Association of socioecological factors with development and persistence of non-suicidal self-injury among Chinese adolescents: evidence from the Youth Mental Health Promotion study.

BACKGROUND

Non-suicidal self-injury (NSSI) is a major public health concern among adolescents, yet the individual and combined effects of socioecological factors on the development and persistence of NSSI remain underexplored.

METHODS

Based on the Youth Mental Health Promotion cohort (N = 46,782 adolescents with complete baseline and one-year follow-up data), we identified 2330 with newly observed NSSI and 1379 with persistent NSSI. Socioecological exposures were assessed across 62 factors spanning individual, family, and community/school levels. Then, we estimated the associations of each socioecological factor with newly observed and persistent NSSI, using conditional logistic regression models stratified by school. Using an unsupervised data-driven method, we identified four highly stable subtypes among adolescents with baseline NSSI, and assessed their associations with persistent NSSI using similar models.

RESULTS

Of 62 factors, 59 were associated with newly observed NSSI and 9 with persistent NSSI. Self-esteem showed the strongest negative association with both outcomes, while negative coping strategies and hurting others behavior exhibited the strongest positive associations with newly observed and persistent NSSI, respectively. Over one-third of adolescents in the "Natural disaster, childhood adversity, and externalizing behavior" and "Childhood adversity and externalizing behavior" clusters displayed persistent NSSI, compared to the "Low-risk adaptation" cluster, both of which had greater possibility of childhood adversity, low self-esteem, and hurting others behavior.

CONCLUSIONS

Socioecological factors significantly influenced newly observed and persistent NSSI. Adolescents with childhood adversity, low self-esteem, and hurting others behavior were at high risk for persistent NSSI, necessitating targeted interventions to address these conditions and prevent persistence.