Abstract
Negative life events (NLEs) increase the risk of suicidal ideation (SI) in adolescents. However, it is not known whether the association between NLEs and SI can be moderated by self-esteem and varies with gender. The aim of the current paper was to examine gender differences in the association of SI with NLEs in adolescents, and assess the effects of self-esteem on the association and their gender variations. We conducted a school-based health survey in 15 schools in China between November 2013 and January 2014. A total of 9704 participants aged 11–19 years had sociodemographic data reported and self-esteem (Rosenberg self-esteem scale), NLEs, and SI measured. Multivariate-adjusted logistic regression was used to calculate the odds ratio (OR) of having SI in relation to NLEs. Increased risk of SI was significantly associated with NLEs (adjusted OR 2.19, 95%CI 1.94–2.47), showing no gender differences (in females 2.38, 2.02–2.80, in males 1.96, 1.64–2.36, respectively). The association was stronger in adolescents with high esteem (2.93, 2.34–3.68) than those with low esteem (2.00, 1.65–2.42) (ORs ratio 1.47, p = 0.012). The matched figures in females were 3.66 (2.69–4.99) and 2.08 (1.61–2.70) (1.76, p = 0.006), while in males these figures were 2.27(1.62–3.19) and 1.89 (1.41–2.53) (1.20, p = 0.422), respectively. Self-esteem had moderate effects on the association between NLEs and SI in adolescents, mainly in females. NLEs, self-esteem, and gender need to be incorporated into future intervention programs to prevent SI in adolescents.
Highlights
IntroductionSuicidal ideation (SI) is a major public health problem in China and around the world [1,2]
Suicidal ideation (SI) is a major public health problem in China and around the world [1,2].Suicidal ideation is common among adolescents, present in about 17.5% of the middle school students in China [1] and about 17.7% of adolescents in the United States [3]
Contrary to the findings of above research, our current study found the association between negative life events (NLEs) and SI was stronger in adolescents with high self-esteem than those with moderate or low esteem, suggesting that high self-esteem among those who have accumulated NLEs could be associated with increased risk of SI
Summary
Suicidal ideation (SI) is a major public health problem in China and around the world [1,2]. Suicidal ideation is common among adolescents, present in about 17.5% of the middle school students in China [1] and about 17.7% of adolescents in the United States [3]. Suicidal ideation has been found to be significantly associated with suicidal attempt, depressiveness, anxiety, disordered eating, and so on [4,5,6,7]. To sustain improvements in management and prevention initiatives, we need to identify and understand the risk and protective factors associated with suicidal ideation. Some authors have considered negative life events (NLEs) and self-esteem as an impact factors for SI in adolescents [8,9,10,11,12,13]. The direction of the relationship is that an increased perception in
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