| 1.BackgroundAs a critical public health issue,suicide earns increasing concern.Global suicide rate is 11.4/100,000,and suicide is the second leading death cause among the people aged from fifteen to twenty nine.Death due to suicide in China accounts for about 22%of global suicide death.In China,suicidal behaviors include suicide death,suicide attempt,suicide preparation,suicide plan and suicidal ideation.Adolescent suicide attracts much attention in recent years,even though rate of suicide among children aged ten to fourteen is rare,the frequency of suicidal behavior is significantly increasing during adolescence.Suicidal ideation,suicide plan and suicide attempt are the risk factors of suicide death among adolescents.Suicide rate and suicide methods display particular characteristics in different countries.Suicide is related to multiple factors,and identifying such factors is the basis of adolescent suicide prevention.Questionnaire survey and hospital-based follow-up are the common ways to investigate potential risk factors of suicidal behavior among adolescents.There are gender difference and age difference in terms of adolescent suicide.Suicidal behavior may be associated with psychiatry diseases,emotional problems and health risk behaviors.Parenting is a stereotype about how the parents discipline their children.Harsh parenting style is a common parental discipline.The choice of parenting style depends not only on the parents but also on offspring,and may have effect on the offspring’s psychological health and emotional problems.To our knowledge,research on association between parenting style and adolescent suicidal behaviors is rare in China,especially based on the data of large sample.2.ObjectivesIn this study,we aimed:2.1 To investigate characteristics of parenting style in rural area,and to evaluate the reliability and validity of Parenting Style Scale.2.2 To investigate potential psychological and socioeconomic factors related to adolescent suicidal behavior.2.3 To investigate association between parenting style and suicidal ideation,suicide plan and attempt among Chinese adolescents.3.Methods3.1 SubjectsThe current research was conducted in Lijin County,Yanggu County,and Zoucheng City of Shandong Province in November-December 2015:Two or three schools of each county(city)were chosen.Finally eight schools were included.Three schools only included 10th-12th graders and five schools only included 7th-9th graders.All 7th graders and all 10th graders participated in survey,while 8th graders,9th graders,and 11th graders were selected randomly by using the classes as sampling units.All students in the target classes participated in the survey.Before the survey carried out,we got the consent of principal in target schools and students in the target classes.Two weeks after the investigation in Yanggu County was finished,two classes of 7th,8th,9th,and 10th were selected randomly for retest,and finally 8 classed were retested.Final analyses included 490 participants for retest.3.2 MeasurementA self-administered paper and pencil questionnaire named Adolescent Health Questionnaire(AHQ)was used to collect information on gender,date of birth,family income,educational level of parents,smoking,alcohol use,hopelessness,emotional and behavioral problems,suicidal ideation,suicide plan and suicide attempt.The participants were asked to complete the questionnaire accurately after reading the instruction carefully and being told it was anonymous.Trained public health workers administered the questionnaire during regular school hours.It needed about 45 minutes to complete the questionnaire.The study was approved by the research ethics committee of Shandong University School of Public Health and target school principals.3.3 Statistical AnalysisSPSS 18.0 and AMOS 17.0 were used to analyze data.χ2 test,F test and Student t test were used for factors comparison.Logistic regression model was performed to explore association between measured variables and suicidal ideation,suicide plan and attempt.Structural equation model of parenting,substance use,emotional and behavioral problems and suicidal behaviors was built to explore potential explanation of association between parenting style and suicidal behavior.4.Results4.1 Sample characteristicsThe total number of the students in the target classes was 12,301.A total of 11,836 students participated in the survey,and response rate was 96.22%.5 questionnaires were submitted with blank,so 11,831 questionnaires were included in the final analyses.Of 11,831 students,6,018 were boys(50.9%),and mean age was 14.97±1.46.In terms of parental education,junior high-school educational level was the most common(54.4%in father and 46.9%in mother),while rate of primary school educational level or below in mothers was higher than that in fathers,and rate of senior high school educational level or above in father was higher than that in mothers.Majority of the participants reported medium family economic status(68.5%).4.2 Reliability and validity of Parenting Style ScaleThe exploratory factor analyses indicated that five common factors could be extracted,and they were punishment,hostility,lacking of care,authoritarian,and neglect.In the confirmatory factors analyses,Goodness of Fit Index(GFI),Adjusted Goodness of Fit