Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours.
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ABSTRACT: Background
Self-harm and suicidal behaviour are recognised as public health concerns. Prolonged social withdrawal behaviour, or hikikomori, is reported as a risk factor for suicidal behaviour.Aims
To examine the occurrence and additional risk of prolonged social withdrawal behaviour on self-harm and suicidal behaviour among Chinese university students.Method
A cross-sectional online survey was conducted with three universities in southern China. A two-stage random sampling was adopted for recruitment, with students in different years of study, in different departments of each participating university. Hierarchical logistic regression analyses were conducted to investigate the sociodemographic and psychological correlates of self-harm and suicidal behaviours among male and female participants with hikikomori status.Results
Of the students who completed the online survey, 1735 (72.23%) were included in the analysis; 11.5% (n = 200) reported self-harm behaviour and 11.8% (n = 204) reported suicidal behaviours in the past 12 months. Men showed a higher prevalence rate of self-harm than women (14.7% v. 10.8%, P = 0.048), but a similar rate of suicidal behaviours (11.9% v. 11.3%, P = 0.78). The overall prevalence rate of social withdrawal behaviour was 3.2% (7.0% for men and 2.3% for women, P < 0.001). Prolonged social withdrawal behaviour status was significantly associated with self-harm (odds ratio 2.00, 95% CI 1.22-3.29) and suicidal behaviour (odds ratio 2.35, 95% CI 1.45-3.81). However, the associations became statistically insignificant after adjustment for psychological factors in the final models in the logistic regression analyses.Conclusions
Prolonged social withdrawal behaviour appears to be associated with self-harm and suicidal behaviour, but psychological factors have stronger links with suicidality.
SUBMITTER: Zhu S
PROVIDER: S-EPMC8142544 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background Suicide is the second leading cause of death among young people worldwide and remains a major public health concern. Research indicates that negative social contexts involving familial and peer relationships, have far-reaching influences on levels of suicidal behaviours in later life. Previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent self-harm or suicidality. However, the association between adolescent experiences of humiliation and shame, and subsequent self-harm or suicidal behaviour among children and young adults has not been well examined. As such, this systematic review is conducted to examine the prevalence and association between humiliation and shame and self-harm, suicidal ideation, and death by suicide among adolescents and young adults. Methods A systematic literature search in extant electronic databases including; MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase will be conducted to identify potential studies. Google Scholar, and the reference list of the retrieved articles and/or previous systematic reviews in this area, will also be scanned to identify further potential studies. ProQuest will be searched to identify relevant studies available within grey literature. There are no restrictions on the date of publications. Based on our initial review, the following terms were identified: Population: Adolescent (MESH), young adult (MESH), teen, teenage. Exposure: Humiliation, degradation, shame (MESH) or embarrassment (MESH), harassment victimisation, abasement. Outcome: Self-injurious behaviour (MESH), suicide (MESH), suicide attempted (MESH), suicide completed (MESH), self-harm, intentional self-injury, deliberate self-harm, overdose, deliberate self-poisoning, non-suicidal self-injury, self-mutilation, suicidal thought, suicidal ideation, suicidal intent, suicide. At least one term from each category will be used for conducting the literature search. All original quantitative studies published in the English language which examined the prevalence or association between humiliation or shame and self-harm and/or suicidal ideation and/or completed suicide will be included. The studies will be assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Narrative synthesis will be performed for all of the studies. If the studies are sufficiently homogenous, the results will be pooled for a meta-analysis. This systematic review protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) guidelines. The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843]. Discussion This is the first review to synthesise evidence on the prevalence of, and associations between the experiences of humiliation and shame and subsequent self-harm and/or suicidal behaviours among adolescents and young adults. As there is growing evidence on increased self-harm among this age group, it is important to identify population-specific risk factors for self-harm and suicidality which will have significance in formulating tailored and effective treatment and therapeutic services for adolescents and young adults.
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Project description:IntroductionSchools have an important role in recognising and preventing self-harm and suicidal behaviour in their students, however little is known about which educational factors are associated with heightened risk. We will systematically review the existing evidence on two key educational performance indicators that are routinely collected by school administrative systems: school attendance and exclusion. We will investigate their association with self-harm and suicidal behaviour in school-age children and adolescents. Knowledge of this association could help inform suicide prevention strategies at clinical, school and population levels.Methods and analysisWe will conduct a systematic search of Medline, EMBASE, PsycINFO, British Education Index and Education Resources Information Centre (ERIC) from 1 January 1990, and conduct a manual search for additional references. We aim to identify studies that explore the association between poor school attendance or exclusion and self-harm or suicidal behaviours in school-age children and adolescents. Two independent reviewers will screen titles, abstracts and full-text documents and independently extract relevant data for analysis. Study quality will be assessed using a modified Newcastle-Ottawa Scale. A descriptive analysis will be performed, and where appropriate, results will be combined in meta-analyses.Ethics and disseminationThis is a systematic review of published literature, and therefore ethical approval will not be sought. We will publish reports in health and education journals, present our work at conferences focused on school mental health and communicate our findings to practitioners and managers in public health, education and child mental health.Prospero registration numberCRD42018088608.
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