| BackgroundSuicide is one of the serious public health problems worldwide.Suicide death was the fourth leading cause of death in the all-sex age group of 15-29 years old.In China,the number of young people dying by suicide has increased year by year.Suicidal ideation(SI)refers to an individual’s intention to definitively end his or her life,and is a precursor to suicide attempts and a strong predictor of suicide attempts and deaths.Therefore,the prevention of suicidal ideation plays a key role in reducing the suicide rate,and the identification and active intervention of suicidal ideation among college students is a key aspect of suicide prevention.Experiential avoidance(EA)is the phenomenon that occurs when a person is unwilling to remain in contact with particular private experiences(e.g.,bodily sensations,emotions,thoughts,memories,images,behavioral predispositions)and takes steps to alter the form or frequency of these experiences or the contexts that occasion them,even when these forms of avoidance cause behavioral harm.Experiential avoidance can make the emotions and thoughts that are wanted to be avoided more intense so that one cannot accept and experience one’s negative thoughts and negative emotions well.Mental health problems such as depression,anxiety,and post-traumatic stress disorder were significantly associated with experiential avoidance,and lower quality of life and poorer physical health were also associated with high levels of experiential avoidance.Increasing the understanding of experiential avoidance among college students can be helpful in exploring the development of pathological psychology among college students and can better promote the health development of college students.Experiential avoidance can prospectively predict psychological disorders such as depression,anxiety,and suicidal ideation,and factors such as depression and anxiety are also important risk factors for suicidal ideation.Therefore,this study aimed to use college student health literacy data to explore the relationship between experiential avoidance and suicidal ideation among college students,and to further analyze the mediating role of depressive symptoms and anxiety symptoms in the relationship between the two,and to conduct a preliminary exploration of possible pathways for the relationship between the two.Objectives(1)To test reliability and validity of Acceptance and Action Questionnaire(AAQ-II)as applied to a college student population.(2)To explore the factors associated with suicidal ideation among college students and the relationship between suicidal ideation and experiential avoidance.(3)To explore the current status of depressive and anxiety symptoms among college students and the association with experiential avoidance.(4)To examine the mediating role of depressive symptoms and anxiety symptoms in the relationship between experiential avoidance and suicidal ideation among college students.Method1.SubjectsWe Chose a total of 7 comprehensive universities in Shandong Province,Shanxi Province,and Jilin Province,with 2～4 colleges selected from each university,and in each university,1～2 classes of full-time undergraduate students in each grade were selected as the study population.The survey period was from November 2021 to January 2022,and a total of 5813 college students participated in the survey.In this study,the information was collected using the college students mental health literacy questionnaire,which was collected through the online platform of Questionnaire Star(https://www.wjx.cn/).The survey took about 15 minutes.2.MeasurementThis study used a mental health literacy questionnaire for college students to collect relevant information,including general demographic information,suicidal ideation,experiential avoidance,depression,and anxiety of the study participants.3.Statistical analysisIBM SPSS Statistics 24.0,IBM SPSS AMOS 21,Stata MP 17.0 software were used for statistical analysis.The basic characteristics of the study subjects were described,conforming to a normal distribution using the mean±standard deviation(SD),and not conforming to a normal distribution,using the median(interquartile range,IQR),and the count data were described using n(%).Classical test theory(CTT)was used to evaluate the scales.The internal consistency reliability of the scale was evaluated by calculating Cronbach’s a coefficient,Spearman brown coefficient and Guttman Split-half coefficient,and the items of the scale were evaluated by the coefficient of variation method,Cronbach’s α coefficient method,correlation coefficient method and factor analysis method.The confirmatory factor analysis was conducted to evaluate the structural validity of the scale using the method of constructing structural equation models,and the discriminant validity was evaluated by dividing the sample into high and low subgroups using the scale mean scores.The t-test,χ2 test,and Mann-Whitney U test were used to compare between groups.Multi-factor logistic regression analysis was used to explore the association between suicidal ideation,depressive symptoms,anxiety symptoms and experiential avoidance and the factors