健康素养和非自杀性自伤行为对初中生自杀相关行为的联合作用

罗宇; 魏科; 张荣慧楠; 刘爱妮; 杨思维; 王宏

doi:10.16835/j.cnki.1000-9817.2024141

健康素养和非自杀性自伤行为对初中生自杀相关行为的联合作用

doi: 10.16835/j.cnki.1000-9817.2024141

1.
重庆医科大学公共卫生学院/医学与社会发展研究中心，401331
2.
重庆市渝北区疾病预防控制中心公共卫生科

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:
罗宇(2000-)，女，四川渠县人，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 C913.5 B845.67
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- 被引次数: 0
出版历程
- 收稿日期: 2024-03-05
- 修回日期: 2024-03-22
- 网络出版日期: 2024-05-30
- 刊出日期: 2024-05-25

Combined effect of health literacy and non-suicidal self-injurious behaviors on suicide-related behaviors of junior middle school students

1.
School of Public Health/Medical and Social Development Research Center, Chongqing Medical University, Chongqing (401331), China

摘要

摘要: 目的探讨初中生健康素养和非自杀性自伤行为(NSSI)对自杀相关行为的联合作用，为初中生自杀预防提供参考依据。方法 2023年5—6月采用多阶段分层整群抽样与方便抽样相结合的方法，抽取重庆市7 367名初中生进行自填式问卷调查。建立二元Logistic回归模型，分析健康素养和NSSI与自杀相关行为的关联。结果初中生自杀意念、自杀计划、自杀未遂的检出率分别为27.99%，9.84%，4.64%，NSSI的检出率为38.03%，总健康素养、功能性健康素养、互动性健康素养、批判性健康素养的具备率分别为62.68%，66.51%，54.24%，72.65%。二元Logistic回归分析显示，不具备总健康素养、不具备3个维度健康素养、有NSSI与初中生自杀意念、自杀计划、自杀未遂均呈正相关(OR=1.42~10.30)，且存在联合作用(OR=7.43~18.71)(P值均 < 0.05)。结论不具备健康素养或存在NSSI以及两者共存会增加自杀相关行为的发生风险。应提高初中生健康素养水平，减少NSSI进而预防自杀相关行为的发生。
- 健康教育 /
- 自我伤害行为 /
- 自杀 /
- 精神卫生 /
- 回归分析 /
- 学生
Abstract: Objective To explore the combined effect of health literacy and non-suicidal self-injury on suicide-related behaviors in junior middle school students, so as to provide reference for suicide prevention. Methods During May to June 2023, a self-filling questionnaire survey was conducted among 7 367 junior middle school students selected by the methods of multi-stage stratified cluster sampling combined with conventient sampling in Chongqing. And a binary Logistic regression model was established to analyze the association of health literacy and NSSI with suicide-related behaviors. Results The detection rates of suicidal ideation, suicide planning, and suicide attempt among junior middle school students were 27.99%, 9.84%, and 4.64%, and the detection rate of NSSI was 38.03%, the rates of possessing total health literacy, functional health literacy, interactive health literacy, and critical health literacy were 62.68%, 66.51%, 54.24%, and 72.65%, respectively. Binary Logistic regression analyses showed that the absence of total health literacy and the three dimensions of health literacy and NSSI were positively correlated with suicidal ideation, suicide planning, and suicide attempt in junior middle school students (OR=1.42-10.30), and there were combined effects (OR=7.43-18.71) (P < 0.05). Conclusions Lack of health literacy or the presence of NSSI and their co-existence increase the risk of suicide-related behaviors, and health literacy level should be improved in junior middle school students to reduce NSSI and thereby prevent suicide-related behaviors.
- Health education /
- Self-injurious behavior /
- Suicide /
- Mental health /
- Regression analysis /
- 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检出率比较

