Association between Childhood Maltreatment and Suicidal Ideation and Suicide Attempts among Chinese Adolescents: The Moderating Role of Depressive Symptoms
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Ethical Statement
2.3. Measures
2.3.1. Suicidal Ideation and Suicidal Attempts
2.3.2. Childhood Maltreatment
2.3.3. Depressive Symptoms
2.3.4. Covariates
2.4. Statistical Analysis
3. Results
3.1. Sample Characteristics of 20,517 Students
3.2. Association of Childhood Maltreatment and Depressive Symptoms with Suicidality
3.3. Associations of Interaction Items with Suicidal Ideation and Suicidal Attempts
3.4. Associations of Childhood Maltreatment and Suicidality Stratified by Depressive Symptoms
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Total # (%) | Suicidal Ideation | Suicidal Attempts | ||||
---|---|---|---|---|---|---|---|
Yes # (%) | No # (%) | p-Value * | Yes # (%) | No # (%) | p-Value * | ||
Total | 20,517 (100) | 3732 (18.2) | 16,785 (81.8) | 738 (3.6) | 19,779 (96.4) | ||
Age, mean (SD) | 15.0 (1.8) | 14.9 (1.7) | 15.0 (1.8) | <0.001 | 14.7 (1.6) | 15.0 (1.8) | <0.001 |
Sex | |||||||
Boy | 10,296 (50.2) | 1342 (13.0) | 8954 (87.0) | <0.001 | 234 (2.3) | 10,062 (97.9) | <0.001 |
Girl | 10,221 (49.8) | 2390 (23.4) | 7831 (76.6) | 504 (4.9) | 9717 (95.1) | ||
Grade | |||||||
7th | 3487 (17.0) | 566 (16.2) | 2921 (83.8) | <0.001 | 110 (3.2) | 3377 (96.8) | <0.001 |
8th | 3405 (16.6) | 691 (20.3) | 2714 (79.7) | 163 (4.8) | 3242 (95.2) | ||
9th | 3317 (16.2) | 646 (19.5) | 2671 (80.5) | 126 (3.8) | 3191 (96.2) | ||
10th | 3798 (18.5) | 771 (20.3) | 3027 (79.7) | 184 (4.8) | 3614 (95.2) | ||
11th | 3598 (17.5) | 565 (15.7) | 3033 (84.3) | 91 (2.5) | 3507 (97.5) | ||
12th | 2912 (14.2) | 493 (16.9) | 2419 (83.1) | 64 (2.2) | 2848 (97.8) | ||
Living arrangement | |||||||
Living with parents | 15,325 (74.7) | 2576 (16.8) | 12,749 (83.2) | <0.001 | 485 (3.2) | 14,840 (96.8) | <0.001 |
Living with a single parent | 2677 (13.0) | 674 (25.2) | 2003 (74.8) | 151 (5.6) | 2526 (94.4) | ||
Living with others | 2358 (11.5) | 456 (19.3) | 1902 (80.7) | 96 (4.1) | 2262 (95.9) | ||
Missing data | 157 (0.8) | NA | NA | NA | NA | ||
HSS | |||||||
Above average | 6172 (30.1) | 941 (15.2) | 5231 (84.8) | <0.001 | 179 (2.9) | 5993 (97.1) | <0.001 |
Average | 11,603 (56.6) | 2135 (18.4) | 9468 (81.6) | 430 (3.7) | 11,173 (96.3) | ||
Below average | 2609 (12.7) | 636 (24.4) | 1973 (75.6) | 121 (4.6) | 2488 (95.4) | ||
Missing data | 133 (0.6) | NA | NA | NA | NA | ||
Academic pressure | |||||||
Below average | 4413 (21.5) | 515 (11.7) | 3898 (88.3) | <0.001 | 110 (2.5) | 4303 (97.5) | <0.001 |
Average | 9318 (45.4) | 1377 (14.8) | 7941 (85.2) | 273 (2.9) | 9045 (97.1) | ||
Above average | 6653 (32.4) | 1815 (27.3) | 4838 (72.7) | 350 (5.3) | 6303 (94.7) | ||
Missing data | 133 (0.6) | NA | NA | NA | NA | ||
Parental marital status | |||||||
Harmonious | 18,038 (87.9) | 2940 (16.3) | 15,098 (83.7) | <0.001 | 553 (3.1) | 17,485 (96.9) | <0.001 |