associated with suicidal ideation among college students.Parallel multiple mediation models and KHB methods were used to analyze and verify the mediating effects of depressive symptoms and anxiety symptoms.All of the above statistical tests were two-sided,and differences were considered statistically significant at P<0.05.Results1.Sample characteristicsOf the 4633 valid questionnaires,2192(47.31%)were males and 2441(52.69%)were females.The age of the subjects ranged from 15-26 years old,with an average age of 19.28(SD=1.31).2.Scale evaluationThe Cronbach’s a coefficient for the AAQ-Ⅱ scale was 0.925,the Spearman brown coefficient was 0.901,and the Guttman Split-half coefficient was 0.881,which were considered to have good internal consistency.The results of the items analysis showed that item 1 was fair,and the other items were good.The difference between the high and low groups of the scale scores was statistically significant(P<0.001),and the scale can be considered to have good discriminant validity.The results of the confirmatory factor analysis showed that the structural equation model had good robustness,i.e.,the scale had good structural validity.3.Situation of suicidal ideation among college students and related factorsAmong 4633 college students,180(3.89%)reported having suicidal ideation in the past 12 months,with 3.19%of male college students and 4.51%of female college students reporting suicidal ideation.In addition,the reported rates of suicidal ideation were higher among college students who lived in rural areas,had moderate or poor academic performance,poor family financial status,moderate or poor sleep status,did not attend school activities,smoked,drank alcohol,had depressive symptoms,and anxiety symptoms than their control group(P<0.05).Experiential avoidance was significantly higher in the suicidal ideation group than in the nonsuicidal ideation group(Z=-14.52,P<0.001).Results of multivariate logistic regression analysis of suicidal ideation showed that poor academic performance,moderate sleep status,smoking,depressive symptoms,anxiety symptoms,and experiential avoidance were all positively associated with suicidal ideation,and male,moderate family economic status were negatively associated with suicidal ideation among college students.4.Depression and anxiety among college students and the association with experiential avoidanceThere were 427(9.22%),482(10.40%),131(2.83%),and 79(1.71%)mildly depressed,moderately depressed,severely depressed,and very severely depressed college students,respectively,with a reporting rate of 24.15%for depressive symptoms;409(8.83%),824(17.79%),271(5.85%),and 309(6.67%)mildly anxious,moderately anxious,severely anxious,and very severely anxious college students,respectively,with a reporting rate of 39.13%for anxiety symptoms.The rate of reporting depressive symptoms and anxiety symptoms was significantly higher in males than in females.974 college students had depressive symptoms combined with anxiety symptoms,and the combined number accounted for 21.02%of the total,with a statistical difference between males and females(χ2=48.23,P<0.001).The association of experiential avoidance with depressive symptoms(OR=1.17,95%CI:1.16-1.18),anxiety symptoms(OR=1.13,95%CI:1.12-1.14),and depressive symptoms combined with anxiety symptoms(OR=1.17,95%CI:1.16-1.19)were statistically significant among college students.5.Analysis of the mediating effect of depressive symptoms and anxiety symptoms between experiential avoidance and suicidal ideationDepressive symptoms,anxiety symptoms,suicidal ideation,and experiential avoidance were all associated.After controlling for other covariates,depressive symptoms and anxiety symptoms mediated the relationship between experiential avoidance and suicidal ideation,with direct and indirect effects of 0.099(95%CI:0.077-0.120)and 0.034(95%CI:0.023-0.047),respectively,and direct and indirect effect proportions of 74.44%and 25.56%,respectively.The mediating effect proportions for depressive symptoms and anxiety symptoms were 9.78%and 15.79%,respectively.In the sample of male college students,the direct and indirect effects were 0.078(95%CI:0.045-0.112)and 0.033(95%CI:0.012-0.053),respectively,and the ratios of direct and indirect effects were 70.27%and 29.73%,respectively,and the proportions of mediating effects for depressive symptoms and anxiety symptoms were 18.02%and 11.71%.In the female college student sample,the direct and indirect effects were 0.117(95%CI:0.0890.146)and 0.036(95%CI:0.021-0.050),respectively,and the proportion of direct and indirect effects were 76.47%and 23.53%,respectively,and the proportion of mediating effects for depressive symptoms and anxiety symptoms were 6.54%%and 16.99%,respectively.Conclusion(1)The Acceptance and Action Questionnaire(AAQ-Ⅱ)had good psychometric indicators among college students and can be used as a valid measure of experiential avoidance.(2)Experiential avoidance among college students was associated with suicidal ideation.(3)Depressive symptoms and anxiety symptoms partly mediated the relationship between experiential avoidance and suicidal ideation in college students. |
