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Article(id=1241522925644345362, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202309267, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1694793600000, receivedDateStr=2023-09-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931731854, onlineDateStr=2026-03-19, pubDate=1710000000000, pubDateStr=2024-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931731854, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931731854, creator=13701087609, updateTime=1773931731854, updator=13701087609, issue=Issue{id=1241522919977841545, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931730503, creator=13701087609, updateTime=1773931880386, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523548695622547, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523548695622548, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=848, endPage=853, ext={EN=ArticleExt(id=1241522926877470770, articleId=1241522925644345362, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The relationship between socio-ecological risk factors and non-suicidal self-injury behavior of middle school students, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the current situation of non-suicidal self-injury (NSSI) behavior among middle school students in Taiyuan, and to explore the relationship between socio-ecological risk factors and NSSI behavior of middle school students, so as to provide evidence for targeted intervention strategies.

Methods

A total of 2 635 middle and high school students in Taiyuan were selected by stratified random cluster sampling. The general demographic characteristics, the risk level of social ecology, and the occurrence of NSSI behavior in the past year were investigated. Binary Logistic regression was used to analyze the relationship between NSSI behavior and socio-ecological risk factors.

Results

The reporting rate of NSSI behavior of middle school students was 13.5%. There were significant differences in NSSI behavior report rate among middle school students with different genders (χ2=11.12), the number of close friends (χ2=30.52), and different learning burden (χ2=37.51). After adjusting gender, the number of close friends, and learning burden factors (all P<0.01), the Logistic regression model took the low risk level of social and ecological risk factors as the control group, high risk personal factor (OR=2.93, 95%CI: 1.87-4.59), high risk family factor (OR=3.10, 95%CI: 2.04-4.71), moderate risk family factor (OR=2.08, 95%CI: 1.40-3.08), high risk school factors (OR=2.36, 95%CI:1.48-3.76), and high risk cultural factors (OR=1.44, 95%CI: 1.01-2.06) were positively correlated with NSSI behavior of middle school students.

Conclusion

When middle school students are exposed to high risk levels of individuals, families, schools and cultures in the social ecosystem, the risk of NSSI behavior will increase. While carrying on the intervention of personal, family and school factors, we should also pay attention to the influence of cultural factors on the NSSI of middle school students.

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目的

了解太原市中学生非自杀性自伤（non-suicidal self-injury，NSSI）行为现状，探讨社会生态学风险因素与中学生NSSI行为的关联，为提出有针对性的干预策略提供依据。

方法

采用分层随机整群抽样方法，抽取太原市2 635名初、高中学生作为研究对象，对一般人口学特征、社会生态学风险水平和近一年内NSSI行为发生状况进行调查，采用二元logistic回归对NSSI行为与社会生态学风险因素的关联性进行分析。

结果

中学生NSSI行为报告率为13.5%，不同性别（χ2=11.12）、不同关系密切朋友数量（χ2=30.52）、不同学习负担（χ2=37.51）的中学生之间NSSI行为报告率差异均有统计学意义（P值均<0.01）。Logistic回归模型在调整性别、关系密切朋友数量和学习负担因素后，以社会生态学风险因素的低风险水平作为对照组,个人因素高风险（OR=2.93，95%CI：1.87～4.59）、家庭因素高风险（OR=3.10，95%CI：2.04～4.71）、家庭因素中风险（OR=2.08，95%CI：1.40～3.08）、学校因素高风险（OR=2.36，95%CI：1.48～3.76）、文化因素高风险（OR=1.44，95%CI：1.01～2.06）与中学生NSSI行为呈正向关联（P值均<0.05）。

结论

中学生暴露于社会生态系统中个人、家庭、学校及文化的高风险水平时，将增加NSSI行为的风险。在进行个人、家庭、学校因素干预的同时，也应该关注文化因素对中学生NSSI的影响。

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王莉，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=IUH9yjCUYitP/B57+COK5Q==, magXml=eycNGp/STtBzvRx7WnZDwQ==, pdfUrl=null, pdf=eOKQd6u3fdN+IlueXIa2tQ==, pdfFileSize=607499, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=wb8BrD7RFetBCI2rWhwBuA==, mapNumber=null, authorCompany=null, fund=null, authors=

袁家盛（1999—），男，硕士在读，研究方向：儿童青少年健康促进

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袁家盛（1999—），男，硕士在读，研究方向：儿童青少年健康促进

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袁家盛（1999—），男，硕士在读，研究方向：儿童青少年健康促进