Often quarrel | 586 (2.9) | 265 (45.2) | 321 (54.8) | 69 (11.8) | 517 (88.2) | ||
Separated or divorced | 1745 (8.5) | 506 (29.0) | 1239 (71.0) | 114 (6.5) | 1631 (93.5) | ||
Missing data | 148 (0.7) | NA | NA | NA | NA | ||
Classmate relations | |||||||
Good | 16,699 (81.4) | 2633 (15.8) | 14,066 (84.2) | <0.001 | 455 (2.7) | 16,244 (97.3) | <0.001 |
Average | 3391 (16.5) | 944 (27.8) | 2447 (72.2) | 234 (6.9) | 3157 (93.1) | ||
Poor | 282 (1.4) | 124 (44.0) | 158 (56.0) | 42 (14.9) | 240 (85.1) | ||
Missing data | 145 (0.7) | NA | NA | NA | NA | ||
Teacher-classmate relations | |||||||
Good | 14,179 (69.2) | 2058 (14.5) | 12,139 (85.5) | <0.001 | 369 (2.6) | 13,828 (97.4) | <0.001 |
Average | 5716 (27.9) | 1482 (25.9) | 4234 (74.1) | 311 (5.4) | 5405 (94.6) | ||
Poor | 376 (1.8) | 148 (39.4) | 228 (60.6) | 49 (13.0) | 327 (87.0) | ||
Missing data | 228 (1.1) | NA | NA | NA | NA | ||
Smoking | |||||||
No | 18,481 (90.1) | 3113 (16.8) | 15,368 (83.2) | <0.001 | 564 (3.1) | 17,917 (96.9) | <0.001 |
Yes | 1753 (8.5) | 555 (31.7) | 1198 (68.3) | 153 (8.7) | 1600 (91.3) | ||
Missing data | 283 (1.4) | NA | NA | NA | NA | ||
Drinking | |||||||
No | 11,832 (57.7) | 1472 (12.4) | 10,360 (87.6) | <0.001 | 242 (2.0) | 11,590 (98.0) | <0.001 |
Yes | 8379 (40.8) | 2202 (26.3) | 6177 (73.7) | 481 (5.7) | 7898 (94.3) | ||
Missing data | 306 (1.5) | NA | NA | NA | NA | ||
Depressive symptoms | |||||||
No | 18,269 (89.0) | 2361 (12.9) | 15,908 (87.1) | <0.001 | 346 (1.9) | 17,923 (98.1) | <0.001 |
Yes | 2248 (11.0) | 1371 (61.0) | 877 (39.0) | 392 (17.4) | 1856 (82.6) | ||
CTQ scores of physical abuse a | 5.7 (1.6) | 6.6 (2.4) | 5.5 (1.2) | <0.001 | 7.4 (3.3) | 5.6 (1.4) | <0.001 |
CTQ scores of emotional abuse a | 6.8 (2.9) | 9.3 (4.2) | 6.3 (2.2) | <0.001 | 11.1 (5.2) | 6.7 (2.7) | <0.001 |
CTQ scores of sexual abuse a | 5.2 (1.1) | 5.6 (1.6) | 5.2 (0.9) | <0.001 | 5.8 (2.2) | 5.2 (1.0) | <0.001 |
CTQ scores of physical neglect a | 7.2 (2.8) | 8.1 (3.2) | 7.0 (2.7) | <0.001 | 9.0 (3.7) | 7.2 (2.8) | <0.001 |
CTQ scores of emotional neglect a | 8.6 (5.2) | 11.1 (5.9) | 8.1 (4.9) | <0.001 | 13.4 (6.6) | 8.4 (5.1) | <0.001 |
Variable | Models 1 | Models 2 | ||||||
---|---|---|---|---|---|---|---|---|
Suicidal Ideation | Suicidal Attempts | Suicidal Ideation | Suicidal Attempts | |||||
OR (95% CI) | p-Value | OR (95%CI) | p-Value | AOR (95% CI) | p-Value | AOR (95% CI) | p-Value | |
Physical abuse * | 1.46 (1.43–1.50) | <0.001 | 1.37 (1.33–1.41) | <0.001 | 1.35 (1.32–1.38) | <0.001 | 1.28 (1.24–1.32) | <0.001 |
Emotional abuse * | 1.34 (1.32–1.35) | <0.001 | 1.28 (1.26–1.30) | <0.001 | 1.26 (1.25–1.28) | <0.001 | 1.22 (1.20–1.24) | <0.001 |
Sexual abuse * | 1.35 (1.30–1.40) | <0.001 | 1.23 (1.19–1.28) | <0.001 | 1.25 (1.21–1.30) | <0.001 | 1.18 (1.14–1.23) | <0.001 |
Physical neglect * | 1.12 (1.11–1.14) | <0.001 | 1.20 (1.18–1.23) | <0.001 | 1.09 (1.08–1.11) | <0.001 | 1.15 (1.12–1.17) | <0.001 |
