Suicide and non-suicidal self-injury among Chinese adolescents: a longitudinal study based on the social ecological perspective
J Affect Disord. 2025 May 5:S0165-0327(25)00775-X. doi: 10.1016/j.jad.2025.05.019. Online ahead of print.
ABSTRACT
OBJECTIVE: To explore the impact of social ecological risk factors (SERFs) from seven dimensions of individual, family, school, community, policy, culture, and chronosystem on suicide-related behavior (SRB) and non-suicidal self-injury (NSSI) among adolescents.
METHODS: A longitudinal study was conducted in China. A total of 2114 adolescents (aged 15.25 ± 1.99 years, 48.5 % males) completed questionnaire at baseline and follow-up. Restricted Cubic Spline and logistic regression was performed to identify the association of SERFs with suicidal ideation (SI), suicidal plan (SP), suicidal attempt (SA) and NSSI. Back-propagation artificial neural network was used to test the importance values of SERFs for SRB and NSSI.
RESULTS: RCS showed the risk of SI, SP, SA and NSSI among adolescents increased with the increase of cumulative social ecological risk when the risk score exceeded the median (All P for overall<0.001). Logistic regression analysis showed the high cumulative social ecological risk was associated with SI (OR = 3.028, 95 % CI:2.192-4.183), SP (OR = 2.672, 95 % CI:1.738-4.109), SA (OR = 6.267, 95 % CI:3.087-12.723) and NSSI (OR = 3.541, 95 % CI:2.528-4.971). The similar results were also found in the individual, family, school, community, and culture dimensions (All P < 0.05). The individual dimension of social ecological risk was the most important for predicting SRB and NSSI.
CONCLUSION: Adolescents with high culminative social ecological risk had higher SRB and NSSI risks. Schools and families could strengthen adolescents’ self-efficacy and cultivate positive coping styles on the basis of exerting their own functions. Shaping optimistic personality characteristics and correct cultural values may effectively reduce the risk of SRB and NSSI among adolescents.
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