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Article(id=1325530159247544707, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325530078536553117, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025263, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1744041600000, receivedDateStr=2025-04-08, revisedDate=1752854400000, revisedDateStr=2025-07-19, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960617124, onlineDateStr=2026-11-06, pubDate=1758729600000, pubDateStr=2025-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960617124, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960617124, creator=13701087609, updateTime=1793960617124, updator=13701087609, issue=Issue{id=1325530078536553117, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='9', pageStart='1217', pageEnd='1368', issueExtLink='null', onlineDate='null', pubDate='1758729600000', pubDateStr='2025-09-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960597879, creator='13701087609', updateTime=1793960597879, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1282, endPage=1286, ext={EN=ArticleExt(id=1325530159448871300, articleId=1325530159247544707, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Epidemiological characteristics and trends of non-suicidal self-injury among middle school students in Jiading District of Shanghai from 2015 to 2023, columnId=1259565855189418448, journalTitle=Chinese Journal of School Health, columnName=Mental Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the epidemiological characteristics and changing trends of non-suicidal self-injury (NSSI) behaviors among middle school students in Jiading District of Shanghai, from 2015 to 2023, so as to provide a basis for the development of NSSI prevention and control measures among students.

Methods

Using a stratified cluster random sampling method, a total of five times for Shanghai Adolescent Health Risk Behavior Surveys were conducted for every two years in Jiading District of Shanghai from 2015 to 2023. A total of 5 231 middle school students from junior high schools and senior high schools were selected for questionnaire surveys. Intergroup comparisons were performed using the χ2 test or the χ2 trend test, and the JointPoint 5.0 software was used to analyze the changing trends, with the annual percent change (APC) used for evaluation. A binary Logistic regression model was employed to analyze the related factors of NSSI behavior among middle school students.

Results

In 2023, the reported NSSI rate among middle school students in Jiading District was 14.2%. The rate was significantly higher among junior high school students (17.1%) than that among senior high school students (11.1%), and higher among females (19.2%) than that among males (10.0%) (χ2=10.04, 23.21, both P < 0.01). From 2015 to 2023, the overall reported NSSI rate showed an increasing trend, rising from 8.6% in 2015 to 14.2% in 2023 (χtrend2=22.25), with an APC of 6.64% (t=3.49), and the APC for girls was 9.79% (t=3.20) (all P < 0.05). Among students reporting NSSI, the proportion experiencing ≥6 episodes increased from 10.8% in 2015 to 19.2% in 2023 (χtrend2=6.57, P < 0.05). Multivariate Logistic regression analysis indicated that girls, junior high school students, those with insomnia, depressive emotion and drinkers had higher risks of NSSI, compared to boys, senior high school students, those without insomnia, non-depressive emotion students and non-drinkers (OR=1.71, 1.96, 3.44, 4.76, 1.77, all P < 0.05).

Conclusions

The reported rate of NSSI among middle school students in Jiading District of Shanghai, increased annually from 2015 to 2023, and the proportion of repeated NSSI also showed an upward trend. Early intervention measures targeting middle school students, especially junior high school students and females, should be implemented to prevent and control its occurrence and development.

, authors=Yanhong ZHU1, Qin ZHANG1, Xinxin LIU1, Yanfei ZHANG1, Guangzhuang JING2, Manyu GUO1, Junlei XUE1, Qian PENG1, Feifei MA1, Hongjie YU1, Huijing SHI*, 2, Hui PENG*, 1, authorsList=Yanhong ZHU, Qin ZHANG, Xinxin LIU, Yanfei ZHANG, Guangzhuang JING, Manyu GUO, Junlei XUE, Qian PENG, Feifei MA, Hongjie YU, Huijing SHI, Hui PENG, authorCompany=null, correspAuthors=Huijing SHI, Hui PENG, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325530159880884613, articleId=1325530159247544707, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=上海市嘉定区2015—2023年中学生非自杀性自伤流行特征及趋势, columnId=1259565858817491410, journalTitle=中国学校卫生, columnName=心理卫生, runingTitle=null, highlight=null, articleAbstract=
目的

分析上海市嘉定区2015—2023年中学生非自杀性自伤(NSSI)行为的流行特征和变化趋势，为学生NNSI防控工作的开展提供依据。

方法

采用分层整群随机抽样方法，2015—2023年在上海市嘉定区每2年开展一次，共计5次“上海市青少年健康危险行为调查”，从中学学段(初中、高中)共选取5 231名中学生进行问卷调查。组间比较采用χ2检验或χ2趋势检验，采用JointPoint 5.0软件对变化趋势进行分析，用年度变化百分率(APC)进行评价。采用二分类Logistic回归模型分析中学生NSSI行为的相关因素。