Emotional neglect * | 1.10 (1.09–1.11) | <0.001 | 1.13 (1.12–1.14) | <0.001 | 1.08 (1.08–1.09) | <0.001 | 1.11 (1.09–1.12) | <0.001 |
Depressive symptoms | ||||||||
No | 1.00 | 1.00 | 1.00 | 1.00 | ||||
Yes | 10.53 (9.58–11.58) | <0.001 | 10.94 (9.40–12.74) | <0.001 | 6.77 (6.07–7.54) | <0.001 | 6.56 (5.47–7.86) | <0.001 |
Interaction Item | Suicidal Ideation | Suicidal Attempts | ||
---|---|---|---|---|
AOR (95% CI) | p-Value | AOR (95% CI) | p-Value | |
Depressive symptoms a | ||||
Physical abuse | 0.82 (0.77–0.86) | <0.001 | 0.87 (0.82–0.93) | <0.001 |
Emotional abuse | 0.90 (0.87–0.93) | <0.001 | 0.92 (0.89–0.95) | <0.001 |
Sexual abuse | 0.84 (0.78–0.90) | <0.001 | 0.84 (0.78–0.91) | <0.001 |
Physical neglect | 0.98 (0.95–1.01) | 0.161 | 0.95 (0.91–1.00) | 0.053 |
Emotional neglect | 0.99 (0.97–1.00) | 0.115 | 0.98 (0.95–1.00) | 0.087 |
Variable | With Depressive Symptoms | Without Depressive Symptoms | ||||||
---|---|---|---|---|---|---|---|---|
Suicidal Ideation | Suicidal Attempts | Suicidal Ideation | Suicidal Attempts | |||||
AOR (95% CI) | p-Value | AOR (95% CI) | p-Value | AOR (95% CI) | p-Value | AOR (95% CI) | p-Value | |
Physical abuse * | 1.12 (1.07–1.16) | <0.001 | 1.15 (1.11–1.20) | <0.001 | 1.37 (1.33–1.42) | <0.001 | 1.29 (1.23–1.35) | <0.001 |
Emotional abuse * | 1.13 (1.10–1.16) | <0.001 | 1.13 (1.10–1.16) | <0.001 | 1.25 (1.23–1.27) | <0.001 | 1.22 (1.18–1.25) | <0.001 |
Sexual abuse * | 1.05 (0.99–1.11) | 0.083 | 1.05 (1.00–1.12) | 0.072 | 1.26 (1.21–1.31) | <0.001 | 1.24 (1.17–1.31) | <0.001 |
Physical neglect * | 1.05 (1.02–1.08) | 0.001 | 1.10 (1.06–1.13) | <0.001 | 1.07 (1.06–1.09) | <0.001 | 1.13 (1.09–1.18) | <0.001 |
Emotional neglect * | 1.05 (1.04–1.07) | <0.001 | 1.07 (1.05–1.09) | <0.001 | 1.07 (1.06–1.08) | <0.001 | 1.09 (1.08–1.11) | <0.001 |
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Gong, M.; Zhang, S.; Li, W.; Wang, W.; Wu, R.; Guo, L.; Lu, C. Association between Childhood Maltreatment and Suicidal Ideation and Suicide Attempts among Chinese Adolescents: The Moderating Role of Depressive Symptoms. Int. J. Environ. Res. Public Health 2020, 17, 6025. https://doi.org/10.3390/ijerph17176025
Gong M, Zhang S, Li W, Wang W, Wu R, Guo L, Lu C. Association between Childhood Maltreatment and Suicidal Ideation and Suicide Attempts among Chinese Adolescents: The Moderating Role of Depressive Symptoms. International Journal of Environmental Research and Public Health. 2020; 17(17):6025. https://doi.org/10.3390/ijerph17176025
Chicago/Turabian StyleGong, Meiqian, Sheng Zhang, Wenyan Li, Wanxin Wang, Ruipeng Wu, Lan Guo, and Ciyong Lu. 2020. "Association between Childhood Maltreatment and Suicidal Ideation and Suicide Attempts among Chinese Adolescents: The Moderating Role of Depressive Symptoms" International Journal of Environmental Research and Public Health 17, no. 17: 6025. https://doi.org/10.3390/ijerph17176025