The Influences Of Uncertainty Stress On Deliberate Self-harm Among Medical College Students Based On The Social Capital Mediating Model

BackgroundDeliberate self-harm (DSH) has received significant attention in recent decades. The WHO report on violence and health demonstrated that self-inflicted injuries are the fourth leading cause of death and the sixth leading cause of ill-health and disability. The phenomenon of DSH among adolescent and young adult populations is very common and has increased widespread concern by domestic and international researchers. The prevalence of DSH for Chinese university and college students is about11%-34%. DSH not only brings the physical pain, but also influences affect function, interpersonal relationship, and academic performance. Repeated deliberate self-harm even increased the risk of suicide. DSH becomes a major public health and social issue among young adults. The transition to college often involves significant stress associated with adjusting to a new social environment, physical separation from parents, and alterations in social support networks. Previous studies have indicated that a need for DSH when individuals are confronted with stressful conditions or have difficulty in coping with stress. The individual who self-harms oneself is associated with high stress. Uncertainty is one of the major stressors. However, there is a lack of systematic studies on uncertainty stress, and the association between uncertainty stress and DSH. It is urgent to address this important area of research.ObjectivesThis study aims to explore the current condition of deliberate self-harm among medical college students in China, and to identify the risk factors of DSH at the psychosocial perspective. The current study focuses on understanding the effect of uncertainty stress on DSH among medical students, in comparison with study stress, family stress, and interpersonal stress. Based on stress coping theory and social capital theory, the uncertainty stress-social capital model for DSH is developed and amended. This study is to provide the scientific research evidence for public health policy makers and educators, to improve the population-based injury intervention projects’design, implementation, and evaluation, and finally to improve the mental health among college students.MethodsA cross-sectional survey with a multi-staged stratified randomize sampling method was conducted. According to the geographical location and economic development status,22medical universities were randomly selected for this study. The participants consisted of4,446undergraduate students majoring in clinical medicine, nursing, public health, and/or other medical-related areas. The demographic characteristics of the medical students were collected. Perceived stress from different life pressures including study, family, interpersonal relationship, and uncertainty were assessed. The situation about students’social capital containing cognitive social capital, structural social capital (social participation and social network) were also assessed. The SPSS18.0, SAS9.3and Amos17.0were applied to analyze the data. Cronbach’s alpha coefficient and exploratory factor analysis were used to examine the reliability and validity of the self-designed questionnaire of stress and social capital. Chi-square test and multiple logistic regression models were applied to analyse the influence factors of DSH. The structural equation model was used to examine the network relationship among social capital, uncertainty stress, and DSH.Results1) The rate of DSH of medical college students was9.56%in the past12months. The DSH rate in male students (11.51%) is significantly higher than female students (8.71%). The most common self-harm actions were scratching, cutting, and pinching. Age (x2=26.63, p<0.01), gender (%2=30.24, p<0.01), major (x2=28.13, p<0.01), annual household income (X2=11.10, p<0.05) were statistically associated with DSH. While there was no significant difference among the factors of race, parent occupation, family location, and student’s consumption level. The DSH rate declined with the increased age of the participants of this study. Freshman students had the highest DSH rate. Students who majored in nursing and other medical-related areas had higher DSH rate than that of public health students and clinical medical students. Student participants whose annual household income of more than40,000RMB reported lower DSH rates.2) The results from multiple Logistic regression full model showed that uncertainty stress (OR=1.734, p＜O.Ol), social network (OR=1.352, p＜O.Ol), cognitive social capital (OR=1.352, p<0.01), social participation (OR=1.352, p<0.01) have significant effect on DSH while stress from study, family, interpersonal relationship have no statistically difference on DSH. The students, who perceived larger uncertainty stress or possessed less social capital, have a higher risk for occurrence of DSH.3) Structural equation model demonstrated that the correlation from uncertainty stress to DSH is0.068. The total correlation from cognitive social capital to DSH is-0.172including direct path (r=-0.121, p＜O.Ol) and indirect path(r=-0.051, pO.Ol). The total correlation from social network to DSH is-0.066including direct path (r=-0.059, p<0.01) and indirect path(r=-0.007, p<0.01). The indirectly standard effect between social participation and DSH is0.017and social participation is not directly correlated with DSH.Conclusion:Age, grade, gender, major and annual household income are the influence factors for deliberate self-harm behaviors of medical college students. We should pay more attention on the DSH phenomenon among lower-grade, male, poor, and nursing students. Mental stress was confirmed to influence the DSH behavior. Uncertainty stress is a unique factor for prediction of DSH, and has larger impact on DSH compared with other three stressors. Social capital has a significant effect on DSH as well, especially cognitive social capital. Meanwhile, social capital could indirectly influence DSH through affecting uncertainty stress. It is recommended that DSH intervention study should target on uncertainty stress management and social capital accumulation.