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

WANG Zhouyan; YANG Siwei; WAN Xiaoke; CHEN Gen; LI Xia; PENG Chang; WANG Hong

doi:10.16835/j.cnki.1000-9817.2025247

Volume 46 Issue 9

Sep. 2025

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WANG Zhouyan, YANG Siwei, WAN Xiaoke, CHEN Gen, LI Xia, PENG Chang, WANG Hong. Association of adverse childhood experiences with the co-occurrence of non-suicidal self-injury and suicide attempts in junior high school students[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(9): 1297-1302. doi: 10.16835/j.cnki.1000-9817.2025247

Citation:

WANG Zhouyan, YANG Siwei, WAN Xiaoke, CHEN Gen, LI Xia, PENG Chang, WANG Hong. Association of adverse childhood experiences with the co-occurrence of non-suicidal self-injury and suicide attempts in junior high school students[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(9): 1297-1302. doi: 10.16835/j.cnki.1000-9817.2025247

Citation:

WANG Zhouyan, YANG Siwei, WAN Xiaoke, CHEN Gen, LI Xia, PENG Chang, WANG Hong. Association of adverse childhood experiences with the co-occurrence of non-suicidal self-injury and suicide attempts in junior high school students[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(9): 1297-1302. doi: 10.16835/j.cnki.1000-9817.2025247

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

doi: 10.16835/j.cnki.1000-9817.2025247

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

Received Date: 2025-06-10
Rev Recd Date: 2025-06-26

Available Online: 2025-10-10

Publish Date: 2025-09-25

Abstract

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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References(31)