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Guangzhou: Guangzhou University, 2022., articleTitle=Parental rejection and non-suicidal self-injury in adolescents: mediating effects of sleep problems and moderating effects of school connectedness, refAbstract=null), Reference(id=1241678341644809113, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, doi=null, pmid=null, pmcid=null, year=2021, volume=40, issue=5, pageStart=76, pageEnd=87, url=null, language=null, rfNumber=[18], rfOrder=26, authorNames=王建平, 陈雨漩, 甄霜菊, journalName=中国青年社会科学, refType=null, unstructuredReference=王建平， 陈雨漩， 甄霜菊.学校联结与青少年非自杀性自伤:心理需求满足、同伴侵害的作用[J].中国青年社会科学，2021，40（5）：76-87., articleTitle=学校联结与青少年非自杀性自伤:心理需求满足、同伴侵害的作用, refAbstract=null), Reference(id=1241678342043267997, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, doi=null, pmid=null, pmcid=null, year=2021, volume=40, issue=5, pageStart=76, pageEnd=87, url=null, language=null, rfNumber=[18], rfOrder=27, authorNames=Wang JP, Chen YX, Zhen SJ, journalName=Journal of China Youth University for Political Sciences, refType=null, unstructuredReference=Wang JP, Chen YX, Zhen SJ. The school ties and adolescent non-suicidal self-injury: the role of psychological needs satisfaction and peer aggression[J]. Journal of China Youth University for Political Sciences, 2021, 40(5):76-87., articleTitle=The school ties and adolescent non-suicidal self-injury: the role of psychological needs satisfaction and peer aggression, refAbstract=null), Reference(id=1241678344039756706, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, doi=null, pmid=null, pmcid=null, year=2014, volume=14, issue=null, pageStart=137, pageEnd=null, url=null, language=null, rfNumber=[19], rfOrder=28, authorNames=Young R, Sproeber N, Groschwitz RC, journalName=BMC Psychiatry, refType=null, unstructuredReference=Young R, Sproeber N, Groschwitz RC, et al. Why alternative teenager’s self-harm: exploring the Link between non-suicidal self-injury, attempted suicide and adolescent identity[J]. BMC Psychiatry,2014, 14: 137., articleTitle=Why alternative teenager’s self-harm: exploring the Link between non-suicidal self-injury, attempted suicide and adolescent identity, refAbstract=null)], funds=[Fund(id=1241678327010882287, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, awardId=null, language=CN, fundingSource=中国青少年行为健康新型风险因素监测与队列研究（横向合作项目）, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241678285864759605, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, xref=1., ext=[AuthorCompanyExt(id=1241678285868953910, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, companyId=1241678285864759605, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Pediatrics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi 030001, China), AuthorCompanyExt(id=1241678285877342519, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, companyId=1241678285864759605, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.山西医科大学公共卫生学院儿少教研室，山西 太原 030001)]), AuthorCompany(id=1241678286133195075, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, xref=2., ext=[AuthorCompanyExt(id=1241678286141583684, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, companyId=1241678286133195075, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.山西医科大学汾阳学院基础医学部)]), AuthorCompany(id=1241678288196792656, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, xref=3., ext=[AuthorCompanyExt(id=1241678288205181265, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, companyId=1241678288196792656, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.太原市中小学学生卫生保健所)])], figs=[ArticleFig(id=1241678321986106022, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, language=EN, label=Table 1, caption=

Comparison of the reporting rate of NSSI behavior in different demography groups among middle school students［ n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数无NSSI有NSSIχ2值P值
性别11.12<0.01
男1 308(49.6)1 161(88.8)147(11.2)
女1 327(50.4)1 119(84.3)208(15.7)
独生子女*3.200.07
是1 094(41.5)931(85.1)163(14.9)
否1 492(56.6)1 306(87.5)186(12.5)
家庭居住地13.370.19
农村201(7.6)175(87.1)26(12.9)
乡镇674(25.6)597(88.6)77(11.4)
城市1 748(66.3)1 499(85.8)249(14.2)
关系密切朋友数（个）*30.52<0.01
≤2642(24.5)514(80.1)128(19.9)
3～51 260(48.1)1 110(88.1)150(11.9)
≥6715(27.3)639(89.4)76(10.6)
父亲文化程度*2.720.44
小学及以下245(9.3)206(84.1)39(15.9)
初中980(37.2)860(87.8)120(12.2)
高中或中专728(27.6)627(86.1)101(13.9)
大专及以上656(24.9)565(86.1)91(13.9)
母亲文化程度*4.760.19
小学及以下274(10.4)229(83.6)45(16.4)
初中982(37.3)861(87.7)121(12.3)
高中或中专698(26.5)609(87.2)89(12.8)
大专及以上660(25.0)561(85.0)99(15.0)
家庭经济条件*2.070.36
差/较差276(10.5)231(83.7)45(16.3)
中等1 911(73.0)1 656(86.7)255(13.3)
较好/好430(16.4)375(87.2)55(12.8)
学习负担*37.51<0.01
很轻/轻146(5.6)119(81.5)27(18.5)
一般1 630(62.4)1 462(89.7)168(10.3)
重715(27.4)581(81.3)134(18.7)
很重120(4.6)97(80.8)23(19.2)
年级1.070.30
初中1 307(49.6)1 140(87.2)167(12.8)
高中1 328(50.4)1 140(85.8)188(14.2)
), ArticleFig(id=1241678322401342127, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, language=CN, label=表1, caption=

