Investigation Of Non-suicidal Self-injury And Influencing Factors Among Rural Middle School Students

Objective: To investigate the prevalence of non-suicidal self-injury(NSSI) among rural middle school students in China, and explore the influencing factors on NSSI, so as to provide scientific basis for the prevention of NSSI. Method: Multistage stratified random sampling was applied in 15 cities of 5 provinces(Hubei, Anhui, Guangdong, Heilongjiang, Yunnan) across China, 15590 rural middle school students aged 11 to 18 years old completed the scale of Self-injurious Behavior Evaluation Questionnaire, Resilience Scale for Chinese Adolescents, Adolescent Self-Rating Life Events Check List and the Loneliness Rating Scale. Epidata 3.1 and SPSS 18.0 were used for data recording and analysis. Descriptive statistics, variance analysis, chi-square test and multinomial logistic regression analysis were used to analyzed the data. Results: 1. A total of 4454(28.57%) rural middle school students conducted NSSI at least one time during the past year. The action of NSSI occurring five times or more accounted for 11.52%. The three most reported forms of NSSI in student were hitting, pinching and pulling hair.2. Regional difference in NSSI of middle school students were statistically significant(P<0.05), and the prevalence rates were highest in Anhui and Guangdong Province, Heilongjiang was the lowest. The findings in current study showed that occasional self-injury is more prevalent among girls than boys(P<0.05), however we found no gender difference in the prevalence on frequent self-injury. The rate of occasional self-injury in Han students was higher than that in minority groups(P<0.05), while minority students had a significant higher prevalence of frequent self-injury than Han students(P<0.05). The development changes of two types of NSSI formed an inverted ―W‖ with grades. In this study, the students with sibling were more likely to reported higher rates of both types NSSI than those without(P<0.05). At the same time, this study suggested that left behind students were more likely to NSSI than non-left behind(P<0.05), and family type, household income and parents’ education were significant associated with self-injury.3. NSSI was significantly associated with the scores of resilience scale, loneliness rating scale and life events scale(P<0.05). The students who engaged in frequent self-injury were significantly more likely to report Lower psychological resilience scores, higher loneliness scores and more life events than students with occasional self-injury.4. Multinomial logistic regression analysis revealed that age, nation, gender, left behind, education level of parents, resilience scale, loneliness and life events were important concomitants of occasional self-injury, frequent self-injury was significantly associated with age, nation, only one child, the education of father, family type, resilience scale, loneliness and life events when the reference category was no self-injury. If the reference category was occasional self-injury, the non-left behind students, who reported family type(single parent), high level of loneliness or more life event demonstrated an elevated risk for frequent self-injury when occasional self-injury was used as the reference category. Whereas the Han students who reported education of mother(less than college) had a decreased risk for frequent self-injury. Conclusion: 1. Overall, the prevalence of NSSI among rural middle school students were 28.57%, and occasional self-injury and frequent self-injury were 17.05%, 11.52% respectively. There were many variables including geographic location, gender, age, ethnicity, left-behind, only one child, and parents’ education were found to have a significant association with NSSI. The girls had a significant higher prevalence than boys and the most frequently reported form of NSSI was hitting.2. The present study highlighted that psychological resilience was associated with self-injury among rural middle school students, and loneliness and life events were risk factors for both types of self-injury.3. The results of this study indicated that both types of NSSI were associated with socialdemological factors and mental health status, and therefore, prevention of self-injury involved the joint efforts of the family, school and society, and mental health education related to self-injury should be strengthened so as to prevent self-injury.