结果

2023年嘉定区中学生NSSI报告率为14.2%，初中生报告率(17.1%)高于高中生(11.1%)，女生(19.2%)高于男生(10.0%)(χ2值分别为10.04，23.21，P值均＜0.01)。2015—2023年中学生NSSI报告率呈增长趋势，由2015年的8.6%上升至2023年的14.2%(χ趋势2=22.25)，APC为6.64%(t=3.49)，其中女生NSSI报告率APC为9.79%(t=3.20)(P值均＜0.05)。在发生NSSI行为的中学生中，≥6次占比由2015年的10.8%上升至2023年的19.2%(χ趋势2=6.57，P＜0.05)。多因素Logistic回归分析结果显示，女生、初中生、失眠、有抑郁情绪及饮酒学生发生NSSI的风险相比男生、高中生、不失眠、无抑郁情绪及不饮酒的学生高(OR值分别为1.71，1.96，3.44，4.76，1.77，P值均＜0.05)。

结论

嘉定区2015—2023年中学生NSSI报告率逐年上升，且反复NSSI的比例呈上升趋势。应及早针对中学生、特别是初中生和女生采取干预措施，控制NSSI的发生和发展。

, authors=朱琰泓1, 张琴1, 刘欣欣1, 张颜菲1, 井光壮2, 郭曼玉1, 薛俊磊1, 彭谦1, 马飞飞1, 于宏杰1, 史慧静*, 2, 彭慧*, 1, authorsList=朱琰泓, 张琴, 刘欣欣, 张颜菲, 井光壮, 郭曼玉, 薛俊磊, 彭谦, 马飞飞, 于宏杰, 史慧静, 彭慧, authorCompany=null, correspAuthors=史慧静, 彭慧, authorNote=

朱琰泓(1992-)，女，上海嘉定人，大学本科，主管医师，主要从事学校卫生工作

, correspAuthorsNote=
史慧静，E-mail:
彭慧，E-mail:
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(in Chinese), articleTitle=null, refAbstract=null)], funds=[Fund(id=1325530167615181271, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, awardId=null, language=CN, fundingSource=复旦—嘉定公共卫生高质量发展重点学科(儿少卫生与妇幼保健学)(GWGZLXK-2023-04), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325530160115765638, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, xref=1, ext=[AuthorCompanyExt(id=1325530160124154247, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, companyId=1325530160115765638, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1School Health and Ophthalmic Disease Prevention, Jiading District Center for Disease Control and Prevention Department, Shanghai 201800, China), AuthorCompanyExt(id=1325530160132542856, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, companyId=1325530160115765638, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1上海市嘉定区疾病预防控制中心学校卫生与眼病防治科，201800)]), AuthorCompany(id=1325530160208040329, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, xref=2, ext=[AuthorCompanyExt(id=1325530160216428938, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, companyId=1325530160208040329, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2复旦大学公共卫生学院妇幼与儿少卫生教研室)])], figs=[ArticleFig(id=1325530165312508367, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, language=EN, label=Tab.1, caption=

Trend of reporting rates of NSSI behavior among middle school students in Jiading District, Shanghai from 2015 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项20152017201920212023APC(95%CI)/%t值
人数NSSI人数人数NSSI人数人数NSSI人数人数NSSI人数人数NSSI人数
性别男44338(8.6)40937(9.0)61861(9.9)66675(11.3)73073(10.0)2.44(-1.88~6.95)1.78
女30927(8.7)42744(10.3)41973(17.4)584111(19.0)626120(19.2)9.79(0.06~20.46)3.20*
学段初中27628(10.1)59653(8.9)62896(15.3)699114(16.3)700120(17.1)8.32(-0.94~18.43)2.85
高中47637(7.8)24028(11.7)40938(9.3)55172(13.1)65673(11.1)4.22(-4.49~13.73)1.51
合计75265(8.6)83681(9.7)1 037134(12.9)1 250186(14.9)1 356193(14.2)6.64(0.57~13.08)3.49*
), ArticleFig(id=1325530165392200144, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, language=CN, label=表1, caption=

上海市嘉定区中学生2015—2023年NSSI行为报告率及变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项20152017201920212023APC(95%CI)/%t值
人数NSSI人数人数NSSI人数人数NSSI人数人数NSSI人数人数NSSI人数
性别男44338(8.6)40937(9.0)61861(9.9)66675(11.3)73073(10.0)2.44(-1.88~6.95)1.78
女30927(8.7)42744(10.3)41973(17.4)584111(19.0)626120(19.2)9.79(0.06~20.46)3.20*
学段初中27628(10.1)59653(8.9)62896(15.3)699114(16.3)700120(17.1)8.32(-0.94~18.43)2.85
高中47637(7.8)24028(11.7)40938(9.3)55172(13.1)65673(11.1)4.22(-4.49~13.73)1.51
合计75265(8.6)83681(9.7)1 037134(12.9)1 250186(14.9)1 356193(14.2)6.64(0.57~13.08)3.49*
), ArticleFig(id=1325530165480280529, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, language=EN, label=Tab.2, caption=

