Citation

Guo L, Wang W, Wang T, Li W, Gong M, Zhang S, Zhang WH, Lu C. J. Affect. Disord. 2019; 258: 25-32.

Affiliation

Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China. Electronic address: luciyong@mail.sysu.edu.cn.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.jad.2019.07.085

PMID

31382101

Abstract

BACKGROUND: There were differences in the characteristics and prevalence rates between individuals with a history of one suicide attempt and those with multiple suicide attempts. This large-scale study was conducted to test, among Chinese adolescents, the associations of emotional and behavioral problems with single and multiple suicide attempts and whether these associations vary with adolescents' academic performance.

METHODS: Data were drawn from the 2019 School-based Chinese Adolescents Health Survey (n = 20,702). Information about emotional and behavioral problems, suicide attempts, suicidal ideation, academic performance, and sleep duration was gathered. Multinomial logistic regression models using Firth penalized likelihood approach and appropriate sampling weights were performed.

RESULTS: Compared with no suicide attempt, peer problems, emotional problems, conduct problems, and hyperactivity were associated with an elevated risk of both a single suicide attempt and multiple suicide attempts, respectively (P < 0.05); the magnitudes of these associations in multiple suicide attempters were higher than those in single suicide attempters. Further stratification analyses by academic performance showed a greater association of the four difficulties with multiple suicide attempts in adolescents reporting poor academic performance than in those with good or average academic performance. LIMITATIONS: The school-based study sample only included students, and causal inference could not be delineated due to the cross-sectional design.

CONCLUSIONS: Emotional and behavioral problems are associated with an elevated risk of single and multiple suicide attempts with differences between multiple suicide attempters and single suicide attempters. Adolescent academic performance plays a modulating role in these associations for multiple suicide attempts.

Copyright © 2019. Published by Elsevier B.V.

Language: en

Keywords

Academic performance; Adolescents; Emotional and behavioral problems; Single and multiple suicide attempts