Abstract
Abstract Aims The associations between suicidal behaviours and childhood maltreatment (CM), as well as Internet addiction (IA) have been extensively examined. However, few studies pay attention to different types of CM and all stages of suicidality, including suicidal ideation (SI), suicidal plans (SP) and suicidal attempts (SA). Moreover, little is known regarding the mediation of IA on the relationship between CM and suicidal behaviours. The study aims to explore the direct effect of CM and IA on three stages of suicidal behaviours, and the indirect effect of CM on suicidality via IA. Methods A total of 16 130 high-school students aged 12–18 were recruited using a stratified cluster sampling strategy across five representative provinces in China. Relevant information was collected by a self-administered anonymous questionnaire. Multinomial logistic regression analysis and structural equation model were used to examine the associations. Results During the last year, 16.0% of participants reported suicidal behaviours. Specifically, 7.9% reported SI only, 4.6% reported SP but no SA, and 3.5% reported SA. The prevalence of neglect, physical abuse and IA in moderate to severe were 28.9, 19.9 and 33.1%, respectively. After controlling for demographic characteristics and confounding factors, such as loneliness, psychological resilience, and social support, moderate and severe neglect, physical abuse and IA were associated with an increased risk of SI, SP and SA (p < 0.01). The total effect of neglect and physical abuse on suicidal behaviours were 0.152 and 0.172, respectively (p < 0.001). The mediation proportion of IA on the association between neglect and suicidal behaviours, as well as physical abuse and suicidal behaviours were 22.4 and 18.0%, respectively. Conclusions CM and IA are independently associated with suicidal behaviours among Chinese adolescents. Moreover, IA plays a mediating role on the relationship between CM and suicidality. Targeted interventions for adolescents’ suicidal behaviours should focus on those who have experience of CM and IA.
Highlights
About 800–000 people die from suicide each year and 78% of these suicides occur in low- and middle-income countries (World Health Organization (WHO), 2019)
The proportion of males was slightly higher than females (51.9% v. 48.1%)
About one-fifth (19.9%) of participants reported moderate-to-severe physical abuse and 28.9% reported moderate to severe neglect in the past year
Summary
About 800–000 people die from suicide each year and 78% of these suicides occur in low- and middle-income countries (World Health Organization (WHO), 2019). It is great importance to pay more attention to suicidal behaviours among adolescents (Shen et al, 2020). It is widely accepted that suicidal behaviours were a continuum of development from mild to severe, most often including the following stages: suicidal ideation (SI), suicidal plans (SP), suicidal attempts (SA) and suicide death (Sveticic and De Leo, 2012; Qu et al, 2021). It is essential for suicide prevention to comprehensively understand the whole suicidal model, including all SI, SP and SA. From this point of view, it seems inappropriate to dichotomise any stage of suicidal behaviours (Sveticic and De Leo, 2012). Individuals with or without suicidal behaviours should be classified into four groups: None group (without SI, SP or SA), SI group (have SI only, neither SP nor SA), SP group (have SP, but no SA) and SA group (have SA) (Sveticic and De Leo, 2012)
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