Reporting rates of NSSI behavior frequencies among middle school students by sex in Jiading District, Shanghai from 2015 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
年份男生女生合计
人数1次2~5次≥6次人数1次2~5次≥6次人数1次2~5次≥6次
201544319(4.3)13(2.9)6(1.4)30915(4.9)11(3.6)1(0.3)75234(4.5)24(3.2)7(0.9)
201740925(6.1)10(2.4)2(0.5)42726(6.1)12(2.8)6(1.4)83651(6.1)22(2.6)8(1.0)
201961833(5.3)21(3.4)7(1.1)41930(7.2)33(7.9)10(2.4)1 03763(6.1)54(5.2)17(1.6)
202166642(6.3)24(3.6)9(1.4)58446(7.9)36(6.2)29(5.0)1 25088(7.0)60(4.8)38(3.0)
202373040(5.5)21(2.9)12(1.6)62651(8.1)44(7.0)25(4.0)1 35691(6.7)65(4.8)37(2.7)
), ArticleFig(id=1325530165568360914, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, language=CN, label=表2, caption=

上海市嘉定区2015—2023年不同性别中学生NSSI行为频次报告率

, figureFileSmall=null, figureFileBig=null, tableContent=
年份男生女生合计
人数1次2~5次≥6次人数1次2~5次≥6次人数1次2~5次≥6次
201544319(4.3)13(2.9)6(1.4)30915(4.9)11(3.6)1(0.3)75234(4.5)24(3.2)7(0.9)
201740925(6.1)10(2.4)2(0.5)42726(6.1)12(2.8)6(1.4)83651(6.1)22(2.6)8(1.0)
201961833(5.3)21(3.4)7(1.1)41930(7.2)33(7.9)10(2.4)1 03763(6.1)54(5.2)17(1.6)
202166642(6.3)24(3.6)9(1.4)58446(7.9)36(6.2)29(5.0)1 25088(7.0)60(4.8)38(3.0)
202373040(5.5)21(2.9)12(1.6)62651(8.1)44(7.0)25(4.0)1 35691(6.7)65(4.8)37(2.7)
), ArticleFig(id=1325530167250276819, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, language=EN, label=Tab.3, caption=

Distribution of different composition ratios of NSSI behavior among middle school students by sex in Jiading District, Shanghai from 2015 to 2023

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年份男生女生合计
1次2~5次≥6次1次2~5次≥6次1次2~5次≥6次
201519(50.0)13(34.2)6(15.8)15(55.6)11(40.7)1(3.7)34(52.3)24(36.9)7(10.8)
201725(67.6)10(27.0)2(5.4)26(59.1)12(27.3)6(13.6)51(63.0)22(27.2)8(9.9)
201933(54.1)21(34.4)7(11.5)30(41.1)33(45.2)10(13.7)63(47.0)54(40.3)17(12.7)
202142(56.0)24(32.0)9(12.0)46(41.4)36(32.4)29(26.1)88(47.3)60(32.3)38(20.4)
202340(54.8)21(28.8)12(16.4)51(42.5)44(36.7)25(20.8)91(47.2)65(33.7)37(19.2)
), ArticleFig(id=1325530167334162900, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, language=CN, label=表3, caption=

上海市嘉定区2015—2023年不同性别中学生发生NSSI行为不同频次构成比分布

, figureFileSmall=null, figureFileBig=null, tableContent=
年份男生女生合计
1次2~5次≥6次1次2~5次≥6次1次2~5次≥6次
201519(50.0)13(34.2)6(15.8)15(55.6)11(40.7)1(3.7)34(52.3)24(36.9)7(10.8)
201725(67.6)10(27.0)2(5.4)26(59.1)12(27.3)6(13.6)51(63.0)22(27.2)8(9.9)
201933(54.1)21(34.4)7(11.5)30(41.1)33(45.2)10(13.7)63(47.0)54(40.3)17(12.7)
202142(56.0)24(32.0)9(12.0)46(41.4)36(32.4)29(26.1)88(47.3)60(32.3)38(20.4)
202340(54.8)21(28.8)12(16.4)51(42.5)44(36.7)25(20.8)91(47.2)65(33.7)37(19.2)
), ArticleFig(id=1325530167409660373, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, language=EN, label=Tab.4, caption=