不同人口学特征的中学生NSSI行为报告率比较［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数无NSSI有NSSIχ2值P值
性别11.12<0.01
男1 308(49.6)1 161(88.8)147(11.2)
女1 327(50.4)1 119(84.3)208(15.7)
独生子女*3.200.07
是1 094(41.5)931(85.1)163(14.9)
否1 492(56.6)1 306(87.5)186(12.5)
家庭居住地13.370.19
农村201(7.6)175(87.1)26(12.9)
乡镇674(25.6)597(88.6)77(11.4)
城市1 748(66.3)1 499(85.8)249(14.2)
关系密切朋友数（个）*30.52<0.01
≤2642(24.5)514(80.1)128(19.9)
3～51 260(48.1)1 110(88.1)150(11.9)
≥6715(27.3)639(89.4)76(10.6)
父亲文化程度*2.720.44
小学及以下245(9.3)206(84.1)39(15.9)
初中980(37.2)860(87.8)120(12.2)
高中或中专728(27.6)627(86.1)101(13.9)
大专及以上656(24.9)565(86.1)91(13.9)
母亲文化程度*4.760.19
小学及以下274(10.4)229(83.6)45(16.4)
初中982(37.3)861(87.7)121(12.3)
高中或中专698(26.5)609(87.2)89(12.8)
大专及以上660(25.0)561(85.0)99(15.0)
家庭经济条件*2.070.36
差/较差276(10.5)231(83.7)45(16.3)
中等1 911(73.0)1 656(86.7)255(13.3)
较好/好430(16.4)375(87.2)55(12.8)
学习负担*37.51<0.01
很轻/轻146(5.6)119(81.5)27(18.5)
一般1 630(62.4)1 462(89.7)168(10.3)
重715(27.4)581(81.3)134(18.7)
很重120(4.6)97(80.8)23(19.2)
年级1.070.30
初中1 307(49.6)1 140(87.2)167(12.8)
高中1 328(50.4)1 140(85.8)188(14.2)
), ArticleFig(id=1241678323043070649, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, language=EN, label=Table 2, caption=

Comparison of the reporting rate of NSSI behavior among middle school students at different levels of exposure to social ecological risk factors ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
社会生态学风险因素与分级人数无NSSI有NSSIχ2值P值
个人164.88<0.01
低风险704(26.7)667(94.7)37(5.3)
中风险1 343(51.0)1 194(88.9)149(11.1)
高风险588(22.3)419(71.3)169(28.7)
家庭130.69<0.01
低风险806(30.6)766(95.0)40(5.0)
中风险1 176(44.6)1 027(87.3)149(12.7)
高风险653(24.8)487(74.6)166(25.4)
学校140.95<0.01
低风险774(29.4)731(94.4)43(5.6)
中风险1 214(46.1)1 074(88.5)140(11.5)
高风险647(24.6)475(73.4)172(26.6)
社区28.95<0.01
低风险720(27.3)659(91.5)61(8.5)
中风险1 439(54.6)1 236(85.9)203(14.1)
高风险476(18.1)385(80.9)91(19.1)
政策18.55<0.01
低风险690(26.2)623(90.3)67(9.7)
中风险1 399(53.1)1 210(86.5)189(13.5)
高风险546(20.7)447(81.9)99(18.1)
时间22.18<0.01
低风险1 404(53.3)1 235(88.0)169(12.0)
中风险899(34.1)785(87.3)114(12.7)
高风险332(12.6)260(78.3)72(21.7)
文化73.49<0.01
低风险777(29.5)705(90.7)72(9.3)
中风险1 299(49.3)1 152(88.7)147(11.3)
高风险559(21.2)423(75.7)136(24.3)
), ArticleFig(id=1241678323319894718, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, language=CN, label=表2, caption=

