Background With the development of society, infectious and malnutrition diseases in adolescents are under good control, but psychological and behavioral problems are more and more prominent. Non-suicidal self-injury (NSSI) behavior is a serious public health problem, and is more likely to occur in adolescence.
Objective This study is designed to investigate the prevalence of NSSI behavior and its association with family factors among middle school students in Shanghai.
Methods By stratified cluster random sampling method, 3 886 students from six middle school in a Shanghai district were selected and invited to finish a self-designed questionnaire and the Adolescence Self-injury Questionnaire in September 2019. Chi-square test was used to compare the incidence of NSSI behavior among the students with different sociodemographic characteristics and family factors, and ordered multi-class logistic regression analysis was used to analyze the variables significant in the univariate analysis.
Results A total of 3 721 valid questionnaires were received in this survey. The results showed that 1 509 students reported NSSI behavior in the past year, and the incidence rate of NSSI was 40.55%; the boys' incidence rate was 34.83% (660/1 895), and the girls' was 46.50% (849/1 826). Among them, 896 students reported repeated NSSI behavior, accounting for 59.38% (896/1 509). The first ranking NSSI behavior of the middle school students was pulling out their hair, accounting for 13.95%; the second, hitting hard things such as walls and glasses intentionally, accounting for 13.63%; the third, purposefully scratching their skin with a piece of glass or a knife, accounting for 9.75%; and the fourth, deliberately picking at or interfering with wound healing, accounting for 9.42%. Regarding reasons for NSSI behavior, 748 students (49.57%) used self-injury to vent their emotions; 257 (17.03%) to express their anger; 170 (11.27%) to punish themselves; 156 (10.34%) to distract themselves from numbness and illusion; and 114 (7.55%) to relief from painful emotions or punishment. The chi-square test results showed that the NSSI behavior incidence varied among the students of different gender, grade, household registration, place of residence, physical self-satisfaction groups (P < 0.05). The results of ordered multi-class logistic regression analysis showed that boys, the students in grade 7 and grade 8, who were satisfied with their bodies, whose parents stayed married were associated with lower risks of NSSI, and the ORs and 95% CIs were 0.609 (0.533-0.696), 0.658 (0.556-0.778), 0.834 (0.700-0.994), 0.656 (0.573-0.749), and 0.786 (0.633-0.976), respectively (P < 0.05); the students whose mothers consumed alcohol, whose parents quarreled frequently or occasionally, and whose parents scolded them frequently or occasionally were associated with higher risks of NSSI, and the ORs and 95% CIs were 1.471 (1.208-1.791), 2.212 (1.682-2.910), 1.292 (1.116-1.495), 3.089 (2.465-3.870), and 1.414 (1.180-1.693), respectively (P < 0.05).
Conclusion The incidence of NSSI among middle school students in the studied district of Shanghai is high. Students who are girls, have a drinking mother, suffer a discordant parent relationship, and experience unfavorable parental education are more likely to commit NSSI behavior.
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