Logistic regression analysis of factors affecting NSSI behavior among middle school students in Jiading District, Shanghai in 2023(n=1 356)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量选项单因素多因素
OR值(95%CI)P值OR值(95%CI)P值
学段高中1.001.00
初中1.65(1.21~2.26)< 0.011.96(1.33~2.90)< 0.01
性别男1.001.00
女2.13(1.56~2.92)< 0.011.71(1.20~2.43)< 0.01
父亲文化初中1.001.00
程度高中1.07(0.71~1.61)0.741.10(0.60~1.70)0.96
大专/大学0.86(0.58~1.26)0.430.83(0.492~1.40)0.48
研究生及以上1.68(0.85~3.32)0.141.40(0.560~3.50)0.47
母亲文化初中1.001.00
程度高中0.98(0.66~1.47)0.931.10(0.66~1.82)0.72
大专/大学0.97(0.67~1.41)0.891.35(0.81~2.25)0.25
研究生及以上1.94(0.83~4.50)0.121.80(0.57~5.70)0.32
家庭类型核心家庭1.001.00
单亲1.66(0.99~2.79)0.061.63(0.90~2.96)0.11
重组2.22(0.93~5.30)0.071.97(0.73~5.18)0.18
隔代1.92(1.01~3.64)0.051.76(0.85~3.65)0.13
独生子女否1.001.00
是1.03(0.75~1.42)0.840.83(0.58~1.21)0.34
孤独否1.001.00
是3.81(2.60~5.57)< 0.011.54(0.99~2.40)0.06
学习压力否1.001.00
是5.24(3.05~9.00)< 0.011.72(0.92~3.24)0.09
失眠否1.001.00
是6.52(4.25~10.02)< 0.013.44(2.09~5.66)< 0.01
抑郁情绪否1.001.00
是6.44(4.55~9.11)< 0.014.76(3.24~6.97)< 0.01
饮酒否1.001.00
是2.67(1.85~3.85)< 0.011.77(1.16~2.71)0.01
网络成瘾否1.001.00
是2.40(1.34~4.29)< 0.010.68(0.35~1.35)0.27
), ArticleFig(id=1325530167497740758, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530159247544707, language=CN, label=表4, caption=

上海市嘉定区2023年中学生NSSI行为相关因素Logistic回归分析(n=1 356)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量选项单因素多因素
OR值(95%CI)P值OR值(95%CI)P值
学段高中1.001.00
初中1.65(1.21~2.26)< 0.011.96(1.33~2.90)< 0.01
性别男1.001.00
女2.13(1.56~2.92)< 0.011.71(1.20~2.43)< 0.01
父亲文化初中1.001.00
程度高中1.07(0.71~1.61)0.741.10(0.60~1.70)0.96
大专/大学0.86(0.58~1.26)0.430.83(0.492~1.40)0.48
研究生及以上1.68(0.85~3.32)0.141.40(0.560~3.50)0.47
母亲文化初中1.001.00
程度高中0.98(0.66~1.47)0.931.10(0.66~1.82)0.72
大专/大学0.97(0.67~1.41)0.891.35(0.81~2.25)0.25
研究生及以上1.94(0.83~4.50)0.121.80(0.57~5.70)0.32
家庭类型核心家庭1.001.00
单亲1.66(0.99~2.79)0.061.63(0.90~2.96)0.11
重组2.22(0.93~5.30)0.071.97(0.73~5.18)0.18
隔代1.92(1.01~3.64)0.051.76(0.85~3.65)0.13
独生子女否1.001.00
是1.03(0.75~1.42)0.840.83(0.58~1.21)0.34
孤独否1.001.00
是3.81(2.60~5.57)< 0.011.54(0.99~2.40)0.06
学习压力否1.001.00
是5.24(3.05~9.00)< 0.011.72(0.92~3.24)0.09
失眠否1.001.00
是6.52(4.25~10.02)< 0.013.44(2.09~5.66)< 0.01
抑郁情绪否1.001.00
是6.44(4.55~9.11)< 0.014.76(3.24~6.97)< 0.01
饮酒否1.001.00
是2.67(1.85~3.85)< 0.011.77(1.16~2.71)0.01
网络成瘾否1.001.00
是2.40(1.34~4.29)< 0.010.68(0.35~1.35)0.27
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上海市嘉定区2015—2023年中学生非自杀性自伤流行特征及趋势
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朱琰泓 1 , 张琴 1 , 刘欣欣 1 , 张颜菲 1 , 井光壮 2 , 郭曼玉 1 , 薛俊磊 1 , 彭谦 1 , 马飞飞 1 , 于宏杰 1 , 史慧静 *, 2 , 彭慧 *, 1
中国学校卫生 | 心理卫生 2025,46(9): 1282-1286
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中国学校卫生 |心理卫生 2025 , 46 (9) : 1282 -1286
上海市嘉定区2015—2023年中学生非自杀性自伤流行特征及趋势
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朱琰泓(1992-)，女，上海嘉定人，大学本科，主管医师，主要从事学校卫生工作