社会生态学风险因素各维度分级中学生NSSI行为的报告率比较［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
社会生态学风险因素与分级人数无NSSI有NSSIχ2值P值
个人164.88<0.01
低风险704(26.7)667(94.7)37(5.3)
中风险1 343(51.0)1 194(88.9)149(11.1)
高风险588(22.3)419(71.3)169(28.7)
家庭130.69<0.01
低风险806(30.6)766(95.0)40(5.0)
中风险1 176(44.6)1 027(87.3)149(12.7)
高风险653(24.8)487(74.6)166(25.4)
学校140.95<0.01
低风险774(29.4)731(94.4)43(5.6)
中风险1 214(46.1)1 074(88.5)140(11.5)
高风险647(24.6)475(73.4)172(26.6)
社区28.95<0.01
低风险720(27.3)659(91.5)61(8.5)
中风险1 439(54.6)1 236(85.9)203(14.1)
高风险476(18.1)385(80.9)91(19.1)
政策18.55<0.01
低风险690(26.2)623(90.3)67(9.7)
中风险1 399(53.1)1 210(86.5)189(13.5)
高风险546(20.7)447(81.9)99(18.1)
时间22.18<0.01
低风险1 404(53.3)1 235(88.0)169(12.0)
中风险899(34.1)785(87.3)114(12.7)
高风险332(12.6)260(78.3)72(21.7)
文化73.49<0.01
低风险777(29.5)705(90.7)72(9.3)
中风险1 299(49.3)1 152(88.7)147(11.3)
高风险559(21.2)423(75.7)136(24.3)
), ArticleFig(id=1241678323852571338, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, language=EN, label=Table 3, caption=

Variables involved in binary logistic regression analysis and their evaluations

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
Y：非自杀性自伤有=1，无=0
X1-7个人/家庭/学校/社区/政策/时间/文化维度风险等级低风险=1，中风险=2，高风险=3
X8性别男=1，女=2
X9关系密切的朋友数量（个）2或以下=1，3～5=2，6或以上=3
X10学习负担很轻/轻=1，一般=2，重=3，很重=4
), ArticleFig(id=1241678324741763797, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, language=CN, label=表3, caption=

参与二元logistic回归分析的变量及其赋值

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
Y：非自杀性自伤有=1，无=0
X1-7个人/家庭/学校/社区/政策/时间/文化维度风险等级低风险=1，中风险=2，高风险=3
X8性别男=1，女=2
X9关系密切的朋友数量（个）2或以下=1，3～5=2，6或以上=3
X10学习负担很轻/轻=1，一般=2，重=3，很重=4
), ArticleFig(id=1241678324859204317, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, language=EN, label=Table 4, caption=

Logistic regression analysis of the correlation between NSSI behavior and exposure levels of social ecological risk factors

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组β标准误WaldP值OR值95%CI
下限上限
个人低风险31.04<0.01
中风险0.400.213.630.061.490.992.25
高风险1.070.2322.00<0.012.931.874.59
家庭低风险28.46<0.01
中风险0.730.2013.27<0.012.081.403.08
高风险1.130.2127.93<0.013.102.044.71
学校低风险15.84<0.01
中风险0.380.213.220.071.460.972.20
高风险0.860.2413.07<0.012.361.483.76
社区低风险0.200.90
中风险0.010.18<0.010.981.010.711.43
高风险0.070.220.120.731.080.711.65
政策低风险1.630.44
中风险-0.170.170.980.320.840.601.18
高风险-0.260.211.600.210.770.521.15
时间低风险5.020.08
中风险-0.180.141.640.200.840.631.10
高风险0.220.171.680.191.250.891.76
文化低风险16.14<0.01
中风险-0.210.171.650.200.810.581.12
高风险0.360.184.00<0.051.441.012.06
), ArticleFig(id=1241678325333160675, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522925644345362, language=CN, label=表4, caption=

