Bullying, Depression, and Suicidal Ideation Among Adolescents in the Fujian Province of China: A Cross-sectional Study

Cyber social proof and hazard: Investigating the impact of social media on pediatric burn incidents - Analysis and comprehensive literature review

Investigating the growing concern of pediatric burn injuries caused by social media challenges. Adolescents, seeking fame or succumbing to peer pressure, engage in risky behaviors, recording and sharing them online. The study presents two case reports detailing severe burn injuries resulting from such challenges, highlighting the physical and psychological toll on affected children and their families. In Case report 1, a 14-year-old suffered severe burns attempting a TikTok challenge involving igniting a soaked t-shirt. The patient's critical condition necessitated intensive care, surgical procedures, and skin grafts, accompanied by complications like anemia and sepsis. Case report 2 features a 9-year-old who sustained extensive burns while attempting another social media challenge. Treatment included escharolysis, skin grafts, and surgeries, with complications managed during the recovery process. A literature review explores social media-generated burn injuries, revealing their physical and psychological impact. The influence of social proof and peer pressure on adolescents' behavior in the digital age is discussed. The pandemic's effect on mental health is considered, emphasizing the vulnerability of adolescents to such challenges. In conclusion, the paper highlights the rising incidence of teen burn injuries linked to social media challenges. Urgent measures are needed to restrict the promotion of risky behaviors on social platforms. Alongside state-of-the-art burn treatments, comprehensive psychological care is essential for young patients and their families to cope with trauma. Increased content monitoring and the dissemination of prevention materials are recommended to mitigate the occurrence of such incidents.

School Bullying Victimization and Depression Symptoms in Adolescents: The Mediating Role of Internet Addiction and Moderating Role of Living Areas

School bullying and depression are both serious social and public health problems among adolescents. Prior studies indicated a correlation between bullying and depression. However, the potential moderators remain largely unexplored. This study aimed to identify the mediating effect of Internet addiction and the moderating effect of living in urban or rural areas in the relationship between school bullying victimization and depression symptoms among Chinese adolescents. This cross-sectional study of adolescents was conducted using two-stage random cluster sampling of students in urban and rural public high schools in China. A moderated mediation model was constructed to uncover the underlying mechanism of school bullying victimization and depression symptoms. A total of 2,376 adolescents (52.65% females, mean age ± SD a 14.69 ± 1.76 years) were included in the study. The prevalence of clinical depression symptoms with a cut-off value of 16 on the Center for Epidemiological Studies Depression Scale (CES-D) was 21.76% (95% CI: 20.15, 23.46), and with a cut-off value of 20 on the CES-D was 13.85% (95% CI: 12.51, 15.30) for overall. Our findings indicated a significant positive association between school bullying victimization and depression symptoms (p < 0.01) and a significant mediating effect of Internet addiction in the association between school bullying victimization and depression symptoms (indirect effect = 1.143, 95% CI: 0.677, 1.609; percentage of mediation: 16.7%, 95% CI: 10.3, 23.1). This indirect relationship was partially moderated by the living in urban or rural areas in the mediation process. Specifically, the effect of school bullying victimization on Internet addiction was greater among urban adolescents (simple slope: 0.774, 95% CI: 0.524, 1.024, p < 0.01) than among rural adolescents (simple slope: 0.337, 95% CI: 0.132, 0.543, p < 0.01), but moderating effect of urban-rural areas was not significant on the relationship between Internet addiction and depression symptoms. These findings highlight the mediating role of Internet addiction and the moderating role of living areas in school bullying victimization and adolescents' depression symptoms, which provide evidence for social work, mental health services, and policy interventions for adolescents in China.

The effect of bullying and cyberbullying on predicting suicide risk in adolescent females: The mediating role of depression

This paper analyzed the role of depression as a mediator in the association between bullying, cyberbullying, and suicide risk in adolescent females. A total of 751 Colombian adolescent females (M= 13.71, SD=1.897), who were administered the Plutchik Suicide Risk Scale, the Beck Depression Inventory, the European Bullying Intervention Project Questionnaire and Cyberbullying. Bullying victimization and aggression and cyberbullying victimization were found to contribute statistically significant effects that explaining 22 % of the variance in depression. The variables of victimization in bullying and cyberbullying and depression explained 64 % of the variance in suicidal risk, and depression mediated the association between victim and aggressor roles in bullying and cyberbullying in predicting suicidal risk, whose total direct and indirect effects are statistically significant. The findings support the role of depression as a mediating variable between bullying and cyberbullying and suicidal risk in female adolescents and highlight the importance of focusing prevention and intervention efforts on risk factors for depression and suicidal behavior in cases of bullying and cyberbullying.