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朱琰泓(1992-)，女，上海嘉定人，大学本科，主管医师，主要从事学校卫生工作

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朱琰泓1, 张琴1, 刘欣欣1, 张颜菲1, 井光壮2, 郭曼玉1, 薛俊磊1, 彭谦1, 马飞飞1, 于宏杰1, 史慧静*, 2 , 彭慧*, 1
作者信息
  • 1上海市嘉定区疾病预防控制中心学校卫生与眼病防治科，201800
  • 2复旦大学公共卫生学院妇幼与儿少卫生教研室
通讯作者:
史慧静，E-mail:
彭慧，E-mail:
作者简介:

朱琰泓(1992-)，女，上海嘉定人，大学本科，主管医师，主要从事学校卫生工作

Epidemiological characteristics and trends of non-suicidal self-injury among middle school students in Jiading District of Shanghai from 2015 to 2023
Yanhong ZHU1, Qin ZHANG1, Xinxin LIU1, Yanfei ZHANG1, Guangzhuang JING2, Manyu GUO1, Junlei XUE1, Qian PENG1, Feifei MA1, Hongjie YU1, Huijing SHI*, 2 , Hui PENG*, 1
Affiliations
  • 1School Health and Ophthalmic Disease Prevention, Jiading District Center for Disease Control and Prevention Department, Shanghai 201800, China
出版时间: 2025-09-25 doi: 10.16835/j.cnki.1000-9817.2025263
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摘要
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目的

分析上海市嘉定区2015—2023年中学生非自杀性自伤(NSSI)行为的流行特征和变化趋势，为学生NNSI防控工作的开展提供依据。

方法

采用分层整群随机抽样方法，2015—2023年在上海市嘉定区每2年开展一次，共计5次“上海市青少年健康危险行为调查”，从中学学段(初中、高中)共选取5 231名中学生进行问卷调查。组间比较采用χ2检验或χ2趋势检验，采用JointPoint 5.0软件对变化趋势进行分析，用年度变化百分率(APC)进行评价。采用二分类Logistic回归模型分析中学生NSSI行为的相关因素。

结果

2023年嘉定区中学生NSSI报告率为14.2%，初中生报告率(17.1%)高于高中生(11.1%)，女生(19.2%)高于男生(10.0%)(χ2值分别为10.04，23.21，P值均＜0.01)。2015—2023年中学生NSSI报告率呈增长趋势，由2015年的8.6%上升至2023年的14.2%(χ趋势2=22.25)，APC为6.64%(t=3.49)，其中女生NSSI报告率APC为9.79%(t=3.20)(P值均＜0.05)。在发生NSSI行为的中学生中，≥6次占比由2015年的10.8%上升至2023年的19.2%(χ趋势2=6.57，P＜0.05)。多因素Logistic回归分析结果显示，女生、初中生、失眠、有抑郁情绪及饮酒学生发生NSSI的风险相比男生、高中生、不失眠、无抑郁情绪及不饮酒的学生高(OR值分别为1.71，1.96，3.44，4.76，1.77，P值均＜0.05)。

结论

嘉定区2015—2023年中学生NSSI报告率逐年上升，且反复NSSI的比例呈上升趋势。应及早针对中学生、特别是初中生和女生采取干预措施，控制NSSI的发生和发展。

自我伤害行为  /  精神卫生  /  回归分析  /  学生
Objective

To analyze the epidemiological characteristics and changing trends of non-suicidal self-injury (NSSI) behaviors among middle school students in Jiading District of Shanghai, from 2015 to 2023, so as to provide a basis for the development of NSSI prevention and control measures among students.

Methods

Using a stratified cluster random sampling method, a total of five times for Shanghai Adolescent Health Risk Behavior Surveys were conducted for every two years in Jiading District of Shanghai from 2015 to 2023. A total of 5 231 middle school students from junior high schools and senior high schools were selected for questionnaire surveys. Intergroup comparisons were performed using the χ2 test or the χ2 trend test, and the JointPoint 5.0 software was used to analyze the changing trends, with the annual percent change (APC) used for evaluation. A binary Logistic regression model was employed to analyze the related factors of NSSI behavior among middle school students.