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

组别	人数	自杀意念			自杀计划			自杀未遂
组别	人数	检出人数	χ²值	P值	检出人数	χ²值	P值	检出人数	χ²值	P值
性别
男	3 624	749(20.67)	189.72	<0.01	266(7.34)	50.29	<0.01	108(2.98)	44.52	<0.01
女	3 743	1 313(35.08)			459(12.26)			234(6.25)
年级
初一	2 473	728(29.44)	12.97	<0.01	267(10.80)	14.17	<0.01	122(4.93)	2.83	0.24
初二	2 431	710(29.21)			261(10.74)			120(4.94)
初三	2 463	624(25.33)			197(8.00)			100(4.06)
经济水平片区
好	2 306	603(26.15)	22.09	<0.01	214(9.28)	13.92	<0.01	95(4.12)	12.86	<0.01
中	2 488	782(31.43)			289(11.62)			146(5.87)
差	2 573	677(26.31)			222(8.63)			101(3.93)
家庭类型
核心家庭	1 922	530(27.58)	34.23	<0.01	157(8.17)	35.63	<0.01	81(4.21)	10.31	0.04
大家庭	4 045	1 056(26.11)			374(9.25)			185(4.57)
重组家庭	567	188(33.16)71			(12.52)			28(4.94)
单亲家庭	694	234(33.72)			100(14.41)			34(4.90)
其他	139	54(38.85)			23(16.55)			14(10.07)
独生子女
是	1 666	479(28.75)	0.62	0.43	173(10.38)	0.72	0.40	75(4.50)	0.10	0.76
否	5 701	1 583(27.77)			552(9.68)			267(4.68)
父亲与母亲的关系
良好	5 581	1 317(23.60)	227.01	<0.01	413(7.40)	173.15	<0.01	177(3.17)	115.84	<0.01
一般	1 373	552(40.20)			217(15.80)			120(8.74)
较差	413	193(46.73)			95(23.00)			45(10.90)
与父亲的关系
良好	5 452	1 220(22.38)	376.78	<0.01	359(6.58)	327.78	<0.01	155(2.84)	200.15	<0.01
一般	1 553	629(40.50)			252(16.23)			127(8.18)
较差	362	213(58.84)			114(31.49)			60(16.57)
与母亲的关系
良好	5 914	1 409(23.82)	274.22	<0.01	450(7.61)	172.80	<0.01	195(3.30)	151.16	<0.01
一般	1 175	501(42.64)			213(18.13)			102(8.68)
较差	278	152(54.68)			62(22.30)			45(16.19)
自评家庭经济情况
较差	749	318(42.46)	88.85	<0.01	133(17.76)	58.90	<0.01	73(9.75)	49.70	<0.01
中等	5 150	1 380(26.80)			462(8.97)			215(4.17)
良好	1 468	364(24.80)			130(8.86)			54(3.68)
自评学习成绩
较差	2 879	942(32.72)	52.55	<0.01	357(12.40)	36.24	<0.01	193(6.70)	45.72	<0.01
中等	2 495	618(24.77)			193(7.74)			87(3.49)
良好	1 993	502(25.19)			175(8.78)			62(3.11)
亲密伙伴个数
0	215	97(45.12)	139.79	<0.01	58(26.98)	112.92	<0.01	32(14.88)	70.93	<0.01
1~2	2 125	740(34.82)			266(12.52)			125(5.88)
3~5	3 112	838(26.93)			271(8.71)			125(4.02)
≥6	1 915	387(20.21)			130(6.79)			60(3.13)
注： ()内数字为检出率/%。

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表 2 初中生健康素养与NSSI对自杀相关行为影响的Logistic回归分析(n=7 367)

Table 2. Logistic regression analysis of the impact of health literacy and NSSI on suicide-related behaviors of junior middle school students(n=7 367)

