Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents

Higher exposure to childhood adversity associates with lower adult flourishing

BACKGROUND

Adverse childhood experiences (ACEs) are prevalent and associated with negative health and social outcomes. However, our understanding of how patterns of ACEs exposure relate to positive outcomes in adulthood remains limited. This study aims to identify patterns of ACEs and examine associations with flourishing in a sample of Chinese young adults.

METHODS

This cross-sectional study was conducted from August to November 2020. Young adults, ages 18-35, enrolled in undergraduate or graduate programs at universities in Mainland China were recruited through convenience and snowball sampling to participate in a survey. The exposure to ACEs was measured by the twelve-item Chinese version of the ACE-International Questionnaire. Additional measures included six domains of flourishing assessed using the Chinese version of the Flourishing Measure, and demographic covariates (i.e., gender, age, year in university, marital status). Descriptive statistical analysis and latent class analysis (LCA) were performed using SPSS 27 and Mplus 8.5.

RESULTS

Participants included 9468 young adults (mean age = 20.1 years). Majority of participants were female (75.3%), undergraduate students (96.4%), and single (79.8%). Approximately 56% of participants reported at least one ACE; 7.0% reported four or more ACEs. Emotional neglect (33.2%), household violence (20.6%), and parental separation/divorce (13.9%) were the most frequently reported ACEs. LCA identified three ACEs classes: multiple maltreatment and household violence (4.7%), emotional neglect and household violence (16.2%), and low ACEs (79.1%). Individuals in the low ACEs class had the highest level of flourishing whereas individuals in multiple maltreatment and household violence had the lowest level of flourishing in all six domains. There were no significant differences in flourishing between the multiple maltreatment and household violence and the emotional neglect and household violence classes except in the physical and mental health (means = 6.17 vs 6.51, p = 0.02) and the financial and material stability domains (means = 5.25 vs 5.66, p = 0.04).

CONCLUSIONS

Patterns of multiple ACEs exposures were associated with lower levels of flourishing. Our findings have implications for efforts to prevent ACEs exposure through monitoring and promoting family well-being and routine screening to identify those with ACEs exposure to prevent negative social and health sequelae.

Resilience mediates the association between impulsivity and self-harm in Chinese adolescents

OBJECTIVE

Existing literature is supportive for the positive connection between impulsivity and self-harm (SH), nevertheless, less is known regarding to the role of resilience in this association. This research primarily explored potential mediation of resilience in the association between impulsivity and SH in a large sample of Chinese adolescents.

METHOD

A population-based cross-sectional survey of 4552 adolescents was conducted in southwest China. A self-administered questionnaire was adopted for data collection from all subjects. The Barratt Impulsiveness Scale (BIS), the Modified version of Adolescents Self-Harm Scale (MASHS) and the Resilience Scale for Chinese Adolescents (RSCA) were used to measure impulsivity, SH, and resilience, respectively. The associations between impulsivity, resilience, and SH were estimated by using stepwise multivariate Logistic regression models. Mediation of resilience in impulsivity and SH association was evaluated by using path model.

RESULTS

The prevalence of SH was 39.1% (95% CI: 34.0%-45.0%) for surveyed adolescents. Impulsivity and resilience were significantly associated with the prevalence of SH. Prominent dose-response association between impulsivity and SH prevalence was further confirmed. Resilience was a salient mediator which accounted for 42.90% of the total impulsivity-SH association. Among all the five dimensions of resilience, goal concentration (23.98%) and emotion regulation (21.94%) showed the strongest mediation.

CONCLUSIONS

The findings suggest that resilience building intervention strategies, particularly those focusing on improving goal concentration, emotion regulation, and positive perception, could be effective in reducing impulsivity related SH risk among Chinses adolescents.

The global and regional burden of sexual behaviors and food insecurity and their combined association on the magnitude of suicidal behaviors among 121,248 adolescent girls: An international observational study in 67 low- and middle-income and high-income countries

BACKGROUND

Food insecurity and early sexual behaviors increase the risk of suicidal behavior, however their combined association on social behaviors receive little attention. Therefore, this study estimated the magnitude of adolescent global suicidal burden, it correlates with food insecurity and sexual behaviors, and assessed the combined association of food insecurity and sexual behaviors on the burden of suicidal behaviors (SBs) among school-going adolescent girls aged between 11 and 17 years.

METHODS

The study design is multi-county, and pooled cross-sectional in nature. Data for 67 countries from the Global School-based Student Health Survey (GSHS) were used. A random-effects meta-analysis was used to generate national and overall pooled estimates of suicidal behaviors. Multinomial logistic regression analyses were employed to estimate the adjusted effect of independent factors and the combined associations of sexual behaviors and food insecurity on adolescent SBs in the context of global, regional, and country income groups and adjusted by a set of explanatory factors.

RESULTS

The study included 121,248 girls aged 11-17 years. The population-weighted prevalence of high-level (SBs) was 40.65% among school-going girls who experienced sexual intercourse and 7.41% among those who reported severe food insecurity. However, the burden of SBs varied according to type of sexual behaviors and the age. The burden of SB among girls who had sexual intercourse with 1-2 sex partners, 3-4 sex partners, or >4 sex partners was 11.49%, 13.28%, or 18.43%, respectively. The high-level SB was double (23.08%) among adolescent girls who had first sexual intercourse aged 11-13 years old compared to adolescent girls aged 14-17 years (11.49%). The burden of SBs (for at least one SB, for two SBs, or for three SBs) were significantly associated with adolescent girls who experienced sexual intercourse (relative risk ratio, RRR = 2.04, 95% confidence interval, CI:1.83-2.28; RRR = 2.24, 1.99-2.52; RRR = 1.86, 1.59-2.18), sexual intercourse with four or more sex partners (RRR = 1.44, 1.15-1.79; RRR = 1.65, 1.33-2.06; RRR = 2.47, 1.94-3.16), first sexual intercourse aged 11-13 years (RRR = 1.22, 1.02-1.46; RRR = 1.51, 1.26-1.82; RRR = 2.26, 1.81-2.83), compared to adolescents who had no experience of SBs. Compared to adolescent girls who did neither experience food insecurity nor sexual intercourse, the overall burden of SBs (for at least one SB, for two SBs or for three SBs) were significantly higher among girls reporting to have experienced both food insecurity and sexual intercourse (RRR = 1.55, 1.29-1.86; RRR = 1.70, 1.42-2.04; RRR = 1.54, 1.26-1.88); and those reporting having experienced food insecurity but have never had sexual intercourse (RRR = 1.66, 1.48-1.87; RRR = 1.45, 1.26-1.67; RRR = 1.62, 1.36-1.92). However, it was significantly lower among girls reporting to have had sexual intercourse but never experienced food insecurity. This association was extended among adolescents in the context of regional and country income groups.

CONCLUSION

The high burden of suicidal behaviors among adolescents calls for an urgent policy interventions to address food insecurity as a means to keep adolescents in school. The interventions should also aim to integrate safeguards that dissuade youngsters from early sex and protect them from sexual victimisation, and the associated adverse outcomes that that hamstring the attainment of SDG 3.4.2.