Results

In 2023, the reported NSSI rate among middle school students in Jiading District was 14.2%. The rate was significantly higher among junior high school students (17.1%) than that among senior high school students (11.1%), and higher among females (19.2%) than that among males (10.0%) (χ2=10.04, 23.21, both P < 0.01). From 2015 to 2023, the overall reported NSSI rate showed an increasing trend, rising from 8.6% in 2015 to 14.2% in 2023 (χtrend2=22.25), with an APC of 6.64% (t=3.49), and the APC for girls was 9.79% (t=3.20) (all P < 0.05). Among students reporting NSSI, the proportion experiencing ≥6 episodes increased from 10.8% in 2015 to 19.2% in 2023 (χtrend2=6.57, P < 0.05). Multivariate Logistic regression analysis indicated that girls, junior high school students, those with insomnia, depressive emotion and drinkers had higher risks of NSSI, compared to boys, senior high school students, those without insomnia, non-depressive emotion students and non-drinkers (OR=1.71, 1.96, 3.44, 4.76, 1.77, all P < 0.05).

Conclusions

The reported rate of NSSI among middle school students in Jiading District of Shanghai, increased annually from 2015 to 2023, and the proportion of repeated NSSI also showed an upward trend. Early intervention measures targeting middle school students, especially junior high school students and females, should be implemented to prevent and control its occurrence and development.