自变量	自杀意念^a			自杀计划^a			自杀未遂^b
自变量	检出人数	β值	OR值(95%CI)	检出人数	β值	OR值(95%CI)	检出人数	β值	OR值(95%CI)
总健康素养
具备	1 012		1.00	300		1.00	125		1.00
不具备	1 050	0.58	1.78(1.59~2.00)^**	425	0.71	2.03(1.71~2.40)^**	217	0.73	2.08(1.63~2.65)^**
功能性健康素养
具备	1 180		1.00	367		1.00	165		1.00
不具备	882	0.35	1.42(1.27~1.59)^**	358	0.49	1.63(1.38~1.93)^**	177	0.44	1.55(1.23~1.97)^**
互动性健康素养
具备	746		1.00	202		1.00	94		1.00
不具备	1 316	0.81	2.26(2.01~2.53)^**	523	0.97	2.65(2.21~3.17)^**	248	0.79	2.20(1.70~2.85)^**
批判性健康素养
具备	1 321		1.00	436		1.00	199		1.00
不具备	741	0.41	1.51(1.34~1.70)^**	289	0.42	1.52(1.28~1.80)^**	143	0.38	1.46(1.16~1.85)^*
NSSI
无	592		1.00	113		1.00	39		1.00
有	1 470	1.84	6.31(5.60~7.10)^**	612	2.17	8.75(7.08~10.82)^**	303	2.33	10.30(7.30~14.52)^**
注： a调整性别、年级、区县、家庭类型、父亲与母亲的关系、与父亲的关系、与母亲的关系、自评家庭经济情况、自评学习成绩、亲密朋友个数因素；b调整性别、区县、家庭类型、父亲与母亲的关系、与父亲的关系、与母亲的关系、自评家庭经济情况、自评学习成绩、亲密朋友个数因素；P<0.05，*P<0.01。

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表 3 初中生健康素养与NSSI的联合作用对自杀相关行为的Logistic回归分析(n=7 367)

Table 3. Logistic regression analysis of the combined effect of health literacy and NSSI on suicide-related behaviors of junior middle school students(n=7 367)

健康素养	NSSI	自杀意念^a			自杀计划^a			自杀未遂^b
健康素养	NSSI	β值	OR值(95%CI)	P值	β值	OR值(95%CI)	P值	β值	OR值(95%CI)	P值
总健康素养
具备	无		1.00			1.00			1.00
	有	1.90	6.71(5.73~7.86)	<0.01	2.29	9.91(7.32~13.41)	<0.01	2.53	12.57(7.47~21.14)	<0.01
不具备	无	0.49	1.64(1.35~1.97)	<0.01	0.76	2.13(1.45~3.13)	<0.01	0.90	2.46(1.29~4.69)	0.01
	有	2.15	8.60(7.29~10.14)	<0.01	2.67	14.47(10.70~19.57)	<0.01	2.93	18.71(11.19~31.28)	<0.01
功能性健康素养
具备	无		1.00			1.00			1.00
	有	1.87	6.48(5.58~7.52)	<0.01	2.27	9.64(7.28~12.79)	<0.01	2.58	13.24(8.14~21.54)	<0.01
不具备	无	0.25	1.29(1.06~1.56)	0.01	0.56	1.75(1.19~2.58)	<0.01	0.80	2.22(1.17~4.20)	0.01
	有	2.00	7.43(6.29~8.77)	<0.01	2.53	12.53(9.36~16.77)	<0.01	2.77	15.99(9.74~26.23)	<0.01
互动性健康素养
具备	无		1.00			1.00			1.00
	有	1.95	7.06(5.90~8.44)	<0.01	2.22	9.24(6.55~13.04)	<0.01	2.23	9.27(5.54~15.49)	<0.01
不具备	无	0.73	2.08(1.74~2.50)	<0.01	0.85	2.35(1.59~3.50)	<0.01	0.39	1.47(0.78~2.79)	0.23
	有	2.33	10.25(8.68~12.10)	<0.01	2.80	16.52(11.96~22.83)	<0.01	2.66	14.32(8.82~23.27)	<0.01
批判性健康素养
具备	无		1.00			1.00			1.00
	有	1.88	6.57(5.69~7.57)	<0.01	2.29	9.84(7.60~12.80)	<0.01	2.36	10.62(7.00~16.09)	<0.01
不具备	无	0.34	1.40(1.14~1.71)	<0.01	0.55	1.73(1.16~2.58)	<0.01	0.30	1.34(0.68~2.68)	0.40
	有	2.02	7.50(6.33~8.89)	<0.01	2.40	11.07(8.35~14.66)	<0.01	2.50	12.20(7.90~18.82)	<0.01
注： a调整性别、年级、区县、家庭类型、父亲与母亲的关系、与父亲的关系、与母亲的关系、自评家庭经济情况、自评学习成绩、亲密朋友个数因素；b调整性别、区县、家庭类型、父亲与母亲的关系、与父亲的关系、与母亲的关系、自评家庭经济情况、自评学习成绩、亲密朋友个数因素。

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