The Effect of Left-Behind Experience and Self-Esteem on Aggressive Behavior in Young Adults in China : A Cross-Sectional Study

There is little investigation on the independent effects of left-behind experience (LBE) on self-esteem and aggressive behavior in Chinese young adult populations, or the interaction effects of LBE and self-esteem on aggressive behavior. Thus, a school-based health survey was conducted in Anhui province in China in 2017. A total of 4,154 college students completed standard questionnaires which contain details of left-behind-related characters, self-esteem, aggressive behavior, and sociodemographic profile. Of included students, 55.3% were those with LBE (LBEs). Compared to students without left-behind experiences (NLBEs), LBEs had significantly increased scores of aggressive behavior and decreased score of self-esteem. The increased aggression in LBEs was highly related to longer left-behind duration, younger age of left-behind for the first time, and decreased self-esteem. On the other side, the aggressive behavior was demonstrated negatively correlated with self-esteem in both LBEs and NLBEs. There was an interaction effect of left-behind duration and self-esteem on physical aggression and of frequency of contacting with parents and self-esteem on verbal aggression. Besides, the interaction of primary caregiver and self-esteem on hostility and aggression toward self were also observed, respectively. Our results indicated LBEs and low self-esteem are associated with increased risk of aggressive behavior in Chinese young adults. The increased aggressive behavior in LBEs were highly related to longer left-behind duration, younger age of left-behind for the first time and decreased self-esteem. In those LBEs with some certain left-behind-related characters, aggressive behavior decreased more prominently with the increase of self-esteem. Strategies to improve self-esteem, particularly among young adults who have certain characters of LBE, should be a significant component of prevention and interventions of aggressive behavior.

Relationships of adolescents with suicidal behavior with social support networks

OBJECTIVE

To identify the relationships of adolescents with suicidal behavior established with social support networks.

METHOD

Qualitative study addressing ten adolescents with suicidal behavior cared for by a psychosocial care center attending children and adolescents located in southern Brazil. Semi-structured interviews were held in July 2020 via WhatsApp during the COVID-19 pandemic, and data were analyzed according to Minayo's thematic analysis.

RESULTS

Two categories emerged: Dynamics of the relationships established in the family support network and Relationships established with the remaining social support network members, which revealed a weak social support network established with friends and at the school context.

FINAL CONSIDERATIONS

This study enabled identifying how relationships are established in the social support networks and how these reflected on the adolescents' development.

Relationship between thyroid hormone and sex hormone levels and non-suicidal self-injury in male adolescents with depression

OBJECTIVE

Non-suicidal self-injury (NSSI) is the intentional and repeated direct injury to one's bodily tissues or organs without the intent to die, which is not socially sanctioned and does not result in death. This study will be the first to explore the relationship between NSSI behavior and thyroid hormone and sex hormone levels in male adolescents with depression.

METHODS

Among the inpatients in the children's ward of Shandong Mental Health Center, eighty male patients with first-episode depressive disorder were randomly selected. Forty male adolescent depressed patients with NSSI behaviors were set as the NSSI group, and forty male adolescent depressed patients without NSSI behaviors were set as the No-NSSI group. Their thyroid hormones (free triiodothyronine, free thyroxine, and thyroid stimulating hormone) and sex hormones (estradiol, progesterone, and testosterone) were measured, and the severity of self-injury in the NSSI group was assessed using the Adolescent Self-Injury Questionnaire. The NSSI group was tested again after 6 weeks of sertraline treatment for biological indicators and assessed by the Self-Injury Questionnaire to compare the hormonal differences between the NSSI group and the No-NSSI group and compare the differences of each index before and after treatment in the NSSI group.

RESULTS

T3/T4 (p = 0.001) and FT3 (p = 0.023), TSH levels (p < 0.001) were lower in the NSSI group than in the No-NSSI group before treatment, and FT4 (p = 0.036) and T (p < 0.001) levels were higher than in the No-NSSI group. T3/T4 levels were higher in the NSSI group after treatment (p < 0.001). FT4 (p < 0.001) and T (p = 0.001) levels and self-injury questionnaire scores (p < 0.001) decreased after treatment in the NSSI group. In the NSSI group at baseline, FT4 levels were negatively correlated with self-injury questionnaire scores (r = -0.459, p = 0.003) and testosterone levels were positively correlated with self-injury questionnaire scores (r = 0.383, p = 0.015), and in the NSSI group after treatment, FT4 difference was negatively correlated with self-injury questionnaire score reduction rate (r = -0.037, p = 0.019), and testosterone difference was positively correlated with self-injury questionnaire score reduction rate (r = 0.424, p = 0.006). Logistic regression analysis showed that low TSH and high testosterone levels were independent risk factors for the development of non-suicidal self-harming behaviors in male adolescent depressed patients.

CONCLUSION

Changes in thyroid hormone and sex hormone levels may be associated with non-suicidal self-injurious behavior in male adolescent depressed patients.

Adverse Childhood Experiences and Mental Health in an Adolescent Partial Hospital Program

Childhood adversity has been associated with myriad physical, emotional, and mental health symptoms across the lifespan, including higher risk for substance abuse, depression, suicidal ideation, and premature mortality. The current study evaluates the association between cumulative adverse childhood experiences and mental health distress at admission and discharge in an adolescent partial hospital program. Data were collected from 157 adolescents through clinical assessments administered during admission and discharge procedures (Youth Outcomes Questionnaire Self-Report (YOQ-SR), Treatment Support Measure (TSM), and Center for Youth Wellness Adverse Childhood Experiences Questionnaire Teen (CYW ACE-Q Teen)). Regression analyses were conducted to assess how cumulative ACEs predict admission mental health distress (Intrapersonal Distress, Critical Items, and Total Score) as well as mental health distress at discharge, above and beyond other clinically relevant factors. While ACEs significantly predicted overall distress at admission (p = .026), there were no other significant associations between ACEs and outcomes at admission, nor ACEs and any outcomes at discharge. This suggests experiences of adversity may not hinder or influence outcomes over the course of treatment in this setting. Experiences of adversity were highly endorsed in this sample; thus, further understanding of experiences of trauma and resilience in acute treatment settings is a critical area for future research to improve interventions for adolescents.

Differences in Influencing Factors Between Non-suicidal Self-Injury and Suicide Attempts in Chinese Adolescents: The Role of Gender

INTRODUCTION

Non-suicidal self-injury (NSSI) and suicide attempts (SA) are common in adolescents and are important risk factors for suicide deaths. They are related to various psychosocial, behavioral, and biological factors. We aimed to compare the differences on psychological behavior problem and family environment characteristics between NSSI and SA, and the role of gender.

METHODS

A multi-center population-based survey was conducted in 29 schools across 4 provinces in China. A total of 14,500 urban and rural adolescents in grades 7-12 completed a structured questionnaire to report their sociodemographic information, psychological and behavioral characteristics, childhood maltreatment, parent-child relationships, NSSI, and SA. Post-hoc tests, pairwise comparisons, and multinomial logistic regression analyses were conducted to explore the differences and similarities between subjects who had engaged in NSSI and SA.