Self-injurious behavior  /  Mental health  /  Regression analysis  /  Students
朱琰泓, 张琴, 刘欣欣, 张颜菲, 井光壮, 郭曼玉, 薛俊磊, 彭谦, 马飞飞, 于宏杰, 史慧静, 彭慧. 上海市嘉定区2015—2023年中学生非自杀性自伤流行特征及趋势. 中国学校卫生, 2025 , 46 (9) : 1282 -1286 . DOI: 10.16835/j.cnki.1000-9817.2025263
Yanhong ZHU, Qin ZHANG, Xinxin LIU, Yanfei ZHANG, Guangzhuang JING, Manyu GUO, Junlei XUE, Qian PENG, Feifei MA, Hongjie YU, Huijing SHI, Hui PENG. Epidemiological characteristics and trends of non-suicidal self-injury among middle school students in Jiading District of Shanghai from 2015 to 2023[J]. Chinese Journal of School Health, 2025 , 46 (9) : 1282 -1286 . DOI: 10.16835/j.cnki.1000-9817.2025263
正文
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非自杀性自伤(non-suicidal self-injury，NSSI)是指无自杀意图的故意、直接、损伤自身组织的行为[1]，是重要的公共卫生问题；自伤与自杀存在一定关联，严重影响青少年身心健康[2]。国外一项大样本研究报告儿童青少年NSSI发生率为19.5%[3]，中国青少年的NSSI检出率为27.4%，高于西方[4-5]，并且呈现上升趋势[6]。相关研究显示，自伤的影响因素包括神经生物学、社会、心理等方面[7]，NSSI学生自杀意念的检出率高于无NSSI的学生[8]，中学生暴露在高风险的个人、家庭、学校等社会生态系统中会增加NSSI的风险[9]。为保障青少年的健康成长、掌握中学生NSSI的长期流行趋势，本研究基于2015—2023年上海市嘉定区青少年健康相关行为调查数据，分析中学生NSSI行为的流行状况、相关因素及变化趋势，为科学制订青少年NSSI防控政策提供参考依据。
1　对象与方法
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1.1　对象
于2015，2017，2019，2021及2023年，在上海市嘉定区开展共计5次“上海市青少年健康危险行为调查”；采用分层整群随机抽样方法，每次按中学学段分层(初中、高中)，采用直接抽选法抽取3~4所学校，在抽中学校的每个年级中采用直接抽选法抽取2~3个班级，以班级作为整体纳入调查。共纳入9所初中、9所高中，发放并回收5 237份问卷，对问卷进行核查，剔除基本信息缺失问卷，单份问卷项目缺失30%以上为无效问卷，共计纳入5 231名学生。其中男生2 866名(54.8%)，女生2 365名(45.2%)；初中生2 899名(55.4%)，高中生2 332名(44.6%)；年龄为10~19岁，平均(14.6±2.10)岁。2015—2023年纳入研究人数分别为752，836，1 037，1 250和1 356名。本研究通过上海市嘉定区疾病预防控制中心伦理委员会批准(批号：2024-007)，研究对象均知情同意。
1.2　方法
现场调查员由嘉定区疾病预防控制中心学校卫生工作人员担任。调查前，对调查人员进行统一培训，确保调查员明确调查目的、意义和方法，统一指标含义。以班级为单位，采用匿名自填式纸质问卷对学生进行调查。调查工具采用上海市青少年健康相关行为调查问卷，该问卷参考美国疾病预防控制中心设计的青少年危险行为监测问卷，并结合实际情况进行设计[10]。调查内容包括学生基本情况、健康相关行为、心理状况等，分为初中版和高中版，该问卷被证实有较好的重复信度[11]。(1)基本情况。包括学段、性别、父母文化程度、家庭类型、是否独生子女等信息。(2)相关行为和心理状况。评价中学生孤独、学习压力、失眠、抑郁情绪、饮酒及网络成瘾情况，主要内容：①在过去12个月，你曾感到孤独吗?②在过去12个月，你是否因为学习压力或成绩问题感到心情不愉快?③在过去12个月，你是否因担心某事而失眠?④在过去12个月，你是否连续2周或更长时间感到非常伤心或绝望而停止平常的活动?⑤过去30 d，你是否至少喝过一杯酒?⑥参考Young编制[12]的网络成瘾量表评价方法，平均每天用于非工作学习目的上网时间≥4 h，同时出现以下4项及以上，即可判定为网络成瘾：由于经常上网，所以即使不上网，脑中也一直浮现与网络有关的事情；一旦不能上网，就感到不舒服、无所事事或不能静下心来干别的事情；希望增加上网时间，以便满足自己的愿望；上网时间超过自己预想的时间；多次想停止上网，但总也不能控制自己；因为上网而不能完成作业或逃学；向家长或老师、同学隐瞒自己上网的事实；因为上网而与家长发生冲突；为了逃避现实、摆脱自己的困境或郁闷、无助、焦虑情绪才上网。本研究中该量表的Cronbach α系数为0.79。以上①~⑤问题选“是”则判定为存在相应行为或心理状况。(3)NSSI。采用“过去12个月里，有意伤害过自己，如用烟头烫、用刀片割、用头撞墙等非自杀性行为？”条目评价，选项分为0，1，2~5，≥6次4类。
1.3　质量控制
调查前，由上海市疾病预防控制中心对区级学校卫生工作人员进行集中培训。取得学校和家长的知情同意和支持后，在每个班级安排1名调查人员进入班级，并由班主任老师配合，调查人员当场复核每份问卷。质控人员在数据录入前对每份问卷再次复核，审核逻辑问题。录入完成后，对所有数据进行系统校对。
1.4　统计学分析
对所有纸质问卷采用EpiData 3.0软件进行数据录入，数据采用Excel 2003和SPSS 23.0软件进行分析。计数资料用频数或百分率描述，计量资料用(x±s)描述。组间比较采用χ2检验或χ2趋势检验；采用JointPoint 5.0软件对变化趋势进行分析，用年度变化百分率(annual percent change, APC)进行评价。单因素和多因素分析采用Logistic回归分析模型。检验水准α=0.05。
2　结果
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2.1　嘉定区中学生2015—2023年NSSI报告率及变化趋势
2015，2017，2019，2021，2023年中学生NSSI报告率分别为8.6%，9.7%，12.9%，14.9%，14.2%，呈上升趋势(χ趋势2=22.25，P < 0.01)。2023年女生NSSI报告率(19.2%)高于男生(10.0%)，初中生(17.1%)高于高中生(11.1%)，差异均有统计学意义(χ2值分别为23.21，10.04，P值均 < 0.01)。2015—2023年中学生NSSI总体报告率为12.6%，APC为6.64%(t=3.49)，其中女生APC为9.79%(t=3.20)(P值均＜0.05)；男生、初中生、高中生APC分别为2.44%，8.32%，4.22%(P值均>0.05)。见表1。