社会生态学风险因素和中学生NSSI行为关联性的logistic回归

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组β标准误WaldP值OR值95%CI
下限上限
个人低风险31.04<0.01
中风险0.400.213.630.061.490.992.25
高风险1.070.2322.00<0.012.931.874.59
家庭低风险28.46<0.01
中风险0.730.2013.27<0.012.081.403.08
高风险1.130.2127.93<0.013.102.044.71
学校低风险15.84<0.01
中风险0.380.213.220.071.460.972.20
高风险0.860.2413.07<0.012.361.483.76
社区低风险0.200.90
中风险0.010.18<0.010.981.010.711.43
高风险0.070.220.120.731.080.711.65
政策低风险1.630.44
中风险-0.170.170.980.320.840.601.18
高风险-0.260.211.600.210.770.521.15
时间低风险5.020.08
中风险-0.180.141.640.200.840.631.10
高风险0.220.171.680.191.250.891.76
文化低风险16.14<0.01
中风险-0.210.171.650.200.810.581.12
高风险0.360.184.00<0.051.441.012.06
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社会生态学风险因素与中学生非自杀性自伤行为的关联
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袁家盛 1 , 永忠甜 1 , 王凯 1 , 武美琼 1 , 王立言 2 , 韩江涛 3 , 朱文华 3 , 王莉 1
现代预防医学 | 儿少卫生与妇幼保健 2024,51(5): 848-853
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(5): 848-853
社会生态学风险因素与中学生非自杀性自伤行为的关联
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袁家盛1, 永忠甜1, 王凯1, 武美琼1, 王立言2, 韩江涛3, 朱文华3, 王莉1
作者信息
  • 1.山西医科大学公共卫生学院儿少教研室，山西 太原 030001
  • 2.山西医科大学汾阳学院基础医学部
  • 3.太原市中小学学生卫生保健所

    • 袁家盛（1999—），男，硕士在读，研究方向：儿童青少年健康促进

通讯作者:

王莉，E-mail:
The relationship between socio-ecological risk factors and non-suicidal self-injury behavior of middle school students
Jia-sheng YUAN1, Zhong-tian YONG1, Kai WANG1, Mei-qiong WU1, Li-yan WANG2, Jiang-tao HAN3, Wen-hua ZHU3, Li WANG1
Affiliations
  • Department of Pediatrics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi 030001, China
出版时间: 2024-03-10 doi: 10.20043/j.cnki.MPM.202309267
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摘要
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目的

了解太原市中学生非自杀性自伤（non-suicidal self-injury，NSSI）行为现状，探讨社会生态学风险因素与中学生NSSI行为的关联，为提出有针对性的干预策略提供依据。

方法

采用分层随机整群抽样方法，抽取太原市2 635名初、高中学生作为研究对象，对一般人口学特征、社会生态学风险水平和近一年内NSSI行为发生状况进行调查，采用二元logistic回归对NSSI行为与社会生态学风险因素的关联性进行分析。

结果

中学生NSSI行为报告率为13.5%，不同性别（χ2=11.12）、不同关系密切朋友数量（χ2=30.52）、不同学习负担（χ2=37.51）的中学生之间NSSI行为报告率差异均有统计学意义（P值均<0.01）。Logistic回归模型在调整性别、关系密切朋友数量和学习负担因素后，以社会生态学风险因素的低风险水平作为对照组,个人因素高风险（OR=2.93，95%CI：1.87～4.59）、家庭因素高风险（OR=3.10，95%CI：2.04～4.71）、家庭因素中风险（OR=2.08，95%CI：1.40～3.08）、学校因素高风险（OR=2.36，95%CI：1.48～3.76）、文化因素高风险（OR=1.44，95%CI：1.01～2.06）与中学生NSSI行为呈正向关联（P值均<0.05）。

结论

中学生暴露于社会生态系统中个人、家庭、学校及文化的高风险水平时，将增加NSSI行为的风险。在进行个人、家庭、学校因素干预的同时，也应该关注文化因素对中学生NSSI的影响。

社会生态学风险因素  /  中学生  /  非自杀性自伤  /  回归分析
Objective

To understand the current situation of non-suicidal self-injury (NSSI) behavior among middle school students in Taiyuan, and to explore the relationship between socio-ecological risk factors and NSSI behavior of middle school students, so as to provide evidence for targeted intervention strategies.

Methods

A total of 2 635 middle and high school students in Taiyuan were selected by stratified random cluster sampling. The general demographic characteristics, the risk level of social ecology, and the occurrence of NSSI behavior in the past year were investigated. Binary Logistic regression was used to analyze the relationship between NSSI behavior and socio-ecological risk factors.

