Zhang Yi, Ying Ruixue, Lu Wan, Liu Xuemeng, Hu Keyan, Feng Qing, Yu Zixiang, Wang Zhen, Lu Fangting, Miao Yahu, Ma Nanzhen, Tao Fangbiao, Jiang Tian, Zhang Qiu
Department of Endocrinology, First Affiliated Hospital of Anhui Medical University, No 81 Meishan Road, Anhui, Hefei, 230032, China, 86 18356056506.
Department of Maternal, Child, and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.
JMIR Public Health Surveill. 2025 Feb 21;11:e52928. doi: 10.2196/52928.
Nonsuicidal self-injury (NSSI) is a major public health problem leading to psychological problems in adolescents and young adults, similar to disorders such as depression and anxiety.
The aims of this study were to investigate (1) the interaction between BMI and socioenvironmental factors (including chronotype and mental health) that contribute to NSSI, and (2) whether self-esteem plays a mediating role in this association.
From May to June 2022, the multistage cluster sampling method was used to sample college students in four grades, including freshmen and seniors. The baseline participants were followed up 6 months later, excluding those who did not qualify, and the participants included 1772 college students. Socioenvironmental factors (chronotype/mental health), self-esteem, and NSSI were measured using a questionnaire. Multivariate linear regression models and chi-square analysis were used to evaluate the linear relationship between BMI, socioenvironmental factors, and self-esteem and the NSSI status. We use a process approach (mediation-moderation analysis) to explore the complex relationships between these variables.
The mean age of the participants was 20.53 (SD 1.65) years at baseline. A significant association was revealed, suggesting that a high BMI (β=.056, 95% CI 0.008-0.086, P=.018) was associated with a higher NSSI. There was also an interaction among BMI, socioenvironmental factors, and NSSI. Socioenvironmental factors played both moderating and mediating roles in the relationship between BMI and NSSI, whereas self-esteem only played a mediating role.
Paying attention to factors such as overweight and obesity is important for early BMI control to identify other potential risk factors for NSSI and to evaluate how self-esteem can be improved considering multiple perspectives to improve the effect of BMI on NSSI in adolescents.
非自杀性自伤（NSSI）是一个重大的公共卫生问题，会导致青少年和青年出现心理问题，与抑郁症和焦虑症等疾病类似。
本研究的目的是调查（1）体重指数（BMI）与导致非自杀性自伤的社会环境因素（包括昼夜节律类型和心理健康）之间的相互作用，以及（2）自尊在这种关联中是否起中介作用。
2022年5月至6月，采用多阶段整群抽样方法对四个年级的大学生进行抽样，包括大一和大四学生。对基线参与者在6个月后进行随访，排除不符合条件的参与者，最终纳入1772名大学生。使用问卷测量社会环境因素（昼夜节律类型/心理健康）、自尊和非自杀性自伤情况。采用多元线性回归模型和卡方分析来评估BMI、社会环境因素、自尊与非自杀性自伤状况之间的线性关系。我们采用一种过程方法（中介-调节分析）来探索这些变量之间的复杂关系。
基线时参与者的平均年龄为20.53（标准差1.65）岁。结果显示存在显著关联，表明高BMI（β=0.056，95%置信区间0.008 - 0.086，P = 0.018）与更高的非自杀性自伤相关。BMI、社会环境因素和非自杀性自伤之间也存在相互作用。社会环境因素在BMI与非自杀性自伤的关系中既起调节作用又起中介作用，而自尊仅起中介作用。
关注超重和肥胖等因素对于早期控制BMI很重要，以识别非自杀性自伤的其他潜在风险因素，并从多个角度评估如何提高自尊，以改善BMI对青少年非自杀性自伤的影响。