RESULTS

The prevalence of NSSI and SA were 27.3 and 4.9%, respectively, and the co-occurrence of these two behaviors (NSSI + SA) was reported to 2.8%. The NSSI + SA group scored the highest on all study variables, followed by the SA-only group, the NSSI-only group, and the non-self-harm group (p < 0.001). Compared with the non-self-harm group, adolescents who reported either NSSI or SA scored significantly higher on all study variables (p< 0.0083). The comparison between other self-harm groups, this difference have varied in all research variables.

CONCLUSION

The current study indicate that psychological, behavioral, and family relationships profiles of Chinese adolescents with SA and NSSI are similar, but the measured problematic characteristics were more severe in suicide attempters. In the future, it's necessary to pay more attention to adolescents with more serious psychological and behavioral problems to prevent and early intervene in their self-harm, and actively explore gender differences.

Patterns of adverse childhood experiences and depressive symptom trajectories in young adults: A longitudinal study of college students in China

BACKGROUND

Adverse childhood experiences (ACEs) tend to cluster together in daily life, and most studies focus on the level of depression at certain points, but the dynamic process of depression is often neglected. Thus, research is urgently needed to explore the relationship between ACEs pattern and trajectory of depressive symptom levels at multiple time points in order to provides early targeted interventions to those who are most at risk.

OBJECTIVE

We aimed to explore patterns of ACEs, including types and timing, associated with depression trajectories in college students.

METHODS

A school-based health survey was used to collect data as part of a longitudinal study in two medical college in Anhui province, China. Questionnaires were issued to 3,662 participants aged 17-22 and recorded details of ACEs (types and timing) and depression. Latent class analysis (LCA) was used to identify "patterns" of ACEs type and timing. Depressive symptom trajectories employed latent class growth analysis (LCGA). Multiple logistic regressions were employed to evaluate the relationships between ACEs patterns and depressive symptom trajectories.

RESULTS

We identified five ACEs patterns: "High neglect/emotional abuse/community violence," "High neglect/emotional abuse," "High neglect/family dysfunction," "High neglect," "Low ACEs." We traced three depression trajectories: "High depressive symptom" "Moderate depressive symptom," "Low depressive symptom." "High neglect/emotional abuse/community violence," "High neglect/emotional abuse" and "High neglect/family dysfunction" demonstrated a high risk for "High depressive symptom" and "Moderate depressive symptom." "High neglect" showed a high risk for "Moderate depressive symptom" but not for "High depressive symptom" (P < 0.05).

CONCLUSIONS

The findings address the need for a comprehensive consideration of exposure to childhood adversity associated with the risk of depression in young adults through identifying more problematic ACEs patterns amongst exposed children.

Associations of depressive and anxiety symptoms with non-suicidal self-injury and suicidal attempt among Chinese adolescents: The mediation role of sleep quality

BACKGROUND

Associations of depressive and anxiety symptoms with non-suicidal self-injury (NSSI) and suicide attempt (SA) are not well understood. We aimed to examine these associations among Chinese adolescents, and whether any potential association is mediated through sleep quality.

METHODS

We conducted a cross-sectional study among 1,771 (994 boys [56.1%] and 777 girls [43.9%], mean [SD] age was 12.9 [0.6] years) adolescents who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort (CAHGC) study. Depressive symptoms, anxiety symptoms, NSSI, SA and sleep quality were measured by validated questionnaire. Logistic regression models were employed to estimate the associations of depression and anxiety with NSSI and SA. Mediation analyses were conducted to explore the mediate effect of sleep quality.

RESULTS

The 12-month prevalence of NSSI and SA was 17.1 and 8.3%, respectively. Depressive and anxiety symptoms were significantly associated with NSSI (the adjusted odds ratio [aOR] was 1.89 [95% CI 1.34-2.65] for depressive symptoms and 2.84 [95% CI 2.05-3.94] for anxiety symptoms) and SA (the aOR was 3.20 [95% CI 2.03-5.05] for depressive symptoms and 2.98 [95% CI 1.84-4.84] for anxiety symptoms). No significant gender differences were found in the associations. The mediation proportion of sleep quality on the association of depressive and anxiety symptoms with NSSI, as well as depressive and anxiety symptoms with SA were 21.1, 13.9, 13.6, and 14.7, respectively.

CONCLUSION

Independent associations of depressive and anxiety symptoms with NSSI and SA were observed in Chinese adolescents, and there were no significant gender differences in the associations. Moreover, these associations were partially mediated through sleep quality. Targeted interventions for adolescents' NSSI and SA should focus on those who have depressive and anxiety symptoms, and poor sleep quality.

Childhood neglect and trajectories of affective symptoms throughout adulthood: A British birth cohort study

BACKGROUND

Childhood maltreatment, including neglect, can affect an individual's mental health. However, there is a gap in current literature investigating the long-term, dynamic effects of childhood neglect on adult affective symptoms (AS).

METHOD

Data were used from the National Child Development Study (a British 1958 birth cohort). Childhood neglect was prospectively measured at ages 7 and 11. Five distinct trajectories of AS have been derived previously, using data from the Malaise Inventory Scale (at ages 23, 33, 42 and 50): 'no symptoms', 'persistent mild/moderate symptoms', 'low and increasing symptoms', 'high and increasing symptoms' and 'high and decreasing symptoms' (John et al., 2019). Multinomial logistic regressions were used to explore whether childhood neglect was associated with AS trajectory membership, while adjusting for a number of covariates.

RESULTS

Results revealed that childhood neglect was significantly associated with 'high and decreasing', 'high and increasing' and 'persistent mild/moderate' AS trajectories from young adulthood through midlife. There was no association with the 'low and increasing' AS trajectory. When testing for at age specific effects, neglect experienced at age 7 only, or at age 11 only, was predictive of 'high and decreasing symptoms' trajectory, whereas neglect experienced at both ages was predictive of 'persistent mild/moderate symptoms' trajectory.

CONCLUSIONS

Childhood neglect has negative long-lasting effects on trajectories of adult mental health. This finding has important implications for early intervention for individuals who have experienced childhood neglect.

Nonlinear relationship between sleep duration and non-suicidal self-injurious behaviour among Chinese adolescents

BACKGROUND

Previous studies have shown a positive association between sleep deprivation and non-suicidal self-injury (NSSI) among adolescents, but few studies have described the effects of oversleeping and weekend catch-up sleep on NSSI. The present study aimed to explore the nonlinear relationship between sleep duration and NSSI among Chinese adolescents.

METHODS

Data from China's National Adolescent Health Surveillance for the years 2014 to 2015 were collected from 15,713 students located across four provinces in China. A self-report questionnaire was used to assess sleep duration and 12-month NSSI. Binomial logistic regression models were used to examine the association between NSSI and sleep duration. The locally estimated scatter plot smoothing (LOESS) method was used to explore the associations of total NSSI number with sleep duration, and binomial regression analysis was used to test this relationship.