Results

The reporting rate of NSSI behavior of middle school students was 13.5%. There were significant differences in NSSI behavior report rate among middle school students with different genders (χ2=11.12), the number of close friends (χ2=30.52), and different learning burden (χ2=37.51). After adjusting gender, the number of close friends, and learning burden factors (all P<0.01), the Logistic regression model took the low risk level of social and ecological risk factors as the control group, high risk personal factor (OR=2.93, 95%CI: 1.87-4.59), high risk family factor (OR=3.10, 95%CI: 2.04-4.71), moderate risk family factor (OR=2.08, 95%CI: 1.40-3.08), high risk school factors (OR=2.36, 95%CI:1.48-3.76), and high risk cultural factors (OR=1.44, 95%CI: 1.01-2.06) were positively correlated with NSSI behavior of middle school students.

Conclusion

When middle school students are exposed to high risk levels of individuals, families, schools and cultures in the social ecosystem, the risk of NSSI behavior will increase. While carrying on the intervention of personal, family and school factors, we should also pay attention to the influence of cultural factors on the NSSI of middle school students.

Social ecological risk factors  /  Middle school students  /  Non suicidal self-injury  /  Regression analysis
袁家盛, 永忠甜, 王凯, 武美琼, 王立言, 韩江涛, 朱文华, 王莉. 社会生态学风险因素与中学生非自杀性自伤行为的关联. 现代预防医学, 2024 , 51 (5) : 848 -853 . DOI: 10.20043/j.cnki.MPM.202309267
Jia-sheng YUAN, Zhong-tian YONG, Kai WANG, Mei-qiong WU, Li-yan WANG, Jiang-tao HAN, Wen-hua ZHU, Li WANG. The relationship between socio-ecological risk factors and non-suicidal self-injury behavior of middle school students[J]. Modern Preventive Medicine, 2024 , 51 (5) : 848 -853 . DOI: 10.20043/j.cnki.MPM.202309267
正文
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非自杀性自伤（non-suicidal self-injury，NSSI）行为一般是指不以自杀为目的，对自己身体组织的故意伤害，包括割伤、烧伤、抓伤、打或用硬物敲击自己等行为[1]。美国精神病学会已将NSSI作为一个独立类别纳入《精神疾病诊断与统计手册第五版》（diagnostic and statistical manual of mental disorders，DSM-V）[2]。Plener PL等人[3]的研究发现，NSSI在青春期中期（15～16岁左右）达到高峰，并在青春期后期（18岁左右）出现下降趋势。目前的研究显示，中国大陆中学生NSSI总检出率为27.4%，且近年来该检出率呈上升趋势[4]。NSSI行为的发生除涉及个体人口学特征、心理状态外，还涉及社会支持等环境因素[5-7]。
Bronfenbrenner的生态系统理论，将影响个体行为和发展的环境因素按层次分为微观系统、中间系统、外部系统和宏观系统，同时强调了时间在其中的作用，即随着时间变迁个体所处环境和自身特征都会发生变化，从而对个体行为产生较大影响[8]。中学生处于身心快速发育的阶段，全面分析影响行为问题发生的环境因素，并同时考虑时间系统的作用，有利于更好地认识青少年行为问题的风险因素。本研究从社会生态学风险因素各个维度出发，包括个人、家庭、学校的自然环境支持以及学校的人际环境支持等微观和中间系统元素，社区环境、社区安全等外部系统因素，政策和文化等宏观系统元素，以及贯穿整个社会生态学系统的时间系统[9]，探究中学生NSSI行为发生与各维度之间的关联，为提出有针对性的干预策略提供依据。
