| BackgroundNon-suicidal self-injury(NSSI)is a socially unacceptable series of deliberate action that alter or directly harm one’s body tissues without any suicidal purpose.Adolescence is a critical period of rapid physical,psychological,and behavioral development.Adolescents are susceptible to psychosocial,behavioral problems and NSSI.Epidemiological studies estimated that 14.2%-17.2%of adolescents had a history of NSSI.Multiple factors are associated with NSSI,including neurobiological,demographical,psychosocial,and family factors.Romantic relationship problems,such as starting a relationship and breakups begin to increase during adolescence.For example,a survey on the heterosexual behavior in secondary school students in China showed that 10.9%of students had been or were in a relationship,and 15.3%had ever dated.Adolescents’ romantic relationship problems have been demonstrated to be associated with mental health problems and poor school performance.However,studies on the relationship between adolescents’ romantic relationship problems and NSSI are scarce and the findings are mixed,and there is a lack of research on the mechanisms of relationship between adolescents’romantic relationship problems and NSSI.ObjectivesThis study is based on the data collected in the Shandong Adolescent Behavior and Health Cohort.The objectives of the current study are to describe the characteristics of adolescent’s NSSI and romantic relationship problems;to examine the cross-sectional and prospective associations between romantic relationship problems and NSSI;and to explore the role of parenting style in the association between romantic relationship and NSSI.The findings of the study will provide provide scientific evidence for families,schools and society from the perspective of romantic relationship problems and parenting styles,to develop and implement prevention and intervention measures of preventing NSSI in adolescents.Methods1.SubjectsData used for the current study were derived from the Shandong Adolescent Behavior and Health Cohort.A total of 12,301 students participated in the 2015 baseline survey and 11,831 returned usable questionnaires.A total of 6,995 7th and 10th graders were included in the crosssectional analysis.Of the 7th and 10th graders,5807 were followed up in 2016 and 4853 were followed up in 2017.2.MeasurementsParticipants completed a self-administered questionnaire in their classrooms.Before the survey,participants were informed the study objectives and how to fill out the questionnaire.Participating in the survey was voluntary and anonymous.It took about 45 mins to complete the questionnaire.3.ContentsThe questionnaire consisted of seven sections:adolescent general health status,daily activities and health behaviors developmental status,personality and mood,social support,family and community environment,parenting,and stressful life events.Two questions were used to measure romantic relationship problems and two questions were used to measure NSSI.Parenting Styles Scale was used to measure parenting styles,which classified parenting styles as mildly harsh and below,moderately harsh and severely harsh using a cut-off point of 25%and 75%of the total parenting style score.4.Statistical analysisSTATA 15.0 and IBM SPSS Statistics 24.0 statistical software were used for descriptive and statistical association analyses.The χ2 test,t-test.ANOVA,and rank sum test were used for tests of variance.Logistic regression analysis was used to examine the relationship between adolescent romantic relationship problems and NSSI with baseline data.The generalized estimating equation model(GEE)was used to explore the relationship using follow-up data to test whether there was an interaction between parenting style and romantic relationship problems for NSSI.Main results1.Baseline survey in 2015In the baseline survey,a total of 6995 seventh and tenth graders were surveyed.And 1369 adolescents(19.6%)had NSSI in the past year.Differences by gender,age,grade,physical health status,smoking,alcohol consumption,anxiety/depressive symptoms,parenting style,family economic status,and parental marital status were statistically significant(P<0.05)in relation to the occurrence of NSSI in the past year.Of the sample,24.6%had a romantic relationship,29.0%had had a history of breakup in the past year and 43.6%had either.There were statistical differences between male and female adolescents(P<0.001).Logistic regression analysis showed that someone who had starting a romantic relationship,breakups and had romantic relationship problems were all associated with NSSI(P<0.05).After adjustment for age,grade,gender,physical health status,smoking,alcohol consumption,anxiety/depressive symptoms,family economic status,parental occupation,parental education,parental marital status,and parenting style,they were still significantly associated with NSSI(P<0.05).2.Follow-up survey in 2015-2017The prevalence of NSSI reporting was 19.9%among participants in grades 7 and 10 in the 2015 baseline survey,8.7%in 2016,and 11.4%in 2017.The prevalence of NSSI reporting was significantly higher among girls than boys in all three surveys(P<0.05).The prevalence of romantic relationship problems was 43.6%in the baseline survey,30.6%in 2016,and 24.6%in 2017.Univariate GEE results showed that the presence of romantic relationship problems(OR=2.19,95%CI=2.00-2.39),had starting a romantic relationship(OR=2.33,95%CI=2.122.56),and breakups(OR=1.75,95%CI=1.59-1.92)were all associated with NSSI.After adjustment for gender,age,grade,physical health status,smoking,alcohol consumption,anxiety/depressive symptoms,family economic status,parental occupation,parental education,and parental marital status,having romantic relationship problems(OR=1.79,95%CI=1.621.97),starting a romantic relationship(OR=1.94,95%CI=1.74-2.16),and having a breakup(OR=1.51,95%CI=1.37-1.68)were all associated with NSSI.GEE stratified analysis by gender and grade showed that romantic relationship problems were associated with the occurrence of NSSI in both boys and girls,and in both 7th and 10th grade students.The GEE method was used to examine the interaction between parenting style and romantic relationship problems by gender.Both univariate and multivariate analyses showed that having not romantic relationship problems and low levels of strict parenting,having romantic relationship problems and light parenting,having romantic relationship problems and moderate levels of strict parenting,and having romantic relationship problems and heavy parenting were all associated with NSSI,using no romantic relationship problems and low levels of strict parenting as a reference,among boys and girls.The results were consistent between 7th and 10th graders.Conclusions(1)The rate of NSSI in adolescents were reported lower in the second year than there in the first and third year,and it was higher among girls than boys.(2)The rate of romantic relationship problems varied considerably over the three years,and it showed a downward trend among adolescents.The rates of reporting of romantic relationship problems were higher among boys than girls.(3)The baseline data analysis found a correlation between adolescent romantic relationship problems and non-suicidal self-injury.(4)The longitudinal data analysis found that adolescent romantic relationship problems were associated with non-suicidal self-injury and that there was an interaction between parenting style and romantic relationship problems.This association was still statistically significant among boys and girls,and Grades 7 and 10 students.Further,there was an interaction between parenting style and romantic relationship problems on NSSI. |
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