Index(AGFI),Normed Fit Index(NFI),Non-normed Fit Index(NNFI),Comparative Fit Index(CFI),Incremental Fit Index(IFI)were more than 0.9.Root Mean Square Error of Approximation(RMSEA)were 0.060 and 0.066 in father and in mother Parenting Style Scale,respectively.The reliability of Parenting Style Scale in father was high(Cronbach’s α of father and mother parenting style scale were 0.847 and 0.845,respectively).Split-half reliability for the scale was 0.683 in father,and was 0.704 in mother.Retest reliability coefficient was 0.652 for the scale in father,and was 0.637 in mother.4.3 Feature of suicidal behaviorsOf the sample,2400(20.3%),1131(9.6%),461(3.9%)adolescents reported having had suicidal ideation,suicide plan and suicide attempt,respectively.In terms of gender distribution,females took a higher proportion of suicidal ideation,plan and attempt than males.The reporting rate of suicidal ideation of 16 age group was the highest(25.2%),that of suicide plan of 17 age group was the highest(11.7%),and that of suicide attempt of 15 age group was the highest(4.7%).The adolescents with higher scores of emotional and behavioral problems and hopelessness were more likely to report suicide behavior.The adolescents with alcohol use and smoking were more likely to report suicide behavior.Univariate analysis indicated that female gender(OR=1.43,95%CI:1.31-1.57),age more than fifteen(OR=3.30,95%CI:2.41-4.53),smoking(OR=2.42,95%CI:2.19-2.67),alcohol use(OR=2.43,95%CI:2.22-2.67),internalizing(OR=7.69,95%CI:6.82-8.67)and externalizing problems(OR=6.23,95%CI:5.53-7.02),and hopelessness(OR=2.61,95%CI:2.33-2.91)were significantly associated with suicidal ideation;female gender(OR=1.22,95%CI:1.08-1.38),age more than fifteen(OR=2.21,95%CI:1.49-3.27),smoking(OR=2.63,95%CI:2.31-2.99),alcohol use(OR=2.39,95%CI:2.11-2.71),internalizing(OR=7.18,95%CI:6.08-8.48)and externalizing problems(OR=6.86,95%CI:5.81-8.11),and hopelessness(OR=3.19,95%CI:2.75-3.71)were significantly associated with suicide plan;female gender(OR=1.34,95%CI:1.11-1.62),age more than fifteen(OR=2.38,95%CI:1.28-4.45),smoking(OR=2.87,95%CI:2.37-3.47),alcohol use(OR=2.70,95%C1:2.23-3.27),internalizing(OR=6.81,95%CI:5.29-8.75)and externalizing problems(OR=6.48,95%CI:5.04-8.33),and hopelessness(OR=3.04,95%CI:2.41-3.82)were significantly associated with suicide attempt.4.4 Parenting style of Chinese parentsThe mean score of Parenting Style Scale in father was 32.13±8.82,and in mother was 31.75 ± 8.73.Except for lacking of care,other dimensions of Parenting Style Scale demonstrated gender difference significantly(P<0.05),and score of parenting style scale in boys was higher than that in girls.4.5 Association between parenting and suicidal behaviorsMultivariate analyses demonstrated that severe harsh parenting of father was associated with suicidal ideation(OR=1.57,95%CI:1.39-1.78),suicide plan(OR=2.00,95%CI:1.70-2.35)and attempt(OR=2.23,95%CI:1.74-2.86),while moderate(OR=1.15,95%CI:1.02-1.30)and severe harsh parenting of mother(OR=1.16,95%CI:1.43-1.86)were associated with suicidal ideation,and severe harsh parenting of mother was associated with suicide plan(OR=1.97,95%CI:1.67-2.33)and attempt(OR=1.95,95%CI:1.51-2.50).In the structure equation model analyses,(1)parenting style influenced suicidal behavior directly;(2)emotional and behavioral problems were positively associated with parenting style,and emotional and behavioral problems could have impact on suicide directly,and substance use could moderate the effect of emotional and behavioral problems to suicidal behavior;(3)substance use was positive associated with harsh parenting style and emotional and behavioral problems,having influence on suicidal behavior directly.5.Conclusion and Implication5.1 Conclusion(1)Harsh parenting style scale includes five dimensions:punishment,hostility,lacking of care,authoritarian,and neglect,the validity and reliability of total scale were acceptable.(2)Comparing to girls,boys are more likely to experience harsh parenting style.Parenting style is influenced by parental education and economic status of family.(3)Adolescent suicidal ideation,suicide plan and attempt are related to gender,age,smoking,alcohol use,and internalizing and externalizing problems;multivariate analyses demonstrated that severe harsh parenting of father was associated with suicidal ideation,suicide plan and attempt,while moderate and severe harsh parenting of mother were associated with suicidal ideation,and severe harsh parenting of mother was associated with suicide plan and attempt.(4)Harsh parenting style and emotional and behavioral problems are positively associated with substance use.Harsh parenting style has influence on suicidal behavior directly,and also can influence suicidal behavior indirectly through emotional and behavioral problems and substance use.5.2 Implication(1)Parents should raise awareness of the choice of parenting style,avoiding harsh parenting style like punishment and verbal hostility,etc.(2)Adolescents suicidal behaviors as well as their psychological and behavioral problems deserve more attention.(3)Attention should focus on the mental and behavioral health of the adolescents who are under harsh parenting,and the social support environment should be built for them. |
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