RESULTS

About 68.5% of adolescents reported sleeping less than 8 h on weeknights, while 37.8% of adolescents slept more than 10 h per night during weekends. The 12-month prevalence rate of NSSI was 29.4%. Compared to adolescents who reported weekend catch-up sleep of 0-1 h, those who slept < 0 h (adjusted odds ratio [aOR] = 1.38, 95% Confidence Interval [95% CI]: 1.16-1.64) had a higher risk of NSSI. Males who reported ≥3 h of weekend catch-up sleep had significantly increased odds of NSSI (aOR = 1.20, 95%CI: 1.01-1.42). Notably, a positive U-shaped association was observed between the sleep duration and the total NSSI number.

CONCLUSIONS

The findings reveal a nonlinear relationship between sleep duration and NSSI among Chinese adolescents. Therefore, it is necessary to be vigilant and screen for sleep duration among adolescents in NSSI treatment or prevention.

Internet addiction and nonsuicidal self-injury in adolescence: Associations with offline and online social support

OBJECTIVES

Both nonsuicidal self-injury (NSSI) and Internet addiction (IA) are important health issues for adolescents, and social support has been extensively examined as a protective factor for both. This study aims to compare the effect of offline and online social support on IA, and that on NSSI as well.

METHOD

A total of 1911 Chinese adolescents (53.27% females, M_age  = 16.83 ± 0.37) completed self-report questionnaires assessing offline social support, online social support, IA, and NSSI.

RESULTS

The structural equation modeling analysis showed that offline social support was negatively associated with IA and NSSI, while online social support was positively associated with IA and NSSI; IA was positively associated with NSSI. Furthermore, implications for preventions and interventions of IA and NSSI were discussed. The indirect model explained a relatively small variance of NSSI, indicating the possibility of additional factors in the development of NSSI that should be further investigated.

CONCLUSION

This study indicated the differences between offline and online social support, and their different associations with IA and NSSI.

Mediation of Internet addiction on association between childhood maltreatment and suicidal behaviours among Chinese adolescents

Aims

The associations between suicidal behaviours and childhood maltreatment (CM), as well as Internet addiction (IA) have been extensively examined. However, few studies pay attention to different types of CM and all stages of suicidality, including suicidal ideation (SI), suicidal plans (SP) and suicidal attempts (SA). Moreover, little is known regarding the mediation of IA on the relationship between CM and suicidal behaviours. The study aims to explore the direct effect of CM and IA on three stages of suicidal behaviours, and the indirect effect of CM on suicidality via IA.

Methods

A total of 16 130 high-school students aged 12–18 were recruited using a stratified cluster sampling strategy across five representative provinces in China. Relevant information was collected by a self-administered anonymous questionnaire. Multinomial logistic regression analysis and structural equation model were used to examine the associations.

Results

During the last year, 16.0% of participants reported suicidal behaviours. Specifically, 7.9% reported SI only, 4.6% reported SP but no SA, and 3.5% reported SA. The prevalence of neglect, physical abuse and IA in moderate to severe were 28.9, 19.9 and 33.1%, respectively. After controlling for demographic characteristics and confounding factors, such as loneliness, psychological resilience, and social support, moderate and severe neglect, physical abuse and IA were associated with an increased risk of SI, SP and SA (p < 0.01). The total effect of neglect and physical abuse on suicidal behaviours were 0.152 and 0.172, respectively (p < 0.001). The mediation proportion of IA on the association between neglect and suicidal behaviours, as well as physical abuse and suicidal behaviours were 22.4 and 18.0%, respectively.

Conclusions

CM and IA are independently associated with suicidal behaviours among Chinese adolescents. Moreover, IA plays a mediating role on the relationship between CM and suicidality. Targeted interventions for adolescents’ suicidal behaviours should focus on those who have experience of CM and IA.

Nonwillingness to Return to the Emergency Department and Nonattendance of Follow-Up Care Arrangements Following an Initial Suicide-Related Presentation

Background: For people experiencing a suicidal crisis the emergency department (ED) is often the only option to find help. Aims: The aims of this study were (a) to identify predictors of patients' nonwillingness to return to the ED for help with a future suicidal crisis, and (b) whether nonwillingness to return was associated with follow-up appointment nonattendance. Method: This study utilized baseline data from the RESTORE online survey, and included 911 participants who had presented to an ED for suicidal crisis in the past 18 months, across participating local health districts in the Australian Capital Territory and New South Wales. Results: Patients who reported a more negative ED experience and longer triage wait times were less willing to return. Those who were less willing to return were also less likely to attend their follow-up appointment. Limitations: Due to the cross-sectional study design, causal inferences are not possible. Additionally, the self-report measures used are susceptible to recall bias. Conclusion: Patients' experience of service at EDs is a key indicator to drive improvement of patient outcomes for individuals experiencing a suicidal crisis.

Past 12-month history of single and multiple suicide attempts among a national sample of school-going adolescents in Tonga

INTRODUCTION

Suicide attempt may be common among adolescents. Less is known about this in the Pacific Island country, Tonga. Therefore, this analysis estimated the frequency of suicide attempts as well as its associated factors among adolescents in Tonga.

METHOD

Cross-sectional data of 3333 adolescents (median age = 14 years) that took part in the "2017 Tonga Global School-Based Student Health Survey (GSHS)" were analyzed.

RESULTS

Almost one in seven students (16.5%) had attempted suicide in the past year (8.8% once and 7.7% more than once). Female sex, loneliness, having no close friends, often bullied, frequently in a physical fight, frequently truant from school, ever amphetamine use, and past-month tobacco use were associated with ≥2 suicide attempts. Multiple suicide attempts increased with an increase in psychosocial distress, health risk behaviors, and social-environmental factors.

CONCLUSION

Almost one in seven students attempted suicide in the past year and several risk variables were found.

Joint trajectories of life style indicators and their links to psychopathological outcomes in the adolescence

BACKGROUND

Rapid socio-economic development makes China a unique laboratory for examining how lifestyle changes affect adolescent mental health. This study aims to identify joint trajectories of modifiable lifestyle indicators during pubertal transition and its associations with psychopathological outcomes.

METHODS

A cohort of 1974 children aged 7-9 years were recruited in Anhui Province, China during March 2013. The assessment of lifestyle behaviors (screen time, physical activity, sleep duration and beverage intake) and depressive symptoms were conducted from Wave 1 to Wave 4 (2018). Suicide ideation, non-suicidal self-harm (NSSI) and alcohol use were self-reported at Wave 4. Longitudinal trajectories of lifestyle patterns were defined using group-based multi-trajectory models in 2019.

RESULTS

Four lifestyle trajectories were identified: persistent healthy (39.9%), suboptimal healthy (25.3%), unhealthy mitigation (17.2%), and persistent unhealthy (17.7%). Compared with persistent healthy group, the risk of subsequent suicide ideation [odds ratio (OR): 2.86, 95%CI: 2.15-3.81], depressive symptoms (OR: 2.16, 95%CI: 1.39-3.35), alcohol use (OR: 2.53, 95%CI: 1.78-3.61) and non-suicidal self-harm (OR: 1.35, 95%CI: 1.09-1.67) was significantly higher in persistent unhealthy group.

CONCLUSIONS

This study provided convincing evidence that unhealthy lifestyle trajectory during adolescence is associated with more than two-fold elevated odds for multiple domains of psychopathological outcomes over 5 years.

