Stressful Life Events as a Predictor for Nonsuicidal Self-Injury in Southern Chinese Adolescence

Abstract

Stressful life events have been implicated in the etiology of kinds of psychopathology related to nonsuicidal self-injury (NSSI); however, few studies have examined the association between NSSI and stressful life events directly in Chinese school adolescents. In this study, we aim to estimate the prevalence rate of NSSI and examine its association with stressful life events in Southern Chinese adolescents. A total sample of 4405 students with age ranged from 10 to 22 years was randomly selected from 12 schools in 3 cities of Guangdong Province, China. NSSI, stressful life events, self-esteem, emotional management, and coping methods were measured by structured questionnaires. Multinomial logistic regression was used to examine the association of NSSI with stressful life events. Results showed the 1 year self-reported NSSI was 29.2%, with 22.6% engaged in “minor” NSSI (including hitting self, pulling hair, biting self, inserting objects under nails or skin, picking at a wound) and 6.6% in “moderate/sever” NSSI (including cutting/carving, burning, self-tattooing, scraping, and erasing skin). Self-hitting (15.9%), pulling hair out (10.9%), and self-inserting objects under nails or skin picking areas to dram blood (18.3%) were the most frequent types of NSSI among adolescents. Results also showed that “Minor NSSI” was associated with stressful life events on interpersonal, loss and health adaption, and “moderate/severe NSSI” was associated with life events on interpersonal, health adaption in Southern Chinese adolescents, even after adjusted for sex, age, residence, self-esteem, coping style, and emotional management. Results further suggested stressful life events were significantly associated with less risk of NSSI in those who had good emotional management ability.

Low health literacy and psychological symptoms potentially increase the risks of non-suicidal self-injury in Chinese middle school students

“…Recent studies have found that 51 and 55.6 % of students in US and Spain respectively, have engaged in some type of NSSI [ 27 , 28 ]. In the current study, the prevalence of 27.5 % of NSSI is lower than previous study in 4405 Chinese students (29.2 %) [ 29 ], and similar to that reported in 12,068 adolescents of 11 European countries (27.6 %) [ 30 ]. Our results indicated that junior students had significantly higher prevalence of NSSI than senior high school students, as reported in previous studies, namely NSSI seems to occur during early adolescence [ 31 ].…”

“…Importantly, our study found gender differences in the prevalence of NSSI among adolescents. Previous studies reported that female adolescents showed higher frequencies of NSSI than male adolescents [ 27 , 29 ]. However, our findings indicated higher frequency of NSSI in male adolescents.…”

Prevalence of and risk factors for non-suicidal self-injury in rural China: Results from a nationwide survey in China

“…Wan et al also reported that experiencing any forms of childhood abuse should be considered a risk factor for NSSI during adolescence (Wan et al, 2015). Besides, our previous studies found that emotional management ability, coping style and suicidal behaviors may impact the risk of NSSI (Tang et al, 2016;Tang et al, 2011). This is potentially consistent with the models of NSSI for which psychological or self-regulatory factors are considered as proximal and central to self-injury, while social or environmental factors are deemed as more distal factors (Chapman et al, 2006;Nock & Cha, 2009).…”

“…In order to distinguish between NSSI and suicidal behaviors, participants were also asked about whether any of those behaviors was accomplished with intent of suicide. The CH-FASM has been demonstrated satisfactory psychometric properties, yielding an acceptable internal consistency with a Cronbach's α ranged from 0.76 to 0.81 (Tang et al, 2016). According to the criterion A in DSM-5, subjects who engaged in self-injury for ≥ five times during the last year was classified as NSSI, 1-4 times as pre-NSSI, and no self-injury behavior during the last year as non-NSSI, respectively (Tang et al, 2016).…”

“…The onset of NSSI in community population is in early adolescent, with an approximate median age of 13 or 14 years (Muehlenkamp et al, 2012). The epidemiology of NSSI has been extensively studied in some western country in their nationwide longitudinal studies (Plener et al, 2015;Tuisku et al, 2014;Christoffersen et al, 2015), and self-reported life-time history of NSSI ranged from 7% to 66% among adolescents, which depending on the definition and the assessment tools used (Somer et al, 2015;Zetterqvist et al, 2013a;Tang et al, 2016). Yet in China, evidence for the prevalence of NSSI remains sparse and heterogeneous in some studies with small sample sizes (Zhang et al, 2016;Wan et al, 2015).…”