Prevalence of and risk factors for non-suicidal self-injury in rural China: Results from a nationwide survey in China
Prevalence of and risk factors for non-suicidal self-injury in rural China: Results from a nationwide survey in China
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中国农村非自杀性自伤的患病率和危险因素：中国全国范围内的调查结果
DOI：
10.1016/j.jad.2017.09.051
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发表时间：
2018-01-15
影响因子：
6.6
通讯作者：
Yu, Yizhen
中科院分区：
文献类型：
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作者：
Tang, Jie;Li, Guowei;Yu, Yizhen
背景：非自杀性自伤（NSSI）在全球青少年中是一个非常普遍且严重的公共卫生问题。然而，到目前为止，还没有研究按照《精神障碍诊断与统计手册》第五版（DSM - 5）所建议的标准来评估中国青少年中非自杀性自伤的患病率。我们旨在进行一项全国性调查，以探究中国农村在校青少年中非自杀性自伤的患病率及其危险因素。
方法：采用多阶段抽样方法，共纳入中国农村的15623名青少年。通过自我报告问卷收集数据，包括人口统计学特征、被忽视情况、受虐待情况、孤独感、心理韧性、社会支持以及情绪管理能力。非自杀性自伤依据DSM - 5所建议的标准进行定义，即每年自伤行为发生超过5次。采用多项逻辑回归模型来评估危险因素与非自杀性自伤之间的关联。
结果：有12.2%的青少年（n = 1908）符合DSM - 5所建议的标准。约29%的青少年报告在过去一年中至少有过一次非自杀性自伤的经历。在有和没有非自杀性自伤经历的青少年之间，在包括性别、民族、年级和家庭结构等多个人口统计学因素方面存在显著差异。有非自杀性自伤经历的青少年中，排名前三的自伤行为是捶打自己、掐自己和扯头发，其患病率分别为16.7%、14.1%和11.2%。通过多变量分析，女性、汉族、父亲的教育水平、被忽视、受虐待、孤独感、社会支持、自杀行为以及情绪管理能力都与非自杀性自伤显著相关。心理韧性与非自杀性自伤的风险之间未发现显著关系。
局限性：DSM - 5针对非自杀性自伤提出了6组标准，考虑到其更易被接受的可行性和实际应用，我们仅使用了关于频率的标准。因此，这可能与依据其他标准所估计的患病率有所不同。
结论：据我们所知，这是第一项报告按照DSM - 5所建议的标准在中国农村青少年中进行非自杀性自伤患病率的研究。与类似青少年样本的研究结果相比，中国农村青少年似乎有相对较高的患病率。非自杀性自伤的潜在危险因素包括女性、父亲的教育程度、汉族、心理社会因素以及自杀行为。为了预防和管理非自杀性自伤，需要更多证据来进一步了解其发生的背景、改善医疗保健利用的途径以及明确心理社会因素和家庭关系的作用。
Background: Non-suicidal self-injury (NSSI) is a highly prevalent and serious public health problem among adolescents worldwide. However, to date there were no studies assessing the prevalence of NSSI defined by suggested DSM-5 criteria among Chinese adolescents. We aimed to conduct a nationwide survey to explore the prevalence of and risk factors for NSSI among school-based adolescents in rural China.Methods: A total sample of 15,623 adolescents in rural China were enrolled by using a multistage sampling method. Data was collected by self-report questionnaires including demographic characteristics, neglect, maltreatment, loneliness, resilience, social support and emotional management ability. NSSI was defined by suggested DSM-5 criteria, according to which the engagement in self-injury took place more than 5 times a year. Multinomial logistic regression models were used to estimate the association between risk factors and NSSI.Results: There were 12.2% of adolescents (n = 1908) met the suggested DSM-5 criteria. Approximately 29% reported a history of NSSI at least once during the last year. Significant differences were found in several demographic factors including gender, ethnicity, grade, and family structure between adolescents with and without experiencing NSSI. The top three NSSI behaviors among adolescents with NSSI experience were hitting self, pinching, and pulling hair, with a prevalence rate of 16.7%, 14.1% and 11.2%, respectively. Female, Han ethnicity, fathers' education level, neglect, maltreatment, loneliness, social support, suicidal behaviors and emotional management ability were significantly associated with NSSI by multivariate analysis. No significant relationship was found between resilience and risk of NSSI.Limitation: The DSM-5 has proposed 6 groups of criteria for NSSI, we only used criteria on frequency given its more accepted feasibility and pragmatic application. Consequently, it may different from other prevalence that estimated by other criteria.Conclusion: To the best of our knowledge, this is the first study reporting prevalence of NSSI defined by suggested DSM-5 criteria among adolescent in rural China. In comparison to finding from the similar samples of adolescents, Chinese rural adolescents seem to have a relative higher prevalence. The potential risk factors for NSSI include female, father's education, Han ethnicity, psychosocial factors and suicide behaviors. More evidence for further understanding of context of the occurrence, improving access to health care utilization, and identifying the role of psychosocial factors and family relationship, is needed for the prevention and management of NSSI.