Adverse childhood experiences, unhealthy lifestyle, and nonsuicidal self-injury: findings from six universities in Shaanxi province, China

Background: Nonsuicidal self-injury (NSSI) is a serious public health problem. The role of adverse childhood experiences (ACEs) and lifestyle on the risk for NSSI is still underexplored, especially among college students. We aimed to investigate the association of ACEs with the risk of NSSI, and effect modifications by lifestyle among college students. Methods: A total of 18,723 college students from six universities were recruited through a multistage, random cluster sampling method in Shaanxi province, China. The Adverse Childhood Experiences International Questionnaire was used to assess ACEs for each participant, and the Chinese version of the Ottawa Self-injury Inventory was used to assess the presence or absence of NSSI behaviors. Information about lifestyle was collected by a self-designed questionnaire. The associations of NSSI with ACEs and lifestyle were analyzed using logistic regression models. Furthermore, we constructed a combination score of multiple lifestyles and evaluated whether lifestyle modified the effect of ACEs on the risk of NSSI. Results: The prevalence of NSSI for the past 1 month, 6 months, and 12 months was 3.8, 5.3, and 6.5%, respectively. 82.6% of participants have reported experiencing at least one type of ACEs, and participants with higher levels of ACEs (≥4) were more likely to have higher odds of developing NSSI during the past 1 month (OR, 4.10; 95%CI, 3.38–4.97), 6 months (OR, 4.76; 95%CI, 4.03–5.62), and 12 months (OR, 5.62; 95%CI, 4.83–6.55), as compared with participants with low levels of ACEs (0–1). There were additive interactions between ACEs and lifestyle. Compared with participants with low levels of ACEs and healthy lifestyle, participants with high levels of ACEs and unhealthy lifestyle had the highest odds of NSSI during the past 1 month (OR, 5.56; 95%CI, 3.80–8.31), 6 months (OR, 6.62; 95%CI, 4.73–9.42), and 12 months (OR, 7.62; 95%CI, 5.59–10.52). Conclusion: These results suggest that ACEs play an important role in the occurrence of NSSI among college students, especially in those with unhealthy lifestyle. Our findings may help develop targeted intervention strategies for the prevention of NSSI.