The mediating role of sleep problems and depressed mood between psychological abuse/neglect and suicidal ideation in adolescent childhood: a multicentred, large sample survey in Western China

BACKGROUND

Adolescent suicidal ideation are associated with factors including psychological abuse/neglect, sleep problems, and depressed mood, but the systematic effects of these factors on suicidal ideation remain unclear, which is a research gap this work aims to fill.

METHODS

A multi-center, the cluster sampling method was employed to collect general demographic data, such as age, gender, the experience of being left behind, and parents' marital status, from 12,192 students across 17 secondary schools in China. The Child Psychological Abuse and Neglect Scale (CPANS), Pittsburgh Sleep Quality Index (PSQI), the Chinese version of the Depressed mood, Anxiety and Stress Scale - 21 Items (DASS-21) and Chinese version of Positive and Negative Suicide Ideation Inventory (PANSI) were utilized. Data were analyzed using t-tests, chi-square tests, correlation analyses, and structural equation modeling mediation analyses.

RESULTS

The prevalence of psychological abuse/neglect and adolescent suicidal ideation was 34.8% and 13%, respectively. This mediation analysis suggests that, in the relationship between psychological abuse/neglect and suicidal ideation, sleep problems and depressed mood play both parallel and sequential mediating roles.

CONCLUSION

Sleep problems and depressed mood play a mediating role in the development of suicidal ideation in adolescents. Good sleep habits and depressed mood interventions help reduce the risk of suicidal ideation in adolescents who experience psychological neglect/abuse.

The prevalence of suicide attempt and suicidal ideation and its relationship with aggression and bullying in Chilean adolescents

Background

Suicide constitutes one of the main mental health problems worldwide, requiring detection, and prevention efforts, especially in the adolescent population.

Objective

The purpose of this study was to estimate the prevalence of suicide attempts and suicidal ideation and their relationship with aggressiveness and bullying in Chilean adolescents.

Materials and methods

The sample was composed of 728 adolescents schooled from Arica city: 56.6% were males and 43.4% were females. The students attended from de 1st to the 4th year of secondary. The average age of the sample was 15,6 years. The following instruments were used: Okasha's Suicidality Scale, Buss and Perry's Aggressiveness Survey, and the Social Acceptance (School Bullying) sub-test of the Kidscreen-52 Survey. A cross-sectional, descriptive, and correlational design was applied. The sampling was non-probabilistic for convenience.

Results

18.4% of the students reported that they had attempted suicide and 65.6% reported that they had suicidal ideation. The prevalence of suicide attempts was higher than in male adolescents (29,1% vs. 10,2%), and the same prevalence was for suicidal ideation (76,6% vs. 57,3%). Suicide attempts and suicidal ideation were positively and significantly correlated with aggressiveness (r = 0.32, r = 0.48) and bullying (r = 0.37, r = 0.50).

Conclusion

The prevalence of suicide attempts and suicidal ideation is both higher in girls than boys. In this sense, girls constitute a risk group. In addition, this study provides evidence that supports the relationship between suicide attempts and suicidal ideation. The results highlight the role that educational institutions should have in terms of prevention and effective approaches.

Negative life events increase the risk of suicidal ideation in 6653 Chinese freshmen: From a 1-year longitudinal study

BACKGROUND

Suicide is one of the leading causes of juvenile death. Suicidal ideation (SI) is a strong predictor of suicide, while negative life events are associated with SI in adolescents. The aim of this study was to investigate the effect of negative life events on SI in a sample of Chinese freshmen.

METHODS

The current study employed a cluster sampling method with 7118 freshmen at baseline and 6653 at follow-up. Negative life events were assessed by using the Adolescent Self-Rating Life Events Check List (ASLEC), and SI was assessed by a separate question for self-report. The PHQ-9 was used to measure depression at baseline.

RESULTS

The incidence of suicidal ideation was 1.52% (95% CI: 1.22%-1.81%). Two dimensions of negative life events, interpersonal relationship and others were risk factors for SI, while female students were more susceptible to them. Consistently, interpersonal relationship and others were risk factors for SI in participants without depression and with mild depression. However, health & adaptation was found to be the only dimension of negative life events contributing to the risk of SI in participants with moderate, severe and extremely severe depression.

LIMITATIONS

There may be recall bias in this study.

CONCLUSIONS

Negative life events increase the risk of SI in college students. Female students are more susceptible to negative life events. The effect of different dimensions of negative life events on SI varies in participants with and without depression.

Influence of Experiencing Bullying Victimization on Suicidal Ideation and Behaviors in Korean Adolescents

This study was conducted to identify the association between experiencing bullying victimization and suicidal ideation and behaviors, so as to identify the influencing factors on suicidal ideation, suicide plans, and suicide attempts among Korean adolescents. This study analyzed data from the Korean Psychosocial Anxiety Survey. The survey used nationally representative samples of Korean adolescents aged 14 to 18 years old. The experience of bullying victimization negatively influenced suicidal ideation and suicide plans, but not suicide attempts. This influence was reduced, but still remained after controlling depression, anxiety, relationships with family, relationships with teachers and friends, and social support. Influencing factors differed with suicidal ideation, plans, and attempts. Anxiety was the only factor associated with all stages of suicidality. When developing future interventions, health providers need to consider the differences in the factors associated with each stage of suicidality in adolescents.

Bullying as a Risk Factor of Depression on Undergraduate Health Students

Depression is a serious health problem that needs to be treated early so that it does not get worse in the future. Bullying can cause a mental health problem on students. This study aims to analyze the relationship between bullying and depression among undergraduate health students. This was an observational study with a cross-sectional design. Respondents filled out questionnaires online using the Google Form application. A total of 246 undergraduate health students participated in this study. Multivariate logistic regression was used to analyse the data. There was a relationship between bullying and the incidence of depression in undergraduate health students (AOR: 2.158 (95% CI: 1.050-4.435)) after being controlled by physical attacked, close friends, loneliness, and smartphone addiction. This study proves that bullying is a risk factor for depression. Prevention of bullying is important to prevent depression. Handling and prevention are done by involving peer support from students through peer-counselor or peer-educator programs. Students with severe depression need to be treated further through an appropriate referral system.

Bullying and Suicide Ideation: Testing the Buffering Hypothesis of Social Support in a Sub-Saharan African Sample

Substantial evidence indicates that adolescents and young adults have a disproportionately high incidence of most forms of violence, including suicide. Suicidality often includes suicidal ideation. The present study examined the relationship between bullying and suicidal ideation, and further tested whether social support moderates the association between the dimensions of bullying (verbal bullying, physical bullying, and bullying victimization) and suicidal ideation among adolescent secondary school students. A cross-sectional design was adopted for the study. Participants were 394 students (249 boys, 145 girls) drawn from two secondary schools in Nsukka semi-urban area, in southeast Nigeria. Participants completed the Illinois Bully Scale, the Columbia-Suicide Severity Rating Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Hayes' regression-based PROCESS macro was used to analyze the data. Verbal bullying, physical bullying, and victimization were independently positively associated with suicidal ideation. Social support was not independently significantly associated with suicidal ideation, but it moderated the relationship between victimization and suicidal ideation. The positive relationship between victimization and suicidal ideation was strongest for adolescents who had low social support, compared to those who had moderate or high social support. This finding is consistent with the buffering hypothesis of social support, suggesting that supportive relationships for victims can mitigate suicidal ideation.

Bullying Victimization and Life Satisfaction Among Rural Left-Behind Children in China: A Cross-Sectional Study

Objectives: This study aimed to evaluate the associations between bullying victimization and life satisfaction in primary school children and also investigate the interactive effects of left-behind status and bullying victimization on life satisfaction. Materials and Methods: Bullying victimization was measured using the Chinese version of the revised Olweus Bully/Victim Questionnaire. Life satisfaction was assessed using the Multidimensional Students' Life Satisfaction Scale (MSLSS). Life satisfaction is composed of five domains, namely, family, school, friends, environment, and self-satisfaction. Left-behind status of rural children was defined as one or both their parents migrating to working in cities. The data were analyzed using Mann-Whitney U tests, Chi-square tests, and multivariate linear and logistic regression analyses. Results: A total of 810 primary school children were involved, of which 8.5% reported bullying victimization, and 44.3% were left-behind children (LBC). We found that bullying victimization was negatively associated with all domains of life satisfaction (all p < 0.05). With further left-behind status-stratified analysis, we found that negative association between bullying victimization and friend satisfaction was more profound in the LBC group than in the non-LBC group [b(SE)= -0.133 (0.03) vs. -0.061 (0.026) for LBC and non-LBC, respectively, p < 0.05]. When further interaction analysis was conducted, we identified interaction effects between left-behind status and bullying victimization on friend satisfaction (p _interaction = 0.048). Similar interaction effect between bullying victimization and left-behind status on school satisfaction was also found (p _interaction = 0.004). Conclusions: Bullying victimization was associated with low life satisfaction (including lower family, friends, school, self, and environment satisfaction). There were significant interactions between left-behind status and bullying victimization on friend satisfaction, as well as school satisfaction. Left-behind status of children may exaggerate the impact of bullying victimization on friends/school satisfaction rating.

Exposure to violence and suicidal ideation among school-going adolescents

Objective: Despite growing international interest in the area of violence and suicidal ideation among school-going adolescents, epidemiological data are scant in Portugal. The objective of this study was to measure the prevalence of suicidal ideation among Portuguese adolescents from 7th to 12th grade and to estimate the association of violence exposure with suicidal ideation. Method: A cross-sectional survey was conducted among 2 602 adolescents enrolled in public schools in Porto, Portugal. Sampling was performed in four school groups consisting of seven schools, during the 2014/2015 academic year. Results: The results revealed that 11.4% of Portuguese school-going adolescents reported suicidal thoughts during the past 12 months. Moreover, adolescents who had been involved in physical fighting were two times more likely to have suicidal thoughts. These odds substantially increased when bullying and cyberbullying victimisation were included. Conclusion: Effective interventions with multidisciplinary efforts involving parents, school teachers, principals, and mental health professionals, should be integrated into school-based programmes to improve adolescents' mental health and strengthen them against suicidal ideation.

Vertical vs horizontal bullying: A need of socio-interactive ethical trainings at workplace

Bullying at workplaces is a growing problem associated with several antecedents and outcomes of psychological disorders. Extant literature shows the relationship of victimization with the owning-up curriculum to confront bullying, but so far there is little research to cure the issue of bullying through ethics and there is no study to check the impact of ethical lessons and exercises in training materials to curb bullying at workplace. The current paper is based on a literature review of aggression and bullying, and chiefly addresses the HR practices in rescuing the people from peer victimization. Conceptually segregating supervisor-subordinate (vertical) and peer-peer (horizontal) bullying psychology, this paper attempts to see what possible corrective steps can be taken by senior managers, supervisors and psychologists to resolve this critical problem through interior capacities. In this paper, we have developed three propositions for conducting a future empirical investigation in connection to a cohort study. By addressing the counterproductive/deviant behavior, the present report is likely to be beneficial for psychology scientists and HR practitioners in noticing and resolving the bullying issues at the workplace for the well-being of employees.

Bullying victimization among Lebanese adolescents: The role of child abuse, Internet addiction, social phobia and depression and validation of the Illinois Bully Scale

Background

Both bullying victimization and perpetration were associated with depression, social phobia, physical and psychological child abuse and Internet addiction in Lebanon. The prevalence of bullying in Lebanon is alarming, with 50% of school-aged children and adolescents reporting being bullied at some point. The high rate of both bullying victimization can be reflective of the inefficacy of current prevention and intervention policies in targeting associated problematic individual and contextual factors. The objective of the present study was to analyze factors associated with bullying victimization and validate the Illinois Bully Scale among Lebanese adolescents.

Methods

This is cross-sectional study that took place between January and May 2019. We enrolled 1810 adolescents between 14 and 17 years of age. The Illinois Bully scale was used to measure bullying victimization. In order to ensure the adequacy of the sample with values greater than 0.8 - an indicator that component or factor analysis was useful for these variables - we used Kaiser-Meyer-Olkin (KMO) measurement. Statistical significance considered if the p-value < 0.05.

Results

The results showed that 841 (46.5%, CI: 44.1% – 48.7%) participants were classified as having been previously bullied. None of the bullying scale items was removed. Items on the bullying scale converged on a two-factor solution with Eigenvalues greater than 1, accounting for a total of 73.63% of the variance (Factor 1: bullying victimization; Factor 2: bullying perpetration; KMO = 0.899, Bartlett’s sphericity test p < 0.001; αCronbach = 0.955). Having a separate parents (ORa = 3.08), Mild (ORa-4.71) to moderate (ORa = 3.84) internet addiction test, higher social fear (ORa = 1.50), higher psychological abuse (ORa = 3.59), higher child neglect (ORa = 2.21) and physical (ORa = 4.55) abuse were significantly associated with higher odds of being bullied. However, higher social avoidance (ORa = 0.49), poor (ORa = 0.20), fair (ORa = 0.94) and very good (ORa = 0.04) physical activity as compared to sedentary were significantly associated with lower odds of being bullied.

Conclusions

Our findings attest that bullying victimization is likely to be associated with certain factors such as child abuse of all forms, Internet addiction, social fear and avoidance. In addition, the Illinois Bully Scale was validated in Lebanon. More attention should be paid to students vulnerable to bullying victimization, such as those with environmental or domestic problems, and adolescents with psychological disorders such as behavioral addictions.

Persistence and remission of depressive symptoms and psycho-social correlates in Chinese early adolescents

BACKGROUND

This study aimed to investigate a one-year course of persistent/remitted depressive symptoms and associated demographic and psychosocial factors that predict persistent/remitted depressive symptoms in Chinese high school students.

METHODS

One thousand five hundred forty-four Grade 7 students provided data for the first wave. Of the initially recruited students, 483 who were classified as depressed (CESD score ≥ 16) at baseline were then tracked and invited to fill in the questionnaire for a second time (Grade 8) after 1 year. Finally, 435 of them were successfully matched.

RESULTS

Two hundred two (46.4%) of the subset categorized as depressed in the first survey (N = 435) remained with depressive symptoms, while 233 (53.6%) recovered from depression 1 year later. Having siblings, a lower level of positive youth development, non-intact family status, and poor family functioning at baseline significantly predicted a higher likelihood of persistent depression, while those with fathers having higher educational qualifications (bachelor's degree or higher) at baseline showed a significantly higher probability of remitting from depression.

CONCLUSIONS

The findings indicated that the prevalence of persistent depressive symptoms was generally high, and promoting aspects of positive youth development and family functioning for adolescents could be promising in preventing or reducing these symptoms.

The relationship between bullying victimization and depression in adolescents: multiple mediating effects of internet addiction and sleep quality

Various studies have found that bullying victimization is an important factor affecting depression. However, few studies have explored the underlying mechanism of this effect.  The purpose of this study was to examine the effects of bullying victimization on depression, as well as the mediating roles of internet addiction and sleep quality. The participants were 2022 Chinese junior high school students who completed questionnaires regarding bullying victimization, internet addiction, sleep quality and depression. Correlation analysis indicated that bullying victimization, poor sleep quality, internet addiction, and depression have significant, positive correlations with each other. Hayes' PROCESS macro revealed that internet addiction and sleep quality played multiple mediation roles in the relationship between bullying victimization and depression. These results suggested that effective strategies focusing on improving problematic internet use along with sleep quality may contribute to reducing the negative effect of bullying victimization on depressive symptoms.

Association Between Bullying and Suicidal Behavior Among Chinese Adolescents: An Analysis of Gender Differences

Background

Suicide has become the leading cause of death among 15-34 years old in China, and more attention should be paid to risk factors and prevention of suicidal ideation and suicide attempts. The school-based survey was conducted to test the associations of bullying behavior with suicidal ideation and suicide attempts, and to assess whether the biological gender can moderate these associations.

Methods

A multistage stratified cluster sampling method was used to recruit participants from high schools in Guizhou, China, and univariate and multivariate logistic regression models were fitted.

Results

A total of 23,392 students were included in the analysis, and 45.4% were boys. The mean age of the students was 15.2 (SD: 1.9) years. Overall, 3.8% (882) of the students were victims, 4.9% (1144) were bullies, and 3.2% (736) were bully-victims. A total of 18.9% of students reported having suicidal ideation, and 3.9% reported having suicide attempts. Victims (adjusted odds ratio [AOR]=2.15, 95% CI=1.84-2.51), bullies (AOR=3.17, 95% CI=2.78-3.62), and bully-victims (AOR=3.18, 95% CI=2.71-3.73) were at an elevated risk of suicidal ideation than neutrals; similar associations can be found in the associations between bullying behavior and suicide attempts. Further stratification analyses showed that the associations of being bullied or bullying others with suicidal ideation and suicide attempts were slightly stronger in girls than in boys.

Conclusion

Prevention or intervention programs are recommended to take the biological gender into consideration, and future studies are also warranted to investigate the reasons of differences by gender in the association of bullying and suicidal behavior.

Asociación entre matoneo escolar, síntomas depresivos e ideación suicida

El objetivo de la presente investigación fue estimar la relación entre matoneo escolar (ME), síntomas depresivos con importancia clínica (SDIC) y alto nivel de ideación suicida (ANIS) en adolescentes estudiantes de la ciudad de Santa Marta, Colombia. Se diseñó un estudio transversal en el que participaron estudiantes entre 10 y 17 años, de sexto a undécimo grado escolar, quienes diligenciaron una versión de cinco ítems del Cuestionario de Intimidación Escolar Abreviado, CIE-A; la versión de diez ítems de la Escala del Centro de Estudios Epidemiológicos de la Depresión, CES-D-10; y la Escala de Okasha para Suicidalidad, EOS. Participaron 350 estudiantes (M=13,3; DE=1,8), 188 mujeres y 162 hombres, 236 estudiantes de básica secundaria y 114 en media vocacional. Un total de 58 (16,6%) informó ME, 59 (16,9%) SDIC y 33 (9,4%) ANIS. El ME se asoció significativamente a ANIS (OR=3,1; IC95% 1,3-7,9), después de controlar por SDIC y sexo. Se evidencia la relevancia de evaluar SDIC en víctimas de ME, y las posibilidades de reducir el riesgo de ANIS a partir de la identificación y realización de programas de intervención en adolescentes con SDIC.

Being Bullied Is Associated With Depression Among Malaysian Adolescents: Findings From a Cross-Sectional Study in Malaysia

Limited evidence on the association of being bullied with depression among adolescents was found in Malaysia. This study aimed to determine the association of being bullied and depression among Malaysian school-going adolescents. Data from the National Health and Morbidity Survey 2017, a cross-sectional study conducted from March to May 2017, was analyzed using descriptive and multiple logistic regression analysis. A validated tool, the Depression, Anxiety, and Stress Scale-21 was used to categorize those with moderate or higher levels of depressive symptoms as having depression. A total of 27 399 school-going adolescents participated and 18.3% were found depressed. Adolescents of Indian ethnicity (adjusted odds ratio [aOR] = 2.02, P < .001), those with parents living apart (aOR = 1.41, P < .001), and those who were being bullied (aOR = 2.98, P < .001) were more likely to have depression. This study demonstrated the association between being bullied and having depression. Comprehensive preventive strategies should be implemented taking into consideration the findings from this study.

Gender differences in suicidal ideation and health-risk behaviors among high school students in Beijing, China

Background

Suicide is still the leading cause of death in the 15 to 34-year age group, especially for girls aging 15 to 19-year old. In China particularly, the suicide rate of female is 60% higher than male. The gender difference on suicidal ideation and its patterns with academic, family, social and health-risk factors is unknown among adolescents in Beijing, China.

Methods

A total of 33 635 students in grades 7-12 in Beijing participated in the 2014 Chinese Youth Risk Behavior Surveillance. Data were stratified by gender and associations with suicidal ideation were analyzed using χ² test and multivariate regression analyses. The interaction effects on suicidal ideation between gender and the related behaviors were also analyzed.

Results

The prevalence of suicidal ideation was significantly higher for girls (13.3%) than boys (10.7%). The multivariate regression analyses indicated that high academic pressure, running away from home, feeling lonely or sad/hopeless, being bullied, fighting, and binge drinking were significantly associated with suicidal ideation in boys and girls. Factors more strongly associated with suicidal ideation in girls than boys were being in junior vs senior high school (girl vs boys: 1.24 vs NA), high academic pressure (2.42 vs 1.55), ever smoking (1.52 vs NA), binge drinking (1.30 vs 1.17), fighting once (1.63 vs 1.06) and being sad/hopeless (2.39 vs 2.04) and their interaction with gender were all statistically significant (P < 0.05). A lower likelihood of suicidal ideation was found among boys, but not girls, who had PE class two or more days per week.

Conclusions

Girls showed more vulnerability to suicidal ideation than boys particularly among girls in junior school, reporting high academic pressure, smoking, binge drinking and fighting. The combinations of risk factors and differential patterns for boys and girls point to high-risk groups and potential targets for gender-specific suicide prevention.

Association between body weight status and suicidal ideation among Chinese adolescents: the moderating role of the child's sex

PURPOSE

Suicidality (ranging from suicidal ideation to suicidal attempts and completed suicide) is a major and preventable public health concern, and body weight is considered a modifiable factor which might be helpful to the early risk assessment of suicidal ideation. This study aimed to comprehensively evaluate the association of body weight status with suicidal ideation across sex among Chinese adolescents.

METHODS

Data were drawn from the 2015 National School-based Chinese Adolescents Health Survey, and 54,640 students' questionnaires were completed and qualified for the survey. Body mass index z scores were calculated and categorized into four levels: underweight (less than the 5th percentile for sex and age), normal weight (between the 5th and 85th percentile), overweight (between the 85th and 95th percentile), and obese (above the 95th percentile).

RESULTS

Of the total sample, 47.3% (25,852) were boys. The weighted prevalence of suicidal ideation among Chinese adolescents is 15.7% (14.6% in boys and 17.3% in girls). After adjusting for demographics, smoking, drinking, and depressive symptoms, our final multivariate logistic regression models demonstrated that only boys identified as underweight (Adjusted odds ratio [AOR] = 1.23, 95% CI = 1.06-1.44) or obese (AOR = 1.19, 95% CI = 1.02-1.38) were at a higher risk of suicidal ideation. Additionally, the association between weight status and suicidal ideation among boys might be moderated by academic pressure, smoking, and depressive symptoms.

CONCLUSIONS

There was a significant J-shaped association between relative body weight and suicidal ideation in boys. The child's sex should be taken into consideration when developing interventions against unhealthy weight and suicidal ideation.

Positive Education Interventions Prevent Depression in Chinese Adolescents

Positive education aims to improve students’ academic performance as well as their well-being and character strengths. In contrast to traditional school counseling methods that are typically post hoc and pathological, positive education advocates a preventive and positive approach, which teaches students well-being skills that can reduce the chances of depression before it occurs. The current study tested this hypothesis by using a pseudo-experiment design. Six 8th grade classes (N = 173) in a Chinese school were randomly assigned into two groups. In the experiment group, students took positive education courses once a week that taught them primarily knowledge and skills related to positive emotions. Students in the control group took regular moral education courses. After one semester, the level of depression of students in the experiment group had no significant change while that of students in the control group increased significantly. The results showed that adolescent depression can be prevented by positive emotion interventions. Implications and limitations are discussed.

Bullying History and Mental Health In University Students: The Mediator Roles of Social Support, Personal Resilience, and Self-Efficacy

Bullying victimization by peers is highly prevalent in childhood and adolescence. There is convincing evidence that victimization is associated with adverse mental health consequences. In contrast, it has been found that perpetrators suffer no adverse mental health consequences. These findings originate from Western countries such as Germany but have rarely been investigated in collectivistic societies such as China. Furthermore, it has been rarely studied whether positive intrapersonal characteristics (e.g., personal resilience and self-efficacy) and interpersonal positive resources (e.g., social support) may mediate the impact of bullying on mental health. The current study used a path analytic model to examine, firstly, whether previous bullying experiences (both victimization and perpetration) are associated with current positive and negative mental health in university students and, secondly, whether these influences are mediated by social support, resilience, and self-efficacy. The model was tested in 5,912 Chinese and 1,935 German university students. It was found that in both countries, higher victimization frequency was associated with lower levels of social support, personal resilience, and self-efficacy, which in turn predicted poorer mental health. Moreover, and only in China, perpetration was negatively associated with social support and personal resilience but not self-efficacy. In contrast, in the German sample, perpetration experience was found to enhance one's self-efficacy, and the later was associated with better mental health. The results support a mediation model in which social support, personal resilience, and self-efficacy partially mediate the influence of victimization on mental health in both countries. For the relationship between perpetration and mental health, self-efficacy was the only full mediator in Germany, whereas in China, both social support and personal resilience were partial mediators. In conclusion, peer victimization has adverse effects on mental health in both Germany and China. Only in China, however, is perpetration also associated with adverse mental health outcomes. In contrast, getting ahead by bullying in an individualistic society such as Germany is associated with increased self-efficacy and mental health. The differences found between an individualistic country and a collectivistic country have important implications for understanding and planning interventions to reduce bullying.

Relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt among school students: a school-based study in Zhejiang Province, China

BACKGROUND

Suicide is the second leading cause of death among 15-29 year old youths globally, and the third most common external cause of death in China. School bullying can cause serious consequences among adolescents, including psychosocial problems, low self-esteem and post-traumatic stress disorder. Most studies examining the associations between being bullied in school and suicide are from Western, developed countries. Moreover, few studies focus on being threatened or injured with a weapon, which may cause serious body injury. Our study aimed to explore the relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt among middle and high school students in Zhejiang Province, China.

METHODS

A cross-sectional study of 23,543 students in grades 7-12 from 442 schools was carried out through an anonymous self-administered questionnaire between April and May 2017. Multivariable logistic regression models were used to examine the relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt.

RESULTS

51.3% of participants were boys, and mean (SD) age was 15.6 (1.7) years. The overall prevalence of suicidal ideation and attempt were 16.1% (95%CI: 15.3-16.9) and 3.6% (95%CI: 3.3-4.0), respectively. Prevalence was higher among girls than boys (ideation: 19.1% vs. 13.3%. attempt: 4.4% vs. 2.9%). 13.2% of students reported being threatened or injured with a weapon in school in the past 12 months (95%CI: 11.9-14.5), higher among boys than girls (15.7% vs. 10.5%), and among rural students than urban students (13.9% vs. 11.6%). After adjustment for socio-demographic status, lifestyle factors, academic performance, self-reported health and mental health, the odds ratios for suicidal ideation and attempt among students who reported being threatened or injured with a weapon were 1.46 (1.31-1.61) and 1.68 (1.31-2.13) respectively, as compared with those who did not report being threatened or injured.

CONCLUSIONS

Preventive measures for physical bullying in school need to be reinforced in China. Being threatened or injured with a weapon is associated with both suicidal ideation and attempt among middle and high school students. Suicide prevention should be an important component of psychological interventions for threatened or injured students.

Association between sexual minority status and suicidal behavior among Chinese adolescents: A moderated mediation model

BACKGROUND

Evidence shows sexual minority adolescents have a higher risk of suicidality than their heterosexual peers due to minority stressors or lack of social support, but it remains unclear how the combined effects of these influence factors impact suicidality in this population. In this study, we examine whether school victimization mediates association between sexual minority status and suicidal behavior of adolescents and explore whether such mediation is moderated by interpersonal relationships.

METHODS

We sampled a large nationally representative dataset comprising data collected from 7th to 12th graders (the 2015 School-based Chinese Adolescents Health Survey) using a multistage, stratified-cluster, random-sampling method. Our sample consisted of 123,459 students who completed questionnaires regarding their sexual minority status, suicidal ideation, suicide attempts, school victimization, classmate relations, and teacher-classmate relations.

RESULTS

Using a moderated mediation model, we found that school victimization mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.0296, 95% confidence intervals (CI) = 0.0259-0.0333) and suicide attempts (indirect effect = 0.0086, 95% CI = 0.0074-0.0100). These indirect effects were moderated by interpersonal relationships, and a greater effect was seen among sexual minority students with poor classmate or teacher-classmate relations.

LIMITATIONS

Our study sample included only students attending school, and interpretation of the direction of the observed associations is limited due to the cross-sectional design.

CONCLUSIONS

Interpersonal relationships moderate the indirect effects of school victimization on association between sexual minority status and suicidal behavior. Early intervention addressing school violence combined with improving the quality of relationships with school peers would help prevent suicidality in sexual minority adolescents.

Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study

Background

Although there is much literature on adolescent suicide, combined effects of depression and anorexia nervosa on suicide were rarely investigated. The aims of this study are to examine the association between anorexia nervosa and suicidal thoughts and explore the interaction between anorexia nervosa and depression.

Methods

This is a cross-sectional study, in the study, a sample of 8,746 Chinese adolescents was selected by multistage stratified method in 2012/2013 from 20 middle schools in 7 provinces across China Mainland. Multilevel logistic model was introduced to explore association between anorexia nervosa and suicidal thoughts. And subgroup analyses were conducted on participants with or without depression.

Results

Multilevel logistic model revealed that demographic variables, including academic achievement, were not the predictive risk factors of suicidal thoughts. Those who suffered from worse severity of perceived anorexia nervosa were at increased risk of thinking about suicide. The interaction between depression and anorexia nervosa was significant, however, subgroup analyses showed that the associations were significant only among the adolescents without depression.

Conclusions

Our results indicate that all levels of anorexia nervosa serve as predictable indicators of suicidal thoughts in Chinese adolescents, and the effects of anorexia nervosa are modified by depression status.

Suicidal behaviors and associated factors among university students in six countries in the Association of Southeast Asian Nations (ASEAN)

A large data gap remains on suicidal behaviors among youth in the Association of Southeast Asian Nations (ASEAN) countries, despite the increasing rates of suicide in Asian cultures that may be related to rapid economic changes and the loss of social stability. This study was therefore conducted to explore the prevalence of and factors associated with suicidal ideation and suicide attempts among university students in six ASEAN member states. Data were collected in a cross-sectional survey of 4675 undergraduate university students, mean age 20.6 years (SD=2.7), range of 18-30 years, from Cambodia, Indonesia, Malaysia, Myanmar, Thailand and Vietnam. The overall prevalence of ever suicidal ideation and ever suicide attempt among students in this study was 11.7% and 2.4%, respectively. Different rates of these suicidal behaviors were observed across the countries. In multivariable logistic regression models, suicidal ideation was significantly associated with psychosocial factors including childhood sexual abuse, depressive symptoms, involvement in physical fights, and poor academic performance as well as socio-environmental factors including living with parents or guardians and low involvement in organized religious activity. Suicide attempt was significantly associated with childhood sexual abuse, depressive symptoms, low involvement in organized religious activity and being underweight or overweight. Our findings suggest that individual-level strategies for suicide prevention should be targeted toward students with poor academic performance, mental health problems and a history of adverse childhood experiences. Particular attention should be paid to the role of families that could be a potential stressor in the lives of university students.