Summary
This cross-sectional study of 1,313 Chinese middle school students explored pathways linking academic stress and school bullying to self-harm behaviours, with depression and anxiety as potential mediators. Both depressive and anxiety symptoms were associated with increased odds of self-injury and suicide attempts; depression partially mediated associations for both bullying and academic stress with self-harm outcomes, whilst anxiety mediated effects on non-suicidal self-injury only. The findings suggest that reducing academic pressure and school bullying, alongside screening for and intervention on mood symptoms, may reduce self-harm risk in this population.
UK applicability
Whilst the study was conducted in a Chinese middle school context, the underlying relationships between academic stress, bullying, and self-harm are likely relevant to UK adolescent mental health. However, differences in educational systems, cultural stressors, and mental health service availability mean direct translation of findings requires caution; UK-specific research would strengthen evidence for local policy and prevention.
Key measures
Patient Health Questionnaire-9 (PHQ-9) for depression severity; Generalized Anxiety Disorder-7 (GAD-7) for anxiety severity; self-reported measures of bullying experience, academic stress, suicide attempts, and non-suicidal self-injury (NSSI); odds ratios (OR) with 95% confidence intervals
Outcomes reported
The study measured prevalence of suicide attempts (3.40%) and non-suicidal self-injury (4.10%) among middle school students, and examined associations with academic stress, school bullying, depression, and anxiety symptoms.
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