1　对象与方法
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1.1　对象
采用分层随机整群抽样方法，于2021年10—11月，在太原市城乡共选取3所初中、2所高中开展调查，每所学校按年级分层，随机抽取班级，被选到的班级学生全部纳入调查，班级数量用以保证每个年级不少于200人。调查共发放了问卷2 670份，收回有效问卷2 635份，有效率98.7%。其中男生1 308名（49.6%），女生1 327名（50.4%）；初一439名（16.7%），初二452名（17.2%），初三416名（15.8%），高一446名（16.9%），高二448名（17.0%），高三434名（16.5%）；农村学生201名（7.6%），乡镇学生674名（25.6%），城市学生1 748名（66.3%）。调查前得到学校、对象本人及其监护人的知情同意，并通过山西医科大学伦理委员会（2023006）批准。
1.2　内容
调查内容包括一般人口学特征（性别、年级、年龄、是否独生子女、居住地、自评家庭经济条件、父亲/母亲文化程度、关系密切朋友数量以及学习负担等）、社会生态学风险因素、非自杀性自伤行为。
1.2.1　社会生态学风险因素评价
采用《中国青少年社会生态学风险因素评定问卷》评估社会生态学风险因素的状况[9]。该问卷由中国学者编制，适用于中国青少年。问卷共50项题目，根据Likert 5级评分法，每个项目包含5个选项，正向题型的5个选项，依次记1～5分，反向题型记为5～1分，1～5分的意义分别是：1分为从完全符合；2分为基本符合；3分为有点符合；4分为基本不符合；5分为非常不符合。社会生态学风险因素共分为时间维度和空间维度（个人、家庭、学校、社区、政策和文化等7个维度）。分析社会生态学风险因素各维度时，先计算各维度的总分，随着分数的递增，说明社会生态学风险因素暴露水平越高。根据得分的P25和P75为界值，将每个维度的暴露水平分为3个等级，其中≤P25代表低风险，>P25且≤P75代表中风险，>P75代表高风险。已有研究证实该量表的内部一致性较好，Cronbachα系数为0.897[9]；本次研究中量表的Cronbachα系数为0.902。
1.2.2　非自杀性自伤评价
使用万宇辉[10]等编制的《青少年非自杀性自伤行为评定问卷》中的行为问卷来评估近1年内NSSI行为发生状况，共12个条目。被调查者回答每个条目时，先报告是否发生过，如发生过NSSI，则需报告最近一年发生的次数。参考DSM-V的标准并结合相关文献[2,11]，本文将频率≥5次的研究对象判定为“有NSSI”组，≤4次的研究对象判定为“无NSSI”组。已有研究证实该量表的信度较好，Cronbachα系数为0.92；效度较好，KMO值为0.94[10]。该量表在本研究中的Cronbachα系数为0.779；KMO值为0.875。
1.3　方法
本调查以班级为单位，调查员利用自习课或者大课间的时间发放问卷，在教室进行集体施测。现场调查前，调查员宣读指导语、讲解问卷内容和填写的注意事项，并在调查过程中进行现场答疑，调查结束问卷当场收回。
1.4　质量控制
在现场调查之前对参与现场调查的人员进行统一培训，确保调查员能够熟练掌握调查问卷内容，解决现场调查时的突发问题。调查时，调查员需全程监督以确保问卷的应答率及准确性。调查结束后，调查员需现场清点、审核回收问卷。
1.5　统计学方法
采用EpiData 3.1平行双录入建立数据库，使用IBM SPSS 24.0对数据统计分析，使用期望最大化法（expectation-maximization algorithm，EM）[12]填补社会生态学风险因素题目缺失值；分类变量用频数、百分比进行描述，用χ2检验对不同人口学特征的中学生NSSI行为的报告率进行比较；采用二元logistic回归分析NSSI行为与社会生态风险因素暴露程度的关联性，检验水准α=0.05。
2　结果
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2.1　不同人口学特征的中学生NSSI行为报告率比较
被调查对象中，NSSI行为报告率为13.5%（355人）。经χ2检验，女性为15.7%，高于男性的11.2%，差异有统计学意义（χ2=11.12，P<0.01），不同关系密切朋友数量、不同学习负担的中学生之间NSSI行为报告率总体分布不同，差异均有统计学意义（P值均<0.01）。经多重比较，≤2个密切朋友数的中学生（19.9%）显著高于密切朋友数3～5个（11.9%）和≥6个（10.6%），差异有统计学意义（P<0.05/3）；学习负担一般的中学生（10.3%）显著低于学习负担很轻/轻（18.5%）、重（18.7%）、很重（19.2%）的中学生，差异有统计学意义（P<0.05/6）。见表1。
2.2　社会生态学风险因素各维度不同等级的中学生NSSI行为报告率比较
经χ2检验，社会生态学风险因素各维度均可纳入logistic回归，以进一步分析，见表2。
2.3　中学生NSSI行为与社会生态学风险因素各维度分级的关联性分析
