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BackgroundAssociations of depressive and anxiety symptoms with non-suicidal self-injury (NSSI) and suicide attempt (SA) are not well understood. We aimed to examine these associations among Chinese adolescents, and whether any potential association is mediated through sleep quality.MethodsWe conducted a cross-sectional study among 1,771 (994 boys [56.1%] and 777 girls [43.9%], mean [SD] age was 12.9 [0.6] years) adolescents who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort (CAHGC) study. Depressive symptoms, anxiety symptoms, NSSI, SA and sleep quality were measured by validated questionnaire. Logistic regression models were employed to estimate the associations of depression and anxiety with NSSI and SA. Mediation analyses were conducted to explore the mediate effect of sleep quality.ResultsThe 12-month prevalence of NSSI and SA was 17.1 and 8.3%, respectively. Depressive and anxiety symptoms were significantly associated with NSSI (the adjusted odds ratio [aOR] was 1.89 [95% CI 1.34–2.65] for depressive symptoms and 2.84 [95% CI 2.05–3.94] for anxiety symptoms) and SA (the aOR was 3.20 [95% CI 2.03–5.05] for depressive symptoms and 2.98 [95% CI 1.84–4.84] for anxiety symptoms). No significant gender differences were found in the associations. The mediation proportion of sleep quality on the association of depressive and anxiety symptoms with NSSI, as well as depressive and anxiety symptoms with SA were 21.1, 13.9, 13.6, and 14.7, respectively.ConclusionIndependent associations of depressive and anxiety symptoms with NSSI and SA were observed in Chinese adolescents, and there were no significant gender differences in the associations. Moreover, these associations were partially mediated through sleep quality. Targeted interventions for adolescents’ NSSI and SA should focus on those who have depressive and anxiety symptoms, and poor sleep quality.

Background: Bullying tends to peak during adolescence, and it is an important risk factor of self-harm and suicide. However, research on the specific effect of different sub-types of bullying is limited.Objective: The purpose of this study is to examine the associations between four common forms of bullying (verbal, physical, relational, and cyber) and self-harm, suicidal ideation (SI), and suicide attempts (SA).Method: This was a cross-sectional study of a sample including 4,241 Chinese students (55.8% boys) aged 11 to 18 years. Bullying involvement, self-harm, SI, and SA were measured via The Juvenile Campus Violence Questionnaire (JCVQ). The association was examined through multinomial logistic regression analysis, adjusted for demographic characteristics and psychological distress.Results: Bullying victimization and perpetration were reported by 18.0 and 10.7% of participants. The prevalence of self-harm, SI, and SA were 11.8, 11.8, and 7.1%, respectively. Relational bullying victimization and perpetration were significantly associated with SI only, SI plus self-harm, and SA. Physical bullying victimization and perpetration were risk factors of self-harm only and SA. Verbal victimization was significantly associated with SI only. Cyber perpetration was a risk factor of SA.Conclusions: The findings highlight the different effects of sub-types of bullying on self-harm and suicidal risk. Anti-bullying intervention and suicide prevention efforts should be prior to adolescents who are involved in physical and relational bullying.

Sibling bullying is a common phenomenon in childhood and adolescence worldwide and has a significant association with mental health distress. However, there have been few studies that have examined the associations between any specific sub-type of sibling bullying and depression as well as anxiety. Besides, the association between sibling bullying and psychological well-being was never explored among the Chinese population. The purpose of this cross-sectional study was to examine the associations between the number of sub-types of sibling bullying involvement and depression as well as anxiety among Chinese children and adolescents. Multi-stage stratified cluster sampling was used to recruit 5,926 participants aged 10 to 18 who had at least one sibling living in the household. Different sub-types of sibling bullying involvement were determined by using Olweus Bully/Victim Questionnaire (OBVQ). The nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder Scale (GAD-7) were used to screen clinical ranges of major depression and generalized anxiety disorder, respectively. Of the participants, 1,235 (20.8%) were bullied by siblings, and 1,230 (20.8%) perpetrated bullying behavior against siblings over the past 6 months. After controlling potential confounders, adjusted model of logistic regression analyses indicated that all three sub-types of sibling victimization and perpetration were significantly associated with both depression and anxiety. There were linear associations between the number of sub-types of sibling bullying victimization and depression (adjusted OR = 1.49, 95% CI 1.32 to 1.68) as well as anxiety (adjusted OR = 1.68, 95% CI 1.48 to 1.90). Besides, linear trends were found between the number of sub-types of sibling bullying perpetration and depression (adjusted OR = 1.44, 95% CI 1.26 to 1.64) as well as anxiety (adjusted OR = 1.63, 95% CI 1.42 to 1.87). The findings underline dose–response relationships between the number of sub-types of sibling bullying involvement and mental health distress. Intervention programs should be conducted to focus on developing mental health status of those children and adolescents who are involved in multiple sub-types of sibling victimization or perpetration.