Abstract
BackgroundSuicide is the second leading cause of death among 15–29 year old youths globally, and the third most common external cause of death in China. School bullying can cause serious consequences among adolescents, including psychosocial problems, low self-esteem and post-traumatic stress disorder. Most studies examining the associations between being bullied in school and suicide are from Western, developed countries. Moreover, few studies focus on being threatened or injured with a weapon, which may cause serious body injury. Our study aimed to explore the relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt among middle and high school students in Zhejiang Province, China.MethodsA cross-sectional study of 23,543 students in grades 7–12 from 442 schools was carried out through an anonymous self-administered questionnaire between April and May 2017. Multivariable logistic regression models were used to examine the relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt.Results51.3% of participants were boys, and mean (SD) age was 15.6 (1.7) years. The overall prevalence of suicidal ideation and attempt were 16.1% (95%CI: 15.3–16.9) and 3.6% (95%CI: 3.3–4.0), respectively. Prevalence was higher among girls than boys (ideation: 19.1% vs. 13.3%. attempt: 4.4% vs. 2.9%). 13.2% of students reported being threatened or injured with a weapon in school in the past 12 months (95%CI: 11.9–14.5), higher among boys than girls (15.7% vs. 10.5%), and among rural students than urban students (13.9% vs. 11.6%). After adjustment for socio-demographic status, lifestyle factors, academic performance, self-reported health and mental health, the odds ratios for suicidal ideation and attempt among students who reported being threatened or injured with a weapon were 1.46 (1.31–1.61) and 1.68 (1.31–2.13) respectively, as compared with those who did not report being threatened or injured.ConclusionsPreventive measures for physical bullying in school need to be reinforced in China. Being threatened or injured with a weapon is associated with both suicidal ideation and attempt among middle and high school students. Suicide prevention should be an important component of psychological interventions for threatened or injured students.
Highlights
Suicide is the second leading cause of death among 15–29 year old youths globally, and the third most common external cause of death in China
Due to missing or incomplete questionnaires or refusal to participate, 23,543 eligible students were included in the final analyses. 12,068 (51.3%) were boys, and mean age was 15.6 years. 12,207 (51.9%) students were from middle schools, 6477 (27.5%) were from academic high schools, and 4859 (20.6%) came from vocational high schools
Compared with those who reported not being threatened or injured, students who reported being threatened or injured with a weapon in school were more likely to be boys (61.8% vs. 50.3%) (Table 1), to come from a rural area (71.9% vs. 67.6%), to have poor academic performance (31.1% vs. 26.4%), to smoke cigarettes (8.6% vs. 5.0%), to drink alcohol (31.1% vs. 21.5%), to describe their health as very bad or bad (9.0% vs. 5.2%), to report previous sexual experiences (6.4% vs. 3.5%), to feel lonely (18.3% vs. 10.2%) or sad (25.8% vs. 13.9%), and were less likely to come from intact families (88.0% vs. 90.4%)
Summary
Suicide is the second leading cause of death among 15–29 year old youths globally, and the third most common external cause of death in China. Suicide is the second leading cause of death among 15–29 year olds globally [1]. Suicide rates in China decreased significantly during the past 30 years [2, 3] It remains the third most common external cause of death, following road traffic accidents and falls [4]. Mortality due to suicide among adolescents aged 15–19 years decreased from 1.80 to 1.56 per 100,000 in urban areas, and from 3.47 to 2.52 per 100,000 in rural areas [5]. It is necessary to study the epidemiological profile of suicide behaviours among Chinese students
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