将是否有NSSI行为报告作为因变量，以社会生态学风险因素各维度（个人、家庭、学校、社区、政策、时间和文化）为自变量，均以其低风险等级作为对照组，进行二元logistic回归分析。结果显示，在控制性别、关系密切的朋友数量和学习负担后，个人、家庭、学校、文化维度高风险水平和中学生NSSI呈正向相关（P值均<0.05）。存在个人因素高风险的中学生发生NSSI的风险是个人因素低风险学生的2.93倍（OR=2.93，95%CI：1.87～4.59）；存在家庭因素中风险和高风险的中学生发生NSSI的风险分别是家庭因素低风险学生的2.08倍（OR=2.08，95%CI：1.40～3.08）和3.10倍（OR=3.10，95%CI：2.04～4.71）；存在学校因素高风险的中学生发生NSSI的风险是学校因素低风险的2.36倍（OR=2.36，95%CI：1.48～3.76）；存在文化因素高风险的中学生发生NSSI的风险是文化因素低风险学生的1.44倍（OR=1.44，95%CI：1.01～2.06）。见表3、4。
3　讨论
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本研究中，中学生NSSI行为检出率为13.5%，较低于之前的研究（27.4%）[4]，可能由于本研究中采用了更为严格的NSSI判定标准，未区分更低水平非自杀性自伤行为与无NSSI行为的中学生。
二元logistic回归分析发现，社会生态学风险因素的个人、家庭、学校和文化维度较高的风险因素水平与中学生NSSI行为呈正向相关。个人维度主要包括自我效能和应对方式等，维度得分越高提示自我效能越弱，以及面对压力时更多采用消极的应对方式。李思慧等人[13]的研究表明青少年自我效能感与NSSI呈显著负相关；一项来自智利的研究表明[14]，采用回避型应对方式的中学生发生重复NSSI行为的风险是趋近型应对方式学生的3倍以上，与本文结果相符。家庭维度方面，Nemati等人[15]发现低水平的家庭功能会增加青少年发生NSSI行为的风险，与本研究结果一致。根据NSSI的“四功能模型”，家庭因素（如家庭敌意/批评）被认为是NSSI的远端风险因素[16]。学校维度包含学校联结、同伴关系等，先前已有研究发现学校联结紧密与青少年NSSI呈显著负相关，其中，罗依玲[17]的研究提出增强青少年的学校联结和睡眠质量，有助于预防和控制青少年NSSI风险。Madjar等人[18]的研究结果显示，在发生重复NSSI行为的以色列高中生中，常常报告感知教师心理支持和学校的归属感水平较低，而对同伴氛围有更多的负面看法。文化生态包含了主流文化、亚文化和反文化三个方面内容，Young等人[19]研究了NSSI和青少年亚文化之间的联系，结果发现轻度及以上认同哥特、情绪硬核（emotional hardcore，EMO)或朋克等中学生“另类”身份和自伤之间存在中等程度的正向相关性（r≈0.3），“另类”青少年进行某种形式自伤的可能性是同龄人的4～8倍。
本研究从个人、家庭、学校、社区、政策、时间、文化各维度评价了中学生NSSI行为的发生风险，风险水平用得分量化表现，并通过高、中和低水平分组分析了中学生NSSI行为与社会生态风险因素的关联性。这项研究局限性在于，第一，属于横断面设计，这使得很难建立各风险维度与NSSI行为之间的因果关系。第二，研究对象仅限于中部省会城市的中学生，因此在进行结论推广时要注意地域背景。第三，研究涉及的数据都来自自我报告。虽然学生的回答是匿名的，但社会期望可能会产生一些影响，比如可能会不真实地展示NSSI情况，未来的研究可以使用更复杂的评估技术，如生态瞬时评估（ecological momentary assessment，EMA）和从多种角度（教师、父母和重要朋友）进行评估。第四，本研究根据DSM-V中的标准将个体的自伤状况划分为“有NSSI”和“无NSSI”，这样的划分有利于NSSI影响因素的分析，但是没有充分考虑到个体差异，今后可以进一步分析NSSI的方式和功能，此外不同质群体的划分是潜在的，后面的研究也可以通过基于模型的方法对潜在分组进行估计。
本研究表明，个人、家庭、学校维度等微观系统元素，及宏观系统中文化维度的高风险暴露将增加中学生NSSI行为的发生风险。在进行个人、家庭、学校因素干预的同时，也应该关注文化因素对中学生NSSI的影响，以降低NSSI行为的发生。
基金
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  • 中国青少年行为健康新型风险因素监测与队列研究（横向合作项目）
文献
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2024年第51卷第5期
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doi: 10.20043/j.cnki.MPM.202309267
  • 接收时间：2023-09-16
  • 首发时间：2026-03-19
  • 出版时间：2024-03-10
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  • 收稿日期：2023-09-16
基金
中国青少年行为健康新型风险因素监测与队列研究（横向合作项目）
作者信息
    1.山西医科大学公共卫生学院儿少教研室，山西 太原 030001
    2.山西医科大学汾阳学院基础医学部
    3.太原市中小学学生卫生保健所

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