童年不良经历和非自杀性自伤交互作用与初中生自杀相关行为的关联

刘爱妮; 罗宇; 张荣慧楠; 杨思维; 王宏

doi:10.16835/j.cnki.1000-9817.2024200

童年不良经历和非自杀性自伤交互作用与初中生自杀相关行为的关联

doi: 10.16835/j.cnki.1000-9817.2024200

重庆医科大学公共卫生学院/医学与社会发展研究中心，重庆 401331

基金项目:

教育部人文社会科学研究规划基金项目 22YJA840010

详细信息

作者简介:
刘爱妮(2000-)，女，四川广汉人，在读硕士，主要研究方向为儿童青少年健康与卫生

通讯作者:
王宏，E-mail：100113@cqmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 G444 B845.67 C913.5
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出版历程
- 收稿日期: 2024-04-12
- 修回日期: 2024-05-09
- 网络出版日期: 2024-07-27
- 刊出日期: 2024-07-25

Association of adverse childhood experiences and non-suicidal self-injurious interactions with suicide-related behaviors in junior high school students

School of Public Health/Center for the Study of Medicine and Social Development, Chongqing Medical University, Chongqing (401331), China

摘要

摘要: 目的探讨童年不良经历(ACEs)和非自杀性自伤行为(NSSI)与初中生自杀相关行为的关联，为预防初中生自杀行为的发生提供参考依据。方法于2023年5—6月，采用分层整群抽样与方便抽样相结合的方法，抽取重庆市3个区县7 392名初中生，采用中文版儿童期创伤量表、青少年NSSI评定问卷、自杀相关行为问卷进行自填式问卷调查。采用χ²检验和多因素Logistic回归模型进行统计分析，再进行相加交互分析，计算相对超危险度比(RERI)、归因比(AP)和交互作用指数(S)的估计值及95%CI。结果初中生NSSI报告率为38.03%，ACEs报告率为41.76%，自杀意念、自杀计划、自杀未遂报告率分别为27.99%，9.90%，4.75%。ACEs及其各维度和NSSI均是自杀相关行为的影响因素(OR=1.83~10.66，P值均 < 0.01)。相加交互作用分析结果显示，ACEs和NSSI、躯体忽视(PN)和NSSI、情感虐待(EA)和NSSI、情感忽视(EN)和NSSI对自杀相关行为均有相加交互作用(RERI=0.45~39.15，AP=0.10~1.09，S=1.02~13.92)；同时存在ACEs和NSSI的初中生发生自杀意念、自杀计划和自杀未遂的风险是无ACEs且无NSSI的11.45，20.38，28.76倍(P值均 < 0.05)。结论 ACEs和NSSI对初中生自杀相关行为具有相加交互作用。应减少ACEs和NSSI，以预防初中生自杀行为的发生。
- 生活变动事件 /
- 自我伤害行为 /
- 自杀 /
- 回归分析 /
- 精神卫生 /
- 学生
Abstract: Objective To explore the association between adverse childhood experiences (ACEs) and non-suicidal self-injury (NSSI) and suicide-related behaviors among junior high school students, so as to provide a reference basis for the prevention of junior high school students' suicide. Methods From May to June 2023, a total of 7 392 junior high school students in three districts and counties of Chongqing were selected for self-administered questionnaire survey by stratified cluster sampling and convenience sampling methods. The questionnaire survey was conducted using the Chinese version of the Childhood Trauma Scale, Adolescent NSSI Assessment Questionnaire, and Suicide Related Behavior Questionnaire. Statistical analysis was performed by using χ² test, multifactorial Logistic regression model, and additional interaction analysis was used to calculate the estimated relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S), as well as 95%CI. Results The detection rate of NSSI among junior high school students was 38.03%, the detection rate of ACEs was 41.76%, and the detection rates of suicidal ideation, suicide planning, and suicide attempt were 27.99%, 9.90%, and 4.75%, respectively. ACEs and its dimensions, and NSSI were the influencing factors for suicide-related behaviors (OR=1.83-10.66, P < 0.01). The result of the additive interaction showed that ACEs and NSSI, PN and NSSI, EA and NSSI, EN and NSSI all had additive interactions on suicide-related behaviors (RERI=0.45-39.15, AP=0.10-1.09, S=1.02-3.92). And ACEs and its dimensions had additive interactions with NSSI on suicide-related behaviors, for junior high school students with both ACEs and NSSI had 11.45, 20.38, and 28.76 times the risk of suicidal ideation, suicidal planning, and suicidal attempts as compared to junior high school students without ACEs and without NSSI (P < 0.05). Conclusions ACEs and NSSI among junior high school students have an additive interaction effect on suicide related behaviors. ACEs and NSSI should be reduced to prevent suicidal behavior among middle school students.
- Life change events /
- Self-injurious behavior /
- Suicide /
- Regression analysis /
- Mental health /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 不同组别初中生自杀相关行为报告率比较

Table 1. Comparison of detection rates of suicide-related behaviors among junior high school students with different groups

组别	选项	人数	自杀意念			自杀计划			自杀未遂
组别	选项	人数	报告人数	χ²值	P值	报告人数	χ²值	P值	报告人数	χ²值	P值
性别	男	3 642	756(20.76)	186.29	< 0.01	268(7.36)	52.08	< 0.01	114(3.13)	41.57	< 0.01
	女	3 750	1 313(35.01)			464(12.37)			237(6.32)
家庭居住地	农村	1 653	439(26.56)	4.79	0.09	165(9.98)	0.03	0.99	81(4.90)	1.75	0.42
	乡镇	2 377	648(27.26)			236(9.93)			122(5.13)
	城市	3 362	982(29.21)			331(9.85)			148(4.40)
年级	初一	2 480	733(29.56)	12.89	< 0.01	271(10.93)	13.94	< 0.01	126(5.08)	3.47	0.18
	初二	2 447	711(29.06)			262(10.71)			124(5.07)
	初三	2 465	625(25.35)			199(8.07)			101(4.10)
独生子女	是	1 685	485(28.78)	0.68	0.41	177(10.50)	0.89	0.35	81(4.81)	0.02	0.90
	否	5 707	1 584(27.76)			555(9.72)			270(4.73)
家庭经济状况	差	96	44(45.83)	95.95	< 0.01	24(25.00)	63.26	< 0.01	15(15.63)	59.52	< 0.01
	较差	657	276(42.01)109			(16.59)			60(9.13)
	中等	5 159	1 387(26.89)			464(8.99)			221(4.28)
	较好	1 201	308(25.65)			110(9.16)			47(3.91)
	好	279	54(19.35)			25(8.96)			8(2.87)
学习成绩	差	863	331(38.35)	74.78	< 0.01	152(17.61)	327.40	< 0.01	89(10.31)	79.53	< 0.01
	中等偏下	2 022	614(30.37)			208(10.29)			108(5.34)
	中等	2 500	623(24.92)			194(7.76)			90(3.60)
	中等偏上	1 690	433(25.62)			151(8.93)			57(3.37)
	好	317	68(21.45)			27(8.52)			7(2.21)
学习压力	非常大	514	270(52.53)	447.54	< 0.01	139(27.04)	276.60	< 0.01	74(14.40)	146.43	< 0.01
	比较大	2 500	951(38.04)			329(13.16)			149(5.96)
	一般	3 734	751(20.11)			229(6.13)			110(2.95)
	比较小	406	58(14.29)			15(3.69)			10(2.46)
	非常小	238	39(16.39)			20(8.40)			8(3.36)
关系密切伙伴数/个	0	217	99(45.62)	143.19	< 0.01	60(27.65)	119.89	< 0.01	33(15.21)	74.44	< 0.01
	1~2	2 130	743(34.88)			269(12.63)			129(6.06)
	3~5	3 122	838(26.84)			272(8.71)			129(4.13)
	≥6	1 923	389(20.23)			131(6.81)			60(3.12)
注： ()内数字为报告率/%。

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表 2 ACEs、NSSI与初中生自杀相关行为的多因素Logistic回归分析

Table 2. Multivariate Logistic regression analysis of ACEs, NSSI and suicide-related behaviors among junior middle school students

自变量	选项	人数	自杀意念^a			自杀计划^a			自杀未遂^b
自变量	选项	人数	报告人数	OR值(95%CI)	P值	报告人数	OR值(95%CI)	P值	报告人数	OR值(95%CI)	P值
ACEs	是	3 087	1 246	2.63(2.34~2.95)	< 0.01	528	3.49(2.91~4.17)	< 0.01	274	4.19(3.20~5.48)	< 0.01
	否	4 305	823	1.00		204	1.00		77	1.00
PA	是	347	196	3.33(2.63~4.23)	< 0.01	106	3.72(2.86~4.85)	< 0.01	72	5.17(3.79~7.05)	< 0.01
	否	7 045	1 873	1.00		626	1.00		279	1.00
PN	是	2 039	807	1.93(1.71~2.18)	< 0.01	365	2.52(2.13~2.98)	< 0.01	195	2.80(2.22~3.52)	< 0.01
	否	5 353	1 262	1.00		367	1.00		156	1.00
EA	是	479	339	5.65(4.54~7.02)	< 0.01	203	6.35(5.12~7.88)	< 0.01	113	5.62(4.31~7.32)	< 0.01
	否	6 913	1 730	1.00		529	1.00		238	1.00
EN	是	2 096	901	2.39(2.12~2.69)	< 0.01	391	2.73(2.31~3.22)	< 0.01	204	2.85(2.26~3.59)	< 0.01
	否	5 296	1 168	1.00		341	1.00		147	1.00
SA	是	434	178	1.83(1.47~2.27)	< 0.01	99	2.69(2.08~3.48)	< 0.01	65	3.70(2.71~5.05)	< 0.01
	否	6 958	1 891	1.00		633	1.00		286	1.00
NSSI	有	2 811	1 473	6.20(5.51~6.98)	< 0.01	619	9.04(7.31~11.17)	< 0.01	310	10.66(7.62~14.90)	< 0.01
	无	4 581	596	1.00		113	1.00		41	1.00
注： a控制性别、年级、家庭经济状况、自评学习成绩、学习压力、关系密切伙伴数因素；b控制性别、家庭经济状况、自评学习成绩、学习压力、关系密切伙伴数因素。

