Association of the labor migration of parents with nonsuicidal self-injury and suicidality among their offspring in China

© 2021 The Authors. Published by American Medical Association. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785877Importance: The labor migration of parents in China often leaves children behind, which may be adversely associated with children's health. However, few studies have assessed the association of parental migration with nonsuicidal self-injury (NSSI) or with suicidality among their offspring. Objective: To examine the associations of parental labor migration with NSSI and with suicidality as well as potential differential associations by sex among offspring left behind. Design, Setting, and Participants: This nationwide cross-sectional study was conducted from February to October 2015 among individuals aged 11 to 20 years from 45 public middle and high schools across 5 provinces of China. Data analysis was performed from November 1, 2020, to March 1, 2021. Exposures: Parental labor migration, including parental migration status (yes vs no), migration pattern (father, mother, or both), and the child's age at the initial parent-child separation. Main Outcomes and Measures: Less frequent (1-4 episodes) NSSI, more frequent (≥5 episodes) NSSI, suicidal ideation, and suicide attempt in the past year were measured using validated questionnaires. Multinomial or binomial logistic regression analyses were used separately to estimate adjusted odds ratios (aORs) and 95% CIs of the associations between parental migration and NSSI, suicidal ideation, or suicide attempt. Potential covariates (demographic, family-level, and psychological characteristics) were adjusted for in 3 sequential models. Results: A total of 15312 participants (7904 male [51.6%] and 7408 female [48.4%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) were included. Of those participants, 5963 (23.3%) experienced parental migration. The 12-month prevalence of less frequent NSSI was 17.2% (2635 of 15312), the 12-month prevalence of more frequent NSSI was 11.6% (1783 of 15312), the 12-month prevalence of suicidal ideation was 15.2% (2335 of 15312), and the 12-month prevalence of suicide attempt was 3.5% (535 of 15312). Parental migration was associated with less frequent NSSI (adjusted odds ratio [aOR], 1.13; 95% CI, 1.03-1.24); no significant association of parental migration with more frequent NSSI (aOR, 1.01; 95% CI, 0.90-1.13), suicidal ideation (aOR, 1.00; 95% CI, 0.90-1.10), or suicide attempt (aOR, 1.09; 95% CI, 0.90-1.33) was identified. Compared with children whose parents did not migrate, the aOR for less frequent NSSI for participants whose father migrated was 1.18 (95% CI, 1.06-1.31), and the aOR for less frequent NSSI for participants having both parents migrate was 1.12 (95% CI, 1.01-1.28). Compared with children whose parents did not migrate, participants who experienced initial separation from 1 or both parents at preschool age had an aOR for less frequent NSSI of 1.16 (95% CI, 1.03-1.31). No sex disparities were found in these associations except for participants who experienced initial separation from 1 or both migrant parents at preschool age, for which the aOR for more frequent NSSI was higher among male (aOR, 1.27; 95% CI, 1.04-1.55) than female (aOR, 0.96; 95% CI, 0.77-1.19) participants. Conclusions and Relevance: This cross-sectional study found that parental migration, mainly of the father or of both parents, or an initial separation of children at preschool age from 1 or both parents who migrated was associated with higher odds of experiencing 1 to 4 NSSI episodes in 1 year among offspring. Overall, the associations of parental migration with NSSI and suicidality were similar between male and female participants..This study was supported by grants 81773457 and 81302445 (to Dr Tang) from the National Natural Science Foundation of China.Published versio

Association of internet addiction With nonsuicidal self-injury among adolescents in China

© 2020 The Authors. Published by American Medical Association. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: 10.1001/jamanetworkopen.2020.6863Importance: Both nonsuicidal self-injury (NSSI), defined as the direct, deliberate damage of one's body tissue without suicidal intent, and internet addiction among adolescents are public health concerns. However, the possible association of NSSI with internet addiction is not well understood. Objective: To examine the occurrence of internet addiction with NSSI and any sex differences among Chinese adolescents. Design, Setting, and Participants: A multicenter, cross-sectional, survey study was conducted from February 18 to October 15, 2015, among adolescents aged 11 to 20 years from 343 classes in 45 public high schools across 5 provinces of China. Data analysis was performed from August 1, 2018, to March 1, 2019. Exposures: Possible internet addiction and internet addiction. Main Outcomes and Measures: Less-frequent (1-4 times) NSSI and more-frequent (≥5 times) NSSI were surveyed using the Chinese version of the Functional Assessment of Self-Mutilation. Results: A total of 15 623 students (8043 male [51.5%] and 7580 female [48.5%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) participated. Of these, 4670 participants (29.9%) met the criteria for possible internet addiction and 509 participants (3.3%) met the criteria for internet addiction. A total of 2667 students (17.1%) engaged in less-frequent NSSI, while 1798 students (11.5%) engaged in more-frequent NSSI in the 12 months preceding the survey. Both possible internet addiction and internet addiction were associated with less-frequent or more-frequent NSSI. The adjusted odds ratios were 1.29 (95% CI, 1.17-1.42) for possible internet addiction and 1.41 (95% CI, 1.11-1.80) for internet addiction for less-frequent NSSI; for more-frequent NSSI, the adjusted odds ratios were 1.75 (95% CI, 1.56-1.96) for possible internet addiction and 2.66 (95% CI, 2.10-3.38) for internet addiction. These associations were similarly observed among age groups of 11 to 14, 15 to 17, and 18 to 20 years. No sex disparities were found in the associations of internet addiction with NSSI, except among adolescents aged 11 to 14 years, where the odds ratios for possible internet addiction with less-frequent NSSI were higher in male adolescents (1.53; 95% CI, 1.25-1.88) than female adolescents (1.13; 95% CI, 0.90-1.47). Conclusion and Relevance: Internet addiction appears to be associated with NSSI, and the findings of this study suggest that the association was similar between male adolescents and female adolescents. These data suggest that evaluation of the risk of NSSI for adolescents in association with internet addiction may help health care professionals in developing preventive interventions for NSSI.This study was supported by grants from National Natural Science Foundation of China (81773457, 81302445 [Dr Tang], and 81373022 [Dr Yu]), and a European Union grant from Horizon 2020 MSCA (DEMAIRPO 799247 [Drs Tang and Chen]).Published versio