童年期不良经历与初中生非自杀性自伤行为和自杀尝试共发的关联

王周艳; 杨思维; 万小可; 陈根; 李霞; 彭畅; 王宏

doi:10.16835/j.cnki.1000-9817.2025247

童年期不良经历与初中生非自杀性自伤行为和自杀尝试共发的关联

doi: 10.16835/j.cnki.1000-9817.2025247

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

国家自然科学基金项目 82404288

国家资助博士后研究人员计划项目 GZC20242134

详细信息

作者简介:
王周艳(2000-)，男，四川广安人，在读硕士，主要研究方向为儿童青少年心理行为卫生

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: B845.6 C913.5 G444
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出版历程
- 收稿日期: 2025-06-10
- 修回日期: 2025-06-26
- 网络出版日期: 2025-10-10
- 刊出日期: 2025-09-25

Association of adverse childhood experiences with the co-occurrence of non-suicidal self-injury and suicide attempts in junior high school students

College of Public Health/Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 401331, China

摘要

摘要: 目的探讨不同类型童年期不良经历(ACEs)对非自杀性自伤行为(NSSI)和自杀尝试(SA)共发的独立效应及性别差异，为初中生自伤行为的精准防控提供参考依据。方法 2023年5—6月，采用分层整群抽样与方便抽样相结合的方法从重庆市3个区/县12所学校抽取7 360名初中生为研究对象，通过青少年非自杀性自伤行为评定问卷(ANSAQ)、中国青少年健康相关行为调查问卷(初中版)自杀部分、儿童期创伤问卷(CTQ-SF)、流调中心抑郁量表(CES-D)对学生进行问卷调查，获取NSSI、SA、ACEs、抑郁症状等信息。采用χ²检验和多元Logistic回归对数据进行统计分析。结果初中生NSSI、SA、NSSI+SA和ACEs检出率分别为19.2%，4.6%，3.5%和57.9%。控制性别、年级、家庭类型、自评家庭经济、自评学习成绩、自评学习压力、亲密朋友数量、抑郁症状得分等因素后，多元Logistic回归分析结果显示，童年期躯体虐待(OR=1.98，95%CI=1.23~3.18)、情感虐待(OR=2.83，95%CI=1.92~4.19)、性虐待(OR=1.70，95%CI=1.07~2.69)、躯体忽视(OR=1.67，95%CI=1.20~2.33)和目睹家庭暴力(OR=2.10，95%CI=1.41~2.87)的初中生发生NSSI+SA风险均增加(P值均 < 0.05)；性别分层后，童年期性虐待的男生发生NSSI+SA风险增加(OR=2.17，95%CI=1.06~4.43)，童年期情感虐待(OR=3.69，95%CI=2.29~5.94)、躯体忽视(OR=1.62，95%CI=1.07~2.45)和目睹家庭暴力(OR=2.17，95%CI=1.41~3.34)的女生发生NSSI+SA风险均增加(P值均＜0.05)。结论不同类型ACEs对初中生自伤行为共发的效应不同且存在性别差异。干预时应重点关注情感虐待和家庭暴力等方面，同时基于性别差异优化干预措施。
- 生活变动事件 /
- 自我伤害行为 /
- 自杀 /
- 精神卫生 /
- 学生
Abstract: Objective To explore the independent effects and gender differences of different types of adverse childhood experiences (ACEs) on the co-occurrence of non-suicidal self-injury (NSSI) and suicide attempts (SA), so as to provide a reference for the precise prevention and control of self-harm in junior high school students. Methods From May to June 2023, a total of 7 360 junior high school students were selected from 12 schools in three districts/counties of Chongqing using a combination of stratified cluster sampling and convenience sampling methods. Information on NSSI, SA, ACEs, and depressive symptom, as well as other related data were collected through the Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ), suicide-related section of the Chinese Adolescent Health-related Behavior Questionnaire (Junior High School Version), Childhood Trauma Questionnaire-Short Form (CTQ-SF), and Center for Epidemiologic Studies-Depression Scale (CES-D). Statistical analyses of the data were performed using the Chi-square test and multiple Logistic regression. Results The detection rates of NSSI, SA, NSSI+SA and ACEs in junior high school students were 19.2%, 4.6%, 3.5% and 57.9% respectively. After controlling for factors such as gender, grade, family type, self-rated family economic status, self-rated academic performance, self-rated academic pressure, number of close friends, and depressive symptom scores, results from the multiple Logistic regression analysis showed that junior high school students with physical abuse (OR=1.98, 95%CI=1.23-3.18), emotional abuse (OR=2.83, 95%CI=1.92-4.19), sexual abuse (OR=1.70, 95%CI=1.07-2.69), physical neglect (OR=1.67, 95%CI=1.20-2.33) and witnessing domestic violence (OR=2.10, 95%CI=1.41-2.87) in childhood had higher risks for the occurrence of NSSI+SA (all P < 0.05). After stratification by gender, boys with sexual abuse in childhood had a high risk for the occurrence of NSSI+SA (OR=2.17, 95%CI=1.06-4.43), whereas girls with emotional abuse (OR=3.69, 95%CI=2.29-5.94), physical neglect (OR=1.62, 95%CI=1.07-2.45) and witnessing domestic violence (OR=2.17, 95%CI=1.41-3.34) in childhood had hgih risks for the occurrence of NSSI+SA (all P < 0.05). Conclusions Different types of ACEs have different effects on the co-occurrence of self-harm in junior high school students and there are gender differences. When family interventions are conducted for the combined model, emphasis should be placed on aspects of emotional abuse and domestic violence while optimizing the interventions based on gender differences.
- Life change events /
- Self-injurious behavior /
- Suicide /
- Mental health /
- Students
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表 1 不同组别初中生NSSI和SA行为类型分布比较