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表 3 童年不良经历和非自杀性自伤行为的相乘交互作用与初中生自杀相关行为的关联[OR值(95%CI), n=7 392]

Table 3. Association of the multiplicative interaction of adverse childhood experiences and non-suicidal self-injurious behaviors with suicide-related behaviors among junior middle school students[OR(95%CI), n=7 392]

变量	自杀意念^a	自杀计划^a	自杀未遂^b
ACEs×NSSI	1.22(0.96~1.55)	0.95(0.62~1.47)	0.83(0.41~1.70)
PA×NSSI	0.91(0.52~1.59)	0.71(0.32~1.61)	1.69(0.39~7.45)
PN×NSSI	1.08(0.84~1.40)	0.76(0.49~1.16)	0.68(0.35~1.33)
EA×NSSI	0.79(0.48~1.32)	0.63(0.33~1.21)	0.67(0.24~1.84)
EN×NSSI	1.11(0.87~1.44)	0.74(0.49~1.14)	0.66(0.34~1.29)
SA×NSSI	0.95(0.58~1.55)	0.87(0.43~1.79)	0.71(0.27~1.83)
注： a控制性别、年级、家庭经济状况、自评学习成绩、学习压力、关系密切伙伴数因素；b控制性别、家庭经济状况、自评学习成绩、学习压力、关系密切伙伴数因素。

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表 4 ACEs和NSSI的相加交互作用与初中生自杀相关行为的关联(n=7 392)

Table 4. Association of additive interactions of ACEs and NSSIs with suicide-related behaviors among junior middle school students(n=7 392)

自杀相关行为	变量	RERI值(95%CI)	AP值(95%CI)	S值(95%CI)
自杀意念^a	ACEs+NSSI	5.50(4.04~6.97)	0.48(0.40~0.56)	2.11(1.76~2.54)
	PA+NSSI	5.61(1.16~10.07)	0.42(0.18~0.69)	1.88(1.13~3.14)
	PN+NSSI	3.08(1.24~4.92)	0.33(0.17~0.49)	1.58(1.20~2.09)
	EA+NSSI	9.91(4.32~15.50)	0.53(0.35~0.71)	2.26(1.49~3.44)
	EN+NSSI	5.29(3.09~7.50)	0.45(0.32~0.58)	1.96(1.49~2.58)
	SA+NSSI	1.96(-1.43~5.36)	0.23(-0.13~0.58)	1.35(0.79~2.30)
自杀计划^a	ACEs+NSSI	10.66(6.56~14.75)	0.52(0.41~0.64)	2.22(1.71~2.90)
	PA+NSSI	9.33(1.02~17.64)	0.46(0.12~0.80)	1.94(0.98~3.84)
	PN+NSSI	6.90(2.20~11.60)	0.39(0.17~0.61)	1.70(1.14~2.52)
	EA+NSSI	16.83(8.24~25.41)	0.57(0.37~0.76)	2.41(1.48~3.93)
	EN+NSSI	8.15(3.03~13.28)	0.42(0.21~0.64)	1.80(1.20~2.70)
	SA+NSSI	8.30(0.45~16.16)	0.45(0.10~0.80)	1.90(0.95~3.79)
自杀未遂^b	ACEs+NSSI	16.29(6.54~26.04)	0.57(0.42~0.72)	2.42(1.66~3.53)
	PA+NSSI	22.04(4.93~39.15)	0.68(0.27~1.09)	3.36(0.81~13.92)
	PN+NSSI	10.21(1.74~18.68)	0.43(0.14~0.72)	1.82(1.05~3.15)
	EA+NSSI	17.43(5.26~29.60)	0.57(0.25~0.88)	2.43(1.11~5.33)
	EN+NSSI	10.50(1.42~19.57)	0.43(0.13~0.74)	1.82(1.02~3.23)
	SA+NSSI	15.75(2.27~29.23)	0.54(0.18~0.90)	2.27(0.98~5.22)
注： a控制性别、年级、家庭经济状况、自评学习成绩、学习压力、关系密切伙伴数因素；b控制性别、家庭经济状况、自评学习成绩、学习压力、关系密切伙伴数因素。

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