INTRODUCTION: The rising rate of adolescent suicide, and the burden of self-harm and mental health disorders, pose significant threats to Singapore's future health outcomes and human potential. This study sought to examine the risk profile and healthcare utilisation patterns of Singaporean adolescents who presented to the emergency department (ED) for suicidal or self-harm behaviour. METHOD: A retrospective review of medical records for patients aged 10 to 19 years who visited Singapore's KK Women's and Children's Hospital ED for suicidal or self-harm attempts from January to December 2021 was conducted. RESULTS: A total of 221 patients were identified, with a predominance of female patients (85.5%) over males (14.5%). The mean age was 14.2 ± 1.4 years. Intentional drug overdose (52.0%) was the most commonly used method. Significantly more females presented for intentional paracetamol overdose (46.6% versus [vs] 28.1%, P=0.049), whereas jumping from a height was more common among males (18.8% vs 5.8%, P=0.022). The most frequently observed mental health challenges were stress-related and emotional coping difficulties (50.7%), followed by mood and anxiety symptoms (53.4%). A history of self-harm and suicidal behaviours were the most common psychosocial risk factors. Within the year prior to their ED presentation, 15.4% had accessed healthcare services for mild medical ailments, 19.5% for medically unexplained symptoms, and 17.2% for previous self-harm or suicide attempts. CONCLUSION Most cases involved psychosocial and emotional regulation difficulties, some of which displayed sex-specific patterns, rather than complex psychiatric disorders. The identified predictive factors can help inform Singapore's National Mental Health and Well-being Strategy, to guide targeted and transdiagnostic interventions in schools and community settings.
Humans ; Adolescent ; Singapore/epidemiology* ; Female ; Male ; Suicide, Attempted/psychology* ; Emergency Service, Hospital/statistics & numerical data* ; Self-Injurious Behavior/psychology* ; Retrospective Studies ; Child ; Young Adult ; Drug Overdose/epidemiology* ; Risk Factors ; Acetaminophen/poisoning* ; Patient Acceptance of Health Care/statistics & numerical data* ; Sex Factors

BACKGROUND AND OBJECTIVE: Social anxiety arising from intensive social media usage (SMU) among adolescents and youth has gained extensive attention in recent years due to its negative influence on mental health and academic performance. In spite of that, there is a dearth regarding the etiology of SMU-related social anxiety. This study aims to further clarify the influence of introversion personality on SMU-related social anxiety and the mechanism underlying such an association and provide a new perspective for developing effective intervention strategies for the highly prevailing SMU-related anxiety among Chinese college students. METHODS: A cohort of 979 college students (266 males and 713 females) aged 20.90 ± 1.91 years was enrolled in this cross-sectional study. Four measures including the "extroversion" domain of Eysenck Personality Questionnaire Revised, Short Scale (EPQ-R-S E), Interaction Anxiousness Scale (IAS), Mobile Phone Addiction Index (MPAI), and Social Anxiety Scale for Social Media Users (SAS-SMU) were used to evaluate the influence of introversion personality on SMU-related social anxiety that was potentially mediated sequentially by interaction anxiousness and mobile phone addiction. Hayes PROCESS was used for correlation and mediation analysis. RESULTS: Interaction anxiousness (indirect effect = -1.331, 95% CI : -1.559 - -1.122) partially mediated the association between introversion personality and SMU-related social anxiety. Besides, a sequential mediation of interaction anxiousness and mobile phone addiction in the link between introversion personality and SMU-related social anxiety was revealed (indirect effect = -0.308, 95% CI : -0.404 - -0.220). No significant mediating effect was found with mobile phone addiction in the association between introversion personality and SMU-related social anxiety. CONCLUSION: Targeting interaction anxiousness and mobile phone addiction may represent an efficient strategy alleviating SMU-related social anxiety among Chinese college students with introversion personality.
Humans ; Male ; Female ; Social Media ; Students/psychology* ; Anxiety/psychology* ; Young Adult ; Cross-Sectional Studies ; Universities ; Behavior, Addictive/psychology* ; Cell Phone ; Adolescent ; Introversion, Psychological ; China ; Surveys and Questionnaires ; Internet Addiction Disorder/psychology*

BACKGROUND: Changes in socioeconomic inequalities in health behaviours following the COVