重要性。其次，阐明了自杀意念、计划和未遂行为的共同风险因素。第三，本研究提出了针对自杀意念、计划和未遂行为独特影响因素的靶向干预措施。