References

[1]	万宇辉, 刘婉, 郝加虎, 等. 青少年非自杀性自伤行为评定问卷的编制及其信效度评价[J]. 中国学校卫生, 2018, 39(2): 170-173. doi: 10.16835/j.cnki.1000-9817.2018.02.005 WAN Y H, LIU W, HAO J H, et al. Development and evaluation on reliability and validity of Adolescent Non-suicidal Self-injury Assessment Questionnaire[J]. Chin J Sch Health, 2018, 39(2): 170-173. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2018.02.005
[2]	YE Z, XIONG F, LI W. A Meta-analysis of co-occurrence of non-suicidal self-injury and suicide attempt: implications for clinical intervention and future diagnosis[J]. Front Psychiatry, 2022, 13: 976217. doi: 10.3389/fpsyt.2022.976217
[3]	XIAO W, RONG F, LI S, et al. Co-occurrence patterns of adverse childhood experiences and their associations with non-suicidal self-injury and suicidal behaviors and gender difference among middle school students: a three-city survey in China[J]. J Affect Disord, 2023, 320: 140-147. doi: 10.1016/j.jad.2022.09.124
[4]	CHEUNG Y T D, WONG P W C, LEE A M, et al. Non-suicidal self-injury and suicidal behavior: prevalence, co-occurrence, and correlates of suicide among adolescents in Hong Kong[J]. Soc Psychiatry Psychiatr Epidemiol, 2013, 48(7): 1133-1144. doi: 10.1007/s00127-012-0640-4
[5]	POUDEL A, LAMICHHANE A, MAGAR K R, et al. Non suicidal self injury and suicidal behavior among adolescents: co-occurrence and associated risk factors[J]. BMC Psychiatry, 2022, 22(1): 96. doi: 10.1186/s12888-022-03763-z
[6]	WAERN M, STROMSTEN L, WIKTORSSON S, et al. Overlapping pa-tterns of suicide attempts and non-suicidal self-injuries in adults: a prospective clinical cohort study[J]. J Clin Psychiatry, 2022, 83(6): 21m14330.
[7]	LI S, WANG S, GAO X, et al. Patterns of adverse childhood experiences and suicidal behaviors in adolescents: a four-province study in China[J]. J Affect Disord, 2021, 285: 69-76. doi: 10.1016/j.jad.2021.02.045
[8]	CALVO N, LUGO-MARÍN J, ORIOL M, et al. Childhood maltreatment and non-suicidal self-injury in adolescent population: a systematic review and Meta-analysis[J]. Child Abuse Negl, 2024, 157: 107048. doi: 10.1016/j.chiabu.2024.107048
[9]	ANGELAKIS I, AUSTIN J L, GOODING P. Association of childhood maltreatment with suicide behaviors among young people: a systematic review and Meta-analysis[J]. JAMA Netw Open, 2020, 3(8): e2012563. doi: 10.1001/jamanetworkopen.2020.12563
[10]	XU H, JIANG Z, LI S, et al. Differences in influencing factors between non-suicidal self-injury and suicide attempts in Chinese adolescents: the role of gender[J]. Front Psychiatry, 2022, 13: 870864. doi: 10.3389/fpsyt.2022.870864
[11]	BATTLE D E. Diagnostic and statistical manual of mental disorders (DSM)[J]. Codas, 2013, 25(2): 191-192.
[12]	季成叶. 中国青少年健康相关/危险行为调查综合报告2005[M]. 北京: 北京大学医学出版社, 2007. JI C Y. Comprehensive report on the survey of health-related/risky behaviors of Chinese adolescents 2005[M]. Beijing: Peking University Medical Press, 2007. (in Chinese)
[13]	赵幸福, 张亚林, 李龙飞. 435名儿童的儿童期虐待问卷调查[J]. 中国临床心理学杂志, 2004, 12(4): 377-379. ZHAO X F, ZHANG Y L, LI L F. Childhood abuse: an investigation of 435 middle school students[J]. Chin J Clin Psychol, 2004, 12(4): 377-379. (in Chinese)
[14]	XIE P, WU K, ZHENG Y, et al. Prevalence of childhood trauma and correlations between childhood trauma, suicidal ideation, and social support in patients with depression, bipolar disorder, and schizophrenia in southern China[J]. J Affect Disord, 2018, 228: 41-48. doi: 10.1016/j.jad.2017.11.011
[15]	BERNSTEIN D P, STEIN J A, NEWCOMB M D, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire[J]. Child Abuse Negl, 2003, 27(2): 169-190. doi: 10.1016/S0145-2134(02)00541-0
[16]	FELITTI V J, ANDA R F, NORDENBERG D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study[J]. Am J Prev Med, 1998, 14(4): 245-258. doi: 10.1016/S0749-3797(98)00017-8
[17]	万宇辉. 儿童期躯体虐待与中学生非自杀性自伤行为: 痛觉加工的联结作用[D]. 合肥: 安徽医科大学, 2015. WAN Y H. The role of pain processing in the relationship between childhood physical abuse and non suicidal self-injury behaviors among middle school students[D]. Hefei: Anhui Medical University, 2015. (in Chinese)
[18]	RADLOFF L S. The CES-D Scale: a self-report depression scale for research in the general population[J]. Appl Psychol Meas, 1977, 1(3): 385-401. doi: 10.1177/014662167700100306
[19]	陈祉妍, 杨小冬, 李新影. 流调中心抑郁量表在我国青少年中的试用[J]. 中国临床心理学杂志, 2009, 17(4): 443-445, 448. CHEN Z Y, YANG X D, LI X Y. Psychometric features of CES-D in Chinese adolescents[J]. Chin J Clin Psychol, 2009, 17(4): 443-445, 448. (in Chinese)
[20]	刘爱妮, 罗宇, 张荣慧楠, 等. 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[J]. 中国学校卫生, 2024, 45(7): 1026-1030. doi: 10.16835/j.cnki.1000-9817.2024200 LIU A N, LUO Y, ZHANG R H N, et al. Association of adverse childhood experiences and non-suicidal self-injurious interactions with suicide-related behaviors in junior high school students[J]. Chin J Sch Health, 2024, 45(7): 1026-1030. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2024200
[21]	张至贤, 黄雪雪, 胡婕, 等. 中学生心理健康素养和非自杀性自伤行为交互作用与自杀相关行为关联[J]. 中国公共卫生, 2022, 38(12): 1517-1522. ZHANG Z X, HUANG X X, HU J, et al. Association of interaction between mental health literacy and non-suicidal self-injury with suicidal behaviors among middle school students: a cross-sectional survey in three China cities[J]. Chin J Public Health, 2022, 38(12): 1517-1522. (in Chinese)
[22]	TANG J, LI G, CHEN B, et al. Prevalence of and risk factors for non-suicidal self-injury in rural China: results from a nationwide survey in China[J]. J Affect Disord, 2018, 226: 188-195. doi: 10.1016/j.jad.2017.09.051
[23]	赵志雅, 徐慧琼, 汪姗姗, 等. 初中生青春发动时相与心理亚健康关联及性别差异[J]. 中国公共卫生, 2021, 37(2): 270-274. ZHAO Z Y, XU H Q, WANG S S, et al. Association between puberty timing and mental sub-health and its gender differences in junior middle school students[J]. Chin J Public Health, 2021, 37(2): 270-274. (in Chinese)
[24]	MADIGAN S, THIEMANN R, DENEAULT A A, et al. Prevalence of adverse childhood experiences in child population samples: a systematic review and Meta-analysis[J]. JAMA Pediatr, 2025, 179(1): 19-33. doi: 10.1001/jamapediatrics.2024.4385
[25]	CUI N, XUE J, CONNOLLY C A, et al. Does the gender of parent or child matter in child maltreatment in China?[J]. Child Abuse Negl, 2016, 54: 1-9. doi: 10.1016/j.chiabu.2016.01.003
[26]	彭淋, 张思恒, 杨剑, 等. 中国儿童期性虐待发生率的Meta分析[J]. 中华流行病学杂志, 2013, 34(12): 1245-1249. PENG L, ZHANG S H, YANG J, et al. Meta-analysis on the incidence rates of child sexual abuse in China[J]. Chin J Epidemiol, 2013, 34(12): 1245-1249. (in Chinese)
[27]	王永红, 陈晶琦. 1 762名大专学生童年期虐待经历及影响因素分析[J]. 现代预防医学, 2012, 39(18): 4654-4656. WANG Y H, CHEN J Q. Analysis on chilhood abuse experience and the influencing factors among 1 762 college students[J]. Mod Prev Med, 2012, 39(18): 4654-4656. (in Chinese)
[28]	MCEWEN C A, MCEWEN B S. Social structure, adversity, toxic st-ress, and intergenerational poverty: an early childhood model[J]. Annu Rev Sociol, 2017, 43(1): 445-472. doi: 10.1146/annurev-soc-060116-053252
[29]	HAMZA C A, STEWART S L, WILLOUGHBY T. Examining the link between nonsuicidal self-injury and suicidal behavior: a review of the literature and an integrated model[J]. Clin Psychol Rev, 2012, 32(6): 482-495. doi: 10.1016/j.cpr.2012.05.003
[30]	XU H, ZHANG X, WANG J, et al. Exploring associations of adverse childhood experiences with patterns of 11 health risk behaviors in Chinese adolescents: focus on gender differences[J]. Child Adolesc Psychiatry Ment Health, 2023, 17(1): 26. doi: 10.1186/s13034-023-00575-1
[31]	PENG C, CHENG J, RONG F, et al. Specific effects of five subtypes of childhood maltreatment on suicide behaviours in Chinese adolescents: the moderating effect of sex and residence[J]. Epidemiol Psychiatr Sci, 2023, 32: e45. doi: 10.1017/S2045796023000604