Table 1. Comparison of the distribution of NSSI and SA behavior types among junior high school students in different groups

组别	选项	人数	NSH	仅NSSI	仅SA	NSSI+SA	χ²值	P值
性别	男	3 625	3 015(83.2)	504(13.9)	32(0.9)	74(2.0)	70.57	< 0.01
	女	3 735	2 851(76.3)	654(17.5)	50(1.3)	180(4.8)
年级	初一	2 468	1 941(78.6)	408(16.5)	25(1.0)	94(3.8)	17.17	< 0.01
	初二	2 428	1 901(78.3)	409(16.8)	26(1.1)	92(3.8)
	初三	2 464	2 024(82.1)	341(13.8)	31(1.3)	68(2.8)
是否独生子女	是	1 665	1 332(80.4)	257(15.4)	12(0.7)	64(3.8)	4.10	0.25
	否	5 695	4 534(79.6)	901(15.8)	70(1.2)	190(3.3)
家庭居住地	农村	3 417	2 712(79.4)	544(15.9)	40(1.2)	121(3.5)	0.56	0.91
	城镇	3 943	3 154(80.0)	614(15.6)	42(1.1)	133(3.4)
住校	是	2 633	2 067(78.5)	441(16.7)	34(1.3)	91(3.5)	4.58	0.21
	否	4 727	3 799(80.4)	717(15.2)	48(1.0)	163(3.4)
家庭类型	核心家庭	1 959	1 591(81.2)	286(14.6)	22(1.1)	60(3.1)	36.96	< 0.01
	大家庭	4 009	2 326(58.0)	604(15.1)	42(1.0)	137(3.4)
	重组家庭	564	437(77.5)	100(17.7)	7(1.2)	20(3.5)
	单亲家庭	690	518(75.1)	138(20.0)	10(1.4)	24(3.5)
	其他	138	94(68.1)	30(21.7)	1(0.7)	13(9.4)
父亲受教育程度	小学及以下	1 155	884(76.5)	216(18.7)	11(1.0)	44(3.8)	21.00	0.05
	初中	3 422	2 730(79.8)	526(15.4)	39(1.1)	127(3.7)
	高中/中专	1 301	1 058(81.3)	194(14.9)	10(0.8)	39(3.0)
	大专及以上	607	499(82.2)	77(12.7)	10(1.6)	21(3.5)
	不知道	875	695(79.4)	145(16.6)	12(1.4)	23(2.6)
母亲受教育程度	小学及以下	1 434	1 137(79.3)	228(15.9)	16(1.1)	53(3.7)	8.54	0.74
	初中	3 176	2 544(80.1)	492(15.5)	31(1.0)	109(3.4)
	高中/中专	1 188	948(79.8)	179(15.1)	16(1.3)	45(3.8)
	大专及以上	532	432(81.2)	76(14.3)	5(0.9)	19(3.6)
	不知道	1 030	805(78.2)	183(17.7)	14(1.4)	28(2.7)
自评家庭经济	较好	1 468	1 215(82.8)	200(13.6)	16(1.1)	37(2.5)	105.03	< 0.01
	中等	5 142	4 152(80.7)	778(15.1)	53(1.0)	159(3.1)
