Citation

Zhu S, Lee PH, Wong PWC. BJPsych Open 2021; 7(3).

Copyright

(Copyright © 2021, Royal College of Psychiatrists)

DOI

10.1192/bjo.2021.47

PMID

unavailable

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. Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Language: en

Keywords

adult; human; mental health; female; male; China; suicidal ideation; prevalence; Self-harm; suicide attempt; suicidal behavior; hope; suicidal behaviour; risk factor; major clinical study; controlled study; psychological aspect; distress syndrome; automutilation; self concept; cross-sectional study; demography; Chinese; Article; university student; random sample; psychological well-being; Depression, Anxiety and Stress Scale-21; attitude toward seeking professional help assessment; flourishing scale; hikikomori; mindset of depression, anxiety and stress scale; prolonged social withdrawal behaviour; purpose in life test short form