Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents

Yuhui Wan; Ruoling Chen; Shuangshuang Ma; Danielle McFeeters; Ying Sun; Jiahu Hao; Fangbiao Tao

doi:10.1192/bjp.2018.263

Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents

Br J Psychiatry. 2019 Mar;214(3):146-152. doi: 10.1192/bjp.2018.263. Epub 2018 Nov 27.

Authors

Yuhui Wan¹, Ruoling Chen², Shuangshuang Ma³, Danielle McFeeters⁴, Ying Sun⁵, Jiahu Hao⁶, Fangbiao Tao⁶

Affiliations

¹ Associated Professor,Department of Maternal, Child and Adolescent Health,School of Public Health,Anhui Medical University,China,Anhui Provincial Key Laboratory of Population Health and Aristogenics,Anhui Medical University, China and Faculty of Education,Health and Wellbeing,University of Wolverhampton,UK.
² Professor,Faculty of Education,Health and Wellbeing,University of Wolverhampton,UK.
³ Student,Department of Maternal, Child and Adolescent Health,School of Public Health,Anhui Medical UniversityandAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University,China.
⁴ Fellow,Faculty of Education,Health and Wellbeing,University of Wolverhampton,UK.
⁵ Associated Professor,Department of Maternal, Child and Adolescent Health,School of Public Health,Anhui Medical UniversityandAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University,China.
⁶ Professor, Department of Maternal,Child and Adolescent Health,School of Public Health,Anhui Medical UniversityandAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University,China.

Abstract

Background: There is little investigation on the interaction effects of adverse childhood experiences (ACEs) and social support on non-suicidal self-injury (NSSI), suicidal ideation and suicide attempt in community adolescent populations, or gender differences in these effects.AimsTo examine the individual and interaction effects of ACEs and social support on NSSI, suicidal ideation and suicide attempt in adolescents, and explore gender differences.

Method: A school-based health survey was conducted in three provinces in China between 2013-2014. A total of 14 820 students aged 10-20 years completed standard questionnaires, to record details of ACEs, social support, NSSI, suicidal ideation and suicide attempt.

Results: Of included participants, 89.4% reported one or more category of ACEs. The 12-month prevalence of NSSI, suicidal ideation and suicide attempt was 26.1%, 17.5% and 4.4%, respectively; all were significantly associated with increased ACEs and lower social support. The multiple adjusted odds ratio of NSSI in low versus high social support was 2.27 (95% CI 1.85-2.67) for girls and 1.81 (95% CI 1.53-2.14) for boys, and their ratio (Ratio of two odds ratios, ROR) was 1.25 (P = 0.037). Girls with high ACEs scores (5-6) and moderate or low social support also had a higher risk of suicide attempt than boys (RORs: 2.34, 1.84 and 2.02, respectively; all P < 0.05).

Conclusions: ACEs and low social support are associated with increased risk of NSSI and suicidality in Chinese adolescents. Strategies to improve social support, particularly among female adolescents with a high number of ACEs, should be an integral component of targeted mental health interventions.Declaration of interestNone.

Keywords: Adverse childhood experiences; non-suicidal self-injury; social support; suicidal ideation; suicide attempt.

MeSH terms

Adolescent
Adolescent Behavior / psychology*
Adverse Childhood Experiences*
Child
China / epidemiology
Female
Humans
Male
Prevalence
Risk Factors
Schools
Self-Injurious Behavior / epidemiology
Self-Injurious Behavior / psychology*
Sex Factors
Social Support*
Students / psychology
Suicidal Ideation*
Suicide, Attempted / psychology*
Young Adult