	较差	750	499(66.5)	180(24.0)	13(1.7)	58(7.7)
自评学习成绩	较好	1 992	1 635(82.1)	298(15.0)	15(0.8)	44(2.2)	79.87	< 0.01
	中等	2 491	2 062(82.8)	343(13.8)	30(1.2)	56(2.2)
	较差	2 877	2 169(75.4)	517(18.0)	37(1.3)	154(5.4)
自评学习压力	较小	644	549(85.2)	77(12.0)	7(1.1)	11(1.7)	220.19	< 0.01
	一般	3 711	3 168(85.4)	440(11.9)	26(0.7)	77(2.1)
	较大	3 005	2 149(71.5)	641(21.3)	49(1.6)	166(5.5)
亲密朋友数量/个	0~2	2 336	1 741(74.5)	441(18.9)	31(1.3)	123(5.3)	73.78	< 0.01
	3~5	3 108	2 516(81.0)	470(15.1)	34(1.1)	88(2.8)
	≥6	1 916	1 609(84.0)	247(12.9)	17(0.9)	43(2.2)
注：()内数字为构成比/%；核心家庭为父母和子女共同生活，大家庭为父母、子女和祖父母/外祖父母共同生活，重组家庭为父母有过至少一次婚姻且现在已经组建新家庭、并与子女共同生活，单亲家庭为仅与父亲或者母亲一方共同生活，其他为排除以上类型。

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表 2 不同性别初中生各类型ACEs检出率比较

Table 2. Comparison of the detection rates of various types of ACEs among junior high school students by gender

性别	人数	ACEs	躯体虐待	情感虐待	性虐待	躯体忽视	情感忽视	家庭成员物质滥用	父母分居/离婚	目睹家庭暴力	家庭成员患有精神疾病	家庭成员犯罪入狱
男	3 625	2 155(59.4)	205(5.7)	186(5.1)	261(7.2)	1 101(30.4)	1 063(29.3)	262(7.2)	780(21.5)	361(10.0)	76(2.1)	111(3.1)
女	3 735	2 104(56.3)	142(3.8)	294(7.9)	171(4.6)	918(24.6)	1 018(27.3)	260(7.0)	932(25.0)	457(12.2)	113(3.0)	96(2.6)
合计	7 360	4 259(57.9)	347(4.7)	480(6.5)	432(5.9)	2 019(27.4)	2 081(28.3)	522(7.1)	1 712(23.3)	818(11.1)	189(2.6)	207(2.8)
χ²值		7.33	14.07	22.66	22.89	31.02	3.88	0.20	12.17	9.66	6.34	1.63
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	0.05	0.66	< 0.01	< 0.01	0.01	0.20
注：()内数字为检出率/%。

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表 3 ACEs与初中生NSSI和SA行为多元Logistic回归分析[OR值(95%CI)]

Table 3. Multivariate Logistic regression of ACEs with NSSI and SA behaviors in junior high school students[OR(95%CI)]