2.2　嘉定区中学生2015—2023年NSSI频次报告率及构成比变化
2023年嘉定区中学生NSSI行为1，2~5，≥6次的报告率分别为6.7%，4.8%，2.7%，较2015年分别上升了2.2，1.6，1.8百分点(χ趋势2值分别为4.19，6.12，16.09)；其中2023年女生NSSI行为1，2~5，≥6次的报告率分别为8.1%，7.0%，4.0%，较2015年分别上升了3.2，3.4，3.7百分点(χ趋势2值分别为4.33，8.15，17.09)(P值均＜0.05)。2023年男生NSSI行为1，2~5，≥6次的报告率分别为5.5%，2.9%，1.6%，较2015年分别上升了1.2，0，0.2百分点(χ趋势2值分别为0.57，0.11，1.07，P值均>0.05)。见表2。
2015—2023年，NSSI行为发生1次占比由52.3%下降至47.2%，发生2~5次占比由36.9%下降至33.7%(χ趋势2值分别为2.87，0.04，P值均>0.05)，发生≥6次占比由10.8%上升至19.2%(χ趋势2=6.57，P < 0.05)；其中女生NSSI行为发生1次占比由55.6%下降至42.5%，发生2~5次占比由40.7%下降至36.7%(χ趋势2值分别为3.21，0.02，P值均>0.05)，发生≥6次占比由2015年3.7%上升至2023年20.8%(χ趋势2=6.06，P＜0.05)。男生NSSI行为发生1次占比由50.0%上升至54.8%，发生2~5次占比由34.2%下降至28.8%，发生≥6次占比由2015年的15.8%上升至2023年的16.4%(χ趋势2值分别为0.01，0.13，0.49，P值均>0.05)。见表3。
2.3　嘉定区2023年中学生NSSI行为相关因素分析
以中学生是否存在NSSI行为(否=0，是=1)为因变量进行Logistic回归模型分析，单因素分析结果显示，女生、初中生、有学习压力、孤独、失眠、抑郁情绪、饮酒、网络成瘾的学生较其他学生更易发生NSSI(P值均＜0.05)；多因素回归分析结果显示，性别、学段、是否失眠、是否有抑郁情绪、是否饮酒等因素均是中学生发生NSSI的相关因素；其中女生NSSI的发生风险是男生的1.71倍(OR=1.71)，初中生是高中生的1.96倍(OR=1.96)，失眠学生是非失眠学生的3.44倍(OR=3.44)，有抑郁情绪学生是无抑郁情绪学生的4.76倍(OR=4.76)，饮酒学生是非饮酒学生的1.77倍(OR=1.77)(P值均 < 0.01)。见表4。
3　讨论
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本研究调查结果显示，2023年嘉定区中学生NSSI报告率为14.2%，高于使用相同调查问卷的北京市海淀区2008—2016年21所中学22 604名中学生NSSI报告率(13.6%)[13]，低于贵州省中学生NSSI报告率(29.6%)[14]，体现了不同地域之间的差异。
本研究发现，2023年女生NSSI报告率为19.2%，远高于男生10.0%，与相关研究结果一致[15-16]。有研究发现，当生活中出现负向事件时，女生较男生易产生焦虑、抑郁等负面情绪，导致女生更易发生伤害自身的行为[17]。初中生NSSI报告率(17.1%)高于高中(11.1%)，与沈艳辉等[13]研究结果一致。刘洋等[18]发现，初中生刚进入青春期，调节情绪的能力较弱，遇到挫折和压力时不能较好缓解或解决问题，故较高中生更易冲动而发生自伤行为。因此，女生和初中生是自伤防控的重点人群，需要得到各方面更多关注。2015—2023年嘉定区中学生NSSI报告率呈增长趋势，APC为6.64%。针对此现状，需要学校、家庭和社会的高度关注、特别是发生多次NSSI的学生，应及时与其沟通并建议前往专业医疗机构进行规范治疗，以免出现自杀等更为危险的行为。
本研究还发现，有抑郁情绪、失眠及饮酒等是中学生NSSI行为的风险因素，与多项研究[19-20]调查结果相似。袁勇等[21]研究显示，NSSI行为和频发NSSI行为青少年的抑郁症状检出率分别为无NSSI行为青少年的2.65和7.28倍，并指出全社会应共同为青少年建设良好的心理健康环境，促进其身心健康。睡眠质量是影响中学生NSSI行为的重要因素[22]，良好的睡眠是青少年成长的重要保障；家庭需关注孩子的睡眠问题，学校应加强对学生睡眠知识宣教，提升学生睡眠自我管理能力。归冰等[23]调查显示，醉酒行为及频繁饮酒会增加青少年NSSI行为的风险；社会各界应高度重视学生饮酒危害，学校应开展相关的专题宣教，家长应强化健康意识，营造健康的家庭环境。
综上所述，嘉定区中学生2015—2023年NSSI行为报告率呈现逐年上升的趋势，中学生NSSI行为的发生和抑郁情绪、失眠和饮酒等风险因素有关，女生和初中生是NSSI行为的高风险人群。提示为减少学生NSSI行为的发生，应及早针对中学生，尤其是初中生及女生采取干预措施，家庭、学校和专业部门等应给予更多的支持和帮助，加强NSSI知识科普宣传，预防和控制NSSI的发生和发展。
本研究也存在一定的局限性：首先本研究的NSSI行为相关信息由学生自填，可能无法准确体现真实发生的情况；其次，本次分析是基于每2年一次的上海市青少年健康行为监测的横断面调查数据，难以验证因果关系；此外，没有针对学生心理开展专项调查，可能未全面关注NSSI行为发生的相关因素，今后需开展更多研究进一步探讨与NSSI行为相关的因素。
基金
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  • 复旦—嘉定公共卫生高质量发展重点学科(儿少卫生与妇幼保健学)(GWGZLXK-2023-04)
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2025年第46卷第9期
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doi: 10.16835/j.cnki.1000-9817.2025263
  • 接收时间：2025-04-08
  • 首发时间：2026-11-06
  • 出版时间：2025-09-25
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  • 收稿日期：2025-04-08
  • 修回日期：2025-07-19
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复旦—嘉定公共卫生高质量发展重点学科(儿少卫生与妇幼保健学)(GWGZLXK-2023-04)
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    1上海市嘉定区疾病预防控制中心学校卫生与眼病防治科，201800
    2复旦大学公共卫生学院妇幼与儿少卫生教研室

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