Adverse Childhood Experiences and Suicidal Behaviors Among Youth: The Buffering Influence of Family Communication and School Connectedness

PURPOSE

The main objectives of this study were to determine (1) whether family communication and school connectedness offer protection against suicidal behaviors in the presence of adverse childhood experiences (ACEs; direct protective effect) and (2) whether family communication or school connectedness buffer the association between ACEs and suicidal behaviors (interacting protective effect) on the multiplicative and additive scales.

METHODS

Data were obtained from a western state's 2019 Youth Risk Behavior Survey that included 5,341 middle school and 4,980 high school participants. Generalized linear models were used to estimate whether family communication and school connectedness offered direct protection against suicidal behaviors or buffered the association between ACEs and suicidal behaviors using adjusted prevalence ratios and corresponding 95% confidence intervals.

RESULTS

Family communication and school connectedness offered direct protection against suicidal behaviors in the presence of ACEs (a 1-unit higher score was associated with a 32%-42% lower prevalence of suicidal behaviors for middle school youth and a 27%-39% lower prevalence of suicidal behaviors for high school youth). There was evidence that family communication and school connectedness buffered the association between ACEs and suicidal behaviors on the multiplicative scale.

CONCLUSIONS

The findings provide support for the development and implementation of interventions that build family communication and school connectedness to reduce suicidal behaviors. Furthermore, screening for trauma and suicidal behaviors is warranted.

Sex differences in the associations of nonmedical use of prescription drugs with self-injurious thoughts and behaviors among adolescents: A large-scale study in China

Background To investigate the sex differences in the associations of nonmedical use of opioids and sedatives with non-suicidal self-injury (NSSI), suicidal thoughts, and suicide attempts. Methods This study presents secondary analyses of the 2015 National School-based Chinese Adolescents Health Survey. A total of 152, 527 students (aged 10-20 years) completing standard questionnaires were included in analyses. Appropriate sampling weights were utilized. Results After adjusting for the demographic profile, academic pressure, and depressive symptoms, nonmedical use of opioids (adjusted odds ratio [aOR]=1.82, 95% confidence interval [CI]=1.69~1.96) and sedatives (aOR=2.03, 95% CI=1.90~2.18) remain positively associated with NSSI, and adolescents who reported opioids or sedatives misuse were at a higher risk for suicidal thoughts and suicide attempts. A significant sex difference was found in the effects of nonmedical use of sedatives on NSSI, with the effects in girls stronger than that in boys (Ratio of two odds ratio [ROR]=1.18, P=0.011). Girls reporting nonmedical use of opioids and sedatives also had an increased risk of suicidal thoughts than boys (opioids misuse: ROR=1.25, P=0.002; sedatives misuse: ROR=1.21, P=0.006). Limitations Causal inference could not be tested due to the cross-sectional design. Conclusion Although nonmedical use of opioids or sedatives was associated with the increased risks of NSSI, suicidal thoughts, and suicide attempts among both boys and girls, there exist significant sex differences in these associations, and girls exhibited a higher risk of NSSI and suicidal thoughts than boys. Intervention strategies are needed to help vulnerable adolescents (e.g., those involved in NMUPD), with a focus on girls.

Patterns of adverse childhood experiences and suicidal behaviors in adolescents: A four-province study in China

BACKGROUND

Adverse childhood experiences (ACEs) are associated with increased suicidal behaviors in adolescents and most research has been restricted to certain types of or cumulative exposure to ACEs. Few studies have examined the association between patterns of ACEs and suicidal behaviors.

OBJECTIVE

To identify the contributions of type and pattern of exposure to ACEs to suicidal behaviors and their gender differences among middle school students in China.

METHODS

A school-based health survey was conducted in four provinces in China between 2017 and 2018. 14 500 students aged 10-20 years completed standard questionnaires, to record details of ACEs, suicide ideation, suicide plan, and suicide attempt.

RESULTS

Latent class analysis indicated four distinct patterns of ACEs exposure: high ACEs (6.3%), high abuse and neglect (21.4%), high neglect (45.5%), and low ACEs (26.8%). Logistic analyses showed that, compared with low ACEs, the high ACEs were more likely to report suicidal behaviors. No gender differences were found in the independent effects of ACEs type or pattern on suicidal behaviors, except for the emotional neglect associated with suicidal behaviors in girls than boys.

LIMITATIONS

The study was cross-sectional and used self-reported questionnaires. Thus, it is difficult to establish a causal relationship between patterns of ACEs and suicidal behaviors.

CONCLUSION

Our findings addressed the need for a comprehensive consideration of ACEs in preventive healthcare work to identify children exposed to the most problematic ACE patterns. The study provided the evidence of targeted intervention to preempt the emergence of suicide behavior in at-risk students in adolescents.

Moderating effects of plastic packaged food on association of urinary phthalate metabolites with emotional symptoms in Chinese adolescents

Previous research reports that diet is the main source of phthalate exposure to adolescents, and phthalate is associated with adolescent mental and behavioral problems. However, no study has explored the moderating effects of eating behavior in this association. This study aimed to analyze the moderating effects of plastic packaged food consumption in the longitudinal association between phthalate metabolite concentration and emotional symptoms in adolescents. This school-based survey was carried out among adolescents in two Chinese provinces. We conducted a baseline and follow-up surveys for 893 freshmen using the purposive sampling method from December 2018 to November 2019. We used food frequency questionnaire to assess eating behavior. The Chinese version of 21-item Depression Anxiety Stress Scales was used to assess emotional symptoms, and high-performance liquid chromatography-tandem mass spectrometry was used to analyze the concentration of six urine phthalate metabolites. The results of latent moderation model indicated that plastic packaged food consumption moderated the association of low molecular weight phthalate (LMWP) with depressive symptoms (β = 0.27, P = 0.002), anxiety symptoms (β = 0.89, P < 0.01), and stress symptoms (β = 0.23, P = 0.019). The moderating effects were significant at the higher scores (β = 0.14-0.35, P < 0.05) and/or the lower scores (β = -0.35 to -0.12, P < 0.05) of plastic packaged food consumption. The results suggest that plastic packaged food consumption to some extent moderates the longitudinal association of phthalate exposure with emotional symptoms in adolescents.

Single and Multiple Suicide Attempts: Prevalence and Correlates in School-Going Adolescents in Liberia in 2017

Background

This investigation aimed to estimate the prevalence and correlates of single and multiple suicide attempts among adolescents in Liberia.

Methods

Cross-sectional nationally representative data were analysed from 2744 adolescents (18 years of median age) who participated in the "2017 Liberia Global School-Based Student Health Survey (GSHS)".

Results

Results indicate that 33.7% of students had made a suicide attempt in the past 12 months (16.5% single and 17.2% multiple suicide attempts). In adjusted multinomial logistic regression analysis, having no close friends, loneliness, having been frequently physically attacked, ever used amphetamine and fast food intake were associated with multiple suicide attempts in the past 12 months. In addition, having been frequently in a physical fight and current tobacco use were associated with single suicide attempt. In sex stratified analyses, in addition, among boys frequent bullying victimization and among girls, parental tobacco use and parents never or rarely check on home work were associated with multiple suicide attempts. Multiple psychosocial distressors, multiple social-environmental factors, and multiple health risk behaviours were associated with single and multiple suicide attempts.

Conclusion

One in three students had made suicide attempt in the past 12 months (one in six students multiple suicide attempts) and several associated variables were detected which can aid in designing intervention strategies.

Predictors and correlates of lifetime and persistent non-suicidal self-injury and suicide attempts among adult survivors of childhood sexual abuse

Background: Childhood sexual abuse (CSA) is a well-established risk factor for non-suicidal self-injury (NSSI) and suicide attempts (SA); still few studies have examined predictors of individual differences in NSSI/SA amongst CSA survivors. Objective: To examine predictors of NSSI and SA among adult CSA-survivors. Methods: In a sample of 516, primarily female adult CSA-survivors recruited from support centres for sexual abuse survivors in Norway, we examined the role of abuse/perpetrator characteristics, and the degree/severity of exposure to other types of childhood maltreatment (cumulative childhood maltreatment; CCM), as predictors of lifetime NSSI and SA. In a subsample of 138 individuals responding to follow-up waves two- and four years later, these same distal factors, as well as previous NSSI and proximal factors in the form of symptoms of mental health disorders (posttraumatic stress, anxiety, depression, sleep disturbances, and eating disorders), relational problems, and perceived social support, were examined as predictors of persistent NSSI. Finally, those attempting new SA during the follow-up period were compared to those who did not on these variables. Results: Higher CCM scores and having had an unknown perpetrator positively predicted lifetime NSSI scores. Higher CCM scores, violent abuse, and having had an unknown perpetrator predicted lifetime SA. Higher CCM scores, previous NSSI, having had a known perpetrator, as well as higher depression-, anxiety- and eating disorder scores, positively predicted persistent NSSI during the four-year follow-up period. Compared to those with no new SA, those reporting new SA during the follow-up period had higher CCM, lifetime NSSI, mental health symptoms and relational problem scores, lower perceived social support scores, and were more likely to have done a past SA and to have experienced abuse involving physical violence. Conclusions: A broad range of both distal and proximal factors should be assessed as potential predictors of NSSI and SA among adult CSA-survivors.

Resilience is inversely associated with self-harm behaviors among Chinese adolescents with childhood maltreatment

Background

Abundant studies have identified the association between childhood maltreatment and self-harm (SH), but little has been discussed with regard to the role of resilience in SH behaviors of adolescents who had experienced childhood maltreatment. In this study, we investigated if resilience, as well as its five dimensions, could present negative associations with presence, repetition, and severity of SH among maltreated and neglected adolescents in China.

Methods

A cross-sectional survey including 2,084 maltreated teenagers aged from 10 to 17 years was conducted in southwest China Yunnan province. The Childhood Trauma Questionnaire (CTQ), The Resilience Scale for Chinese Adolescents (RSCA), and the Modified version of Adolescents Self-Harm Scale (MASHS) were adopted to measure childhood maltreatment experiences, psychological resilience, and SH behaviors of the respondents, respectively. Binary univariate and multivariate logistic regression models were employed to discuss the associations between resilience and occurrence, repetition, severity of SH.

Results

Among the participants who met the criteria of CTQ, the prevalence rates of SH were 63.83%, 73.94%, 71.50%, 55.53%, and 58.21% for physical abuse (PA), emotional abuse (EA), sexual abuse (SA), physical neglect (PN), and emotional neglect (EN). Final regression model demonstrated that resilience was in general inversely associated with SH, repeated SH, and severe SH for all types of childhood maltreatment, with adjusted odds ratios (aORs) ranging from 0.29 (95% CI: 0.19-0.44) to 0.46 (95% CI: 0.26-0.81). Of the five dimensions of resilience, emotion regulation served as the strongest associated factor of SH among abused youths, regardless of maltreatment types. Besides, compared with those who had lower level of goal concentration and interpersonal assistance, subjects with higher resilience level reported significantly decreased risks of SH occurrence, SH repetition, and more severe SH, in adolescents who had experienced EA and PN.

Conclusions

Resilience showed inverse association with childhood maltreatment related SH in Chinese adolescents. These findings preliminarily indicated that interventions targeting on building up resilience, especially enhancing emotion regulation ability, improving goal concentration, and consolidating interpersonal assistance, could be effective in reducing SH risk, repetition, and severity in maltreated Chinese teenagers.

The social context of nonsuicidal self-injury: Links to severity, suicide risk, and social factors

OBJECTIVES

Though nonsuicidal self-injury (NSSI) is generally considered to be a private act, 21%-52% of individuals who engage in NSSI do so around others. Those who engage in NSSI alone often demonstrate severe behavior. However, little is known about the distinction between those who only sometimes versus always engage in NSSI when they are around others. Three groups of individuals who engage in NSSI were examined: Always, sometimes, and never alone.

METHOD

Participants (N = 861; 84.2% female; M age = 20.06) were undergraduates who answered online questionnaires. Severity of NSSI, suicide risk, and social risk factors were used to predict group membership.

RESULTS

Engaging in NSSI around others aligned with less severe NSSI behavior, lower suicide risk, and fewer interpersonal difficulties versus those who engage in NSSI alone.

CONCLUSIONS

NSSI's social context may indicate clinical severity. This information is useful for clinicians who work with individuals with a history of NSSI.

Prevalence and associated factors of suicidality in Japanese adolescents: results from a population-based questionnaire survey

Background

Suicide is the leading cause of death among Japanese adolescents. However, knowledge gaps regarding contemporary demographics and factors associated with suicidality among Japanese adolescents are a major concern. This study examined the prevalence of suicidality among Japanese adolescents and investigated associated factors.

Methods

A population-based questionnaire survey investigating general health was administered to 22,419 adolescents aged 13–18 years. The 29-item questionnaire covered emotional status, family function, cyberbullying, suicidality, and stressors (e.g., relationships with parents/friends, school performance, and sexual identity). We conducted multiple logistic regression analysis to identify factors associated with suicidality in this population.

Results

The prevalence of suicidal ideation was 21.6% in males and 28.5% in females, and that of attempted suicide was 3.5% in males and 6.6% and in females. Bullying and stress related to family relationships had the strongest associations with suicidality. Exposure to cyberbullying had the highest odds ratio for both junior high (3.1, 95% confidence interval [CI] 2.1–4.4) and high school students (3.6, 95% CI 2.5–5.3). Other factors significantly associated with suicidality were sex, emotional status, and stress about relationships with friends, sexual identity, school records, and academic course. Adolescents accessed a variety of resources to cope with stressors, with the Internet being the most common resource consulted.

Conclusions

Suicidality is commonly experienced among Japanese adolescents. Although there are many associated risk factors, cyberbullying is of particular concern. Recognition of factors associated with adolescent suicidality will inform further research and suicide prevention efforts for healthcare providers and families.

The effect of adverse childhood experiences on depression, psychological distress and suicidal thought in Vietnamese adolescents: Findings from multiple cross-sectional studies

Exposing to adverse childhood experiences (ACEs) has been identified as one of the major contributing factors to poor mental health and suicide in adolescents. However, little is known about this relationship in Vietnamese adolescents. This study aimed to evaluate the effect of ACEs on depression, psychological distress and suicidal thought among Vietnamese adolescents across different areas in Vietnam. Cross-sectional surveys were conducted among 4957 secondary school and high school students aged 13-20 in urban area, rural area, border area and mountainous area. The students were asked to complete a self-report questionnaire which included the Center for Epidemiological studies - Depression, the Kessler-10 and ACE questionnaire from the WHO Adverse Childhood Experiences Study. Suicidal thought was evaluated by a single question from the U.S. Youth Risk Behavior Survey. Among 4720 students included in the analysis, 54.4% were female. The prevalence of depression, psychological distress and suicidal thought was 22.9%, 30.6% and 10.9% respectively. About 86% of participants experienced at least one type of ACEs and nearly 56% reported multiple types of ACEs. Students with four or more types of ACEs had 6.98 (95% CI 5.09 -9.56), 4.72 (95 % CI 3.58-6.23) and 6.43 (95 % CI 4.45-9.30) times higher in odds of having depression, psychological distress and suicidal thought respectively. In conclusion, ACEs are common in Vietnamese adolescents and are strongly associated with depression, psychological distress and suicidal thought. Our finding indicates urgent needs for interventions targeting both ACEs and depression, psychological distress in Vietnamese adolescents.

The prevalence of child maltreatment among Chinese primary and middle school students: a systematic review and meta-analysis

PURPOSE

The purpose of this study was to provide an estimate of the prevalence of child maltreatment among Chinese primary and middle school students. An attempt was also made to explore the causes of heterogeneity by analyzing stratified variables and other potentially related factors included in the study.

METHODS

Literature retrieval has been carried out in the databases, including Pubmed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database and China Biology Medicine disc (CBMdisc), for relevant published studies up to October 2019. The Cochran's chi-squared test (Cochran's Q), I² test and subgroup analysis were performed to evaluate the heterogeneity. Funnel plots were used to detect publication bias. Trim-and-fill method was performed to identify possible asymmetry and assess the robustness of the conclusions.

RESULTS

A total of 1433 studies were obtained after retrieval. Finally, 19 eligible studies were included in meta-analysis after detailed exclusion. The pooled prevalence of child physical abuse (CPA), child emotional abuse (CEA), child sexual abuse (CSA), child physical neglect (CPN) and child emotional neglect (CEN) were 0.20 (95% CI 0.13, 0.27), 0.30 (95% CI 0.20, 0.39), 0.12 (95% CI 0.09, 0.15), 0.47 (95% CI 0.35, 0.58) and 0.44 (95% CI 0.28, 0.59), respectively. In subgroup analyses, a higher prevalence of CEN was reported in rural areas. Meanwhile, the prevalence of CPN and CEN in non-only child group was higher than that observed in only child group. Compared with children without mental symptoms, children with mental symptoms have a higher incidence of all categories of child maltreatment. In terms of assessment tools, studies using Childhood Trauma Questionnaire as an assessment tool reported lower prevalence of CPA, CEA. Childhood Trauma Questionnaire In addition, the prevalence of CPN, CEN in studies conducted in northern China was significantly higher than that estimated in southern and central China. For CSA, eight additional studies required trimming according to the trim-and-fill analysis, and the pooled estimate was 0.042 after filling. For CPA, CEA, CPN and CEN, there were no indications of publication with the trim and fill method (data unchanged).

CONCLUSION

Our findings indicated that primary and middle school students had a relatively high prevalence of maltreatment. Because of the visible heterogeneity of the studies included, more large samples, high-quality and prospective studies are needed in the future to acquire the accurate prevalence of child maltreatment in China. Certainly, future research needs to focus not only on the estimate of prevalence of child maltreatment, but also on risk factors and intervention strategies for child maltreatment.

Association of Childhood Maltreatment With Suicide Behaviors Among Young People: A Systematic Review and Meta-analysis

Importance

Children and young people's reports of experiences of adverse childhood events have increased in recent years, and this trend has been associated with an elevated risk for suicide behaviors. However, a systematic review and meta-analysis is needed to confirm the significance of this association in young people.

Objective

To quantify the association between core types of childhood maltreatment, including sexual, physical, and emotional abuse and/or neglect and suicide behaviors in children and young adults.

Data Sources

Medline, PsychInfo, Embase, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health) databases were searched from January 1, 1980, until December 31, 2019. The reference lists of all the included studies were also checked.

Study Selection

Quantitative studies that focused on the association between core types of childhood abuse and/or neglect and suicide ideation, plans, and attempts.

Data Extraction and Synthesis

Data were extracted by 2 independent raters. Publication bias and risk of bias across studies were assessed. Meta-analyses using random-effect models were applied, and heterogeneity was quantified using the I2 statistic. Data were analyzed from January to May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines.

Main Outcomes and Measures

The association between core types of childhood maltreatment and suicide behaviors.

Results

Seventy-nine studies with 337 185 young individuals (mean [SD] age, 15.67 [2.11] years; 63.19% female) were included. The findings demonstrated that sexual abuse (odds ratio [OR], 3.41; 95% CI, 2.90-4.00), physical abuse (OR, 2.18; 95% CI, 1.75-2.71), emotional abuse (OR, 2.21; 95% CI, 1.37-3.57), emotional neglect (OR, 1.93; 95% CI, 1.36-2.74), physical neglect (OR, 1.79; 95% CI, 1.27-2.53), and combined abuse (OR, 3.38; 95% CI, 2.09-5.47) were significantly associated with higher rates of suicide attempts. Core types of childhood maltreatment were also associated with as much as 2.5-fold greater odds for suicide ideation, and sexual abuse with a 4.0-fold increase for suicide plans. Studies based on community samples (β [SE] = -1.68 [0.79]; P = .04) or with lower methodological quality (β [SE] = -2.86 [1.30]; P = .03) were associated more strongly with suicide attempts in those reporting experiences of sexual abuse, whereas young age was associated with both suicide attempts (β [SE] = -0.59 [0.27]; P = .03) and ideation (β [SE] = -0.41 [0.18]; P = .03).

Conclusions and Relevance

These findings suggest that policy actions should focus on raising public awareness and offering proactive suicide prevention therapies for children and young adults who have experienced abuse and/or neglect.

A Theory-Based Longitudinal Investigation Examining Predictors of Self-Harm in Adolescents With and Without Bereavement Experiences

BACKGROUND

Research has demonstrated that exposure to suicide can lead to increased vulnerability for self-harm or suicide. As a result, ideation-to-action models of suicide (e.g., the Integrated Motivational-Volitional Model of Suicide; IMV) recognise exposure as a significant risk factor which may be implicated in the translation of thoughts into actions. However, few studies have tested this theoretical link explicitly within an adolescent population, and examined how it compares to other types of bereavements.

METHODS

A 6-month prospective questionnaire study was conducted with 185 Scottish adolescents aged 11-17 (113 adolescents also completed the questionnaire at follow-up). The questionnaire included measures on experiences with bereavement and lifetime engagement in self-harm, as well as measures of defeat, entrapment, social support, coping, and other psychological variables.

RESULTS

At baseline, 12% of young people reported exposure to a suicide death, and 61% to a non-suicide death. In addition, 21% of pupils reported ever engaging in self-harm, while 23% had experienced self-harm ideation without engaging in it. Cross-sectional multivariate logistic regressions showed that family social support, glorifying/normalising beliefs about suicide, and family self-harm were significantly associated with self-harm group membership (control, ideation, or enactment groups). At follow-up, 10% of pupils reported exposure to a suicide death and 16% to a non-suicide death for the first time. A total of 26% of the sample reported self-harm at T2 (11% of participants for the first time), and 24% reported self-harm ideation without engaging in it. Multivariate analyses found that self-harm ideation and family self-harm at baseline were the only variables to predict self-harm group membership prospectively, in the expected directions. Bereavement experiences, whether by suicide or non-suicide, did not predict self-harm group status at baseline nor at follow-up.

CONCLUSIONS

This study provides support for the validity of a theoretical model of suicide, even though predictive ability over the 6-months period was limited. Although difficulties with recruitment may have limited the statistical power, this study provides insight into the prevalence and experiences of suicide bereavement among adolescents and the factors related to the onset and maintenance of self-harm.

Research on the Relationships between Psychological Problems and School Bullying and Non-Suicidal Self-Injury among Rural Primary and Middle School Students in Developing Areas of China

(1) Purpose: To analyze the role of psychological problems in connection with school bullying and non-suicidal self-injury (NSSI) among rural primary and middle school students in developing areas of China. (2) Methods: A multi-stage, stratified, cluster random sampling method was used to select 2284 rural primary and middle school students in Jiangxi Province for study. Questionnaires regarding the health risk behaviors of children in developing areas were left behind at primary and middle schools, and they were later collected and analyzed by using the mental health diagnostic monitoring scale for Chinese primary and middle school students. Pearson correlation, logistic regression, and bootstrap tests were conducted to analyze the association between psychological problems, school bullying, and NSSI. (3) Results: The incidence of NSSI in rural primary and middle school students in Jiangxi Province was 14.84%. Compared with other children with behavioral problems, those who had experienced school bullying and had mild/severe psychological problems were more likely to have engaged in NSSI behaviors (p < 0.001). Psychological problems have a mediating effect between school bullying and NSSI, which accounted for 12.96% of the total effect. (4) Conclusion: Psychological problems are likely an effect modifier in the connection between school bullying and NSSI behaviors. Therefore, effectively targeting psychological problems in rural primary and middle school students in Jiangxi Province may help prevent and control NSSI behaviors in students who have experienced school bullying.

Sex differences in the determinants of suicide attempt among adolescents in China

Little is known about the sex differences in the determinants of suicide attempt among adolescents. The results from 14,820 students in China revealed that girls who were in younger age (10-13y), living in urban area, having lower social support and exposed to physical abuse were more likely to report SA compared to their boys counterparts. Conversely, the impact of having psychological symptoms on SA was stronger in boys than girls. Our findings highlight the importance that groups at highest risk of SA should be targeted accordingly by sex.

Mediating Effect of Social Support in the Relationship Between Childhood Abuse and Non-Suicidal Self-Injury Among Chinese Undergraduates: The Role of Only-Child Status

Previous research has found a relationship between child abuse and non-suicidal self-injury (NSSI). However, few studies have examined the role of social support underlying this association. Moreover, the influence of the only child status on the mediating effect of social support has not been studied yet. The aim of this study was to investigate the mediating role of social support on the association between specific forms of child abuse and NSSI as well as the role of the only child status on the mediated pathways, among undergraduates. A total of 4799 participants were selected from two medical colleges in the Anhui province using stratified cluster sampling. Pearson's correlation analysis was used in analyzing the relationship. Bootstrapping procedures were applied to examine the mediating effects. After adjusting for confounders, the results showed that the mediating effect of social support on the association between childhood abuse and NSSI was not significant in the total sample. However, among only children, the mediating effects of social support between overall childhood abuse, physical abuse, emotional abuse, and NSSI were 9.65%, 14.82%, and 8.12%, respectively. Moreover, the mediating effect of social support from family and relatives was relatively higher than that from other sources. Social support had a mediating effect on the relationship between childhood abuse and NSSI among only-children. The enhancing of social support may contribute to the prevention and control of NSSI for those who were only-children in undergraduates, especially those who have experienced childhood abuse.

"A problem shared is half solved" - a qualitative assessment of barriers and facilitators to adolescent retention in HIV care in western Kenya

Adolescents living with HIV (ALHIV, ages 10-19) are retained in care at low rates, resulting in poor clinical outcomes. We investigated barriers and facilitators to retention experienced by perinatally infected ALHIV in western Kenya. This qualitative study purposefully sampled hospitalized ALHIV (engaged and not currently engaged in care), ALHIV engaged in outpatient care, and caregivers of ALHIV. In total, 116 ALHIV and caregivers participated in interviews or focus group discussions. Challenges related to the effects of both stigma and poverty at multiple socio-ecological levels pose the greatest barriers to adolescent retention in HIV care. Adolescents with positive relationships with family, clinic, and/or peers with the resources to support their care are facilitated to overcome these barriers. Conversely, adolescents with few of these supports due to orphanhood, caregiver illness, severe poverty, family conflicts, negative relationships with healthcare workers, or isolation, have the greatest challenges staying in care, and maybe at risk of disengagement. Experiences of trauma emerged from narratives of disengagement, and contribute to isolation, mental health challenges, and difficulties engaging in care. Retention of the most vulnerable adolescents will require interventions to mitigate the impacts of stigma, poverty, mental health issues, and limited social support on HIV care engagement.

Research on Relationships between Sexual Identity, Adverse Childhood Experiences and Non-Suicidal Self-Injury among Rural High School Students in Less Developed Areas of China

Purpose: The objective of this study was to examine the influence of sexual identity and adverse childhood experiences (ACEs) on non-suicidal self-injury (NSSI) among rural high school students in less developed areas of China. Methods: Behavior risk factors data collected from 1810 students from a high school in Jiangxi province, China. Five measures of childhood abuse and household dysfunction were summarized, and ACE was divided into 0, 1, 2, 3–5 ACEs. Logistic regression analysis was used to explore the influence of sexual identity, adverse childhood experiences, and their interaction with non-suicidal self-injury. Results: Compared with heterosexual students, high school students who identify as lesbian, gay, or bisexual (LGB) have a higher tendency of non-suicidal self-injury (AOR = 3.250, 95% CI = 1.69–6.28, p < 0.01). There was also a graded relationship between cumulative ACEs exposure and non-suicidal self-injury behaviors (AOR = 1.627, 95% CI = 1.02–2.60, p < 0.05). Odds for NSSI are higher among students with both experienced ACEs and identified as LGB (AOR = 2.821, 95% CI = 1.51–5.29, p < 0.05). Conclusions: Non-suicidal self-injury is associated with ACEs exposure and with those who identify as LGB, and the NSSI odds are greater when students identify as LGB and have experienced ACEs. More interventions to reduce non-suicidal self-injury should focus on LGB and ACEs and more attention needs to be paid to those who identify as LGB and have been exposed to ACEs.