性别	ACEs	仅NSSI	仅SA	NSSI+SA
男	躯体虐待	1.58(1.04~2.40)^*	1.44(0.42~4.93)	2.34(1.09~5.02)^*
(n=3 625)	情感虐待	1.87(1.23~2.83)^**	0.41(0.08~2.07)	1.73(0.81~3.97)
	性虐待	1.25(0.86~1.81)	3.14(1.19~8.28)^*	2.17(1.06~4.43)^*
	躯体忽视	1.24(0.96~1.58)	1.50(0.67~3.34)	1.63(0.89~2.98)
	情感忽视	0.99(0.77~1.27)	1.18(0.53~2.66)	1.04(0.57~1.92)
	家庭成员物质滥用	1.03(0.71~1.50)	0.27(0.05~1.45)	0.61(0.24~1.55)
	父母分居/离婚	1.27(0.93~1.73)	1.12(0.40~3.18)	1.53(0.75~3.13)
	目睹家庭暴力	1.57(1.14~2.16)^**	1.71(0.63~4.61)	1.71(0.87~3.40)
	家庭成员患有精神疾病	0.82(0.42~1.61)	0.91(0.10~8.42)	0.62(0.16~2.41)
	家庭成员犯罪入狱	1.08(0.61~1.94)	4.90(1.46~16.46)^*	1.86(0.58~5.97)
女	躯体虐待	1.55(0.92~2.61)	1.59(0.46~5.51)	1.96(1.01~3.81)^*
(n=3 735)	情感虐待	1.98(1.38~2.83)^**	1.12(0.41~3.06)	3.69(2.29~5.94)^**
	性虐待	1.23(0.78~1.94)	3.12(1.23~7.95)^*	1.38(0.72~2.61)
	躯体忽视	1.11(0.87~1.41)	0.60(0.29~1.25)	1.62(1.07~2.45)^*
	情感忽视	1.07(0.84~1.37)	1.79(0.91~3.53)	1.15(0.74~1.76)
	家庭成员物质滥用	1.06(0.74~1.54)	1.77(0.75~4.17)	0.72(0.39~1.33)
	父母分居/离婚	1.39(1.06~1.84)^*	0.80(0.34~1.91)	1.59(0.98~2.48)
	目睹家庭暴力	1.35(1.02~1.78)^*	1.85(0.91~3.79)	2.17(1.41~3.34)^**
	家庭成员患有精神疾病	1.04(0.60~1.80)	1.69(0.48~5.99)	1.13(0.52~2.46)
	家庭成员犯罪入狱	1.00(0.56~1.81)	1.38(0.38~5.06)	0.85(0.34~2.15)
总体	躯体虐待	1.55(1.12~2.13)^**	1.42(0.60~3.39)	1.98(1.23~3.18)^**
(n=7 360)	情感虐待	1.90(1.45~2.48)^**	0.79(0.34~1.83)	2.83(1.92~4.19)^**
	性虐待	1.23(0.93~1.64)	3.07(1.57~5.97)^**	1.70(1.07~2.69)^*
	躯体忽视	1.15(0.97~1.37)	0.90(0.53~1.52)	1.67(1.20~2.33)^**
	情感忽视	1.06(0.89~1.26)	1.54(0.92~2.58)	1.10(0.78~1.55)
	家庭成员物质滥用	1.05(0.81~1.36)	0.96(0.45~2.02)	0.67(0.41~1.10)
	父母分居/离婚	1.33(1.09~1.63)^**	0.91(0.47~1.73)	1.43(0.98~2.09)
	目睹家庭暴力	1.43(1.16~1.76)^**	1.77(1.00~3.15)	2.10(1.41~2.87)^**
	家庭成员患有精神疾病	0.97(0.64~1.48)	1.18(0.40~3.49)	0.95(0.50~1.83)
	家庭成员犯罪入狱	1.07(0.71~1.61)	2.38(0.99~5.72)	1.25(0.63~2.49)
注：不同性别分析控制年级、家庭类型、自评家庭经济、自评学习成绩、自评学习压力、亲密朋友数量、抑郁症状得分，总体分析在此基础上控制性别因素；^* P < 0.05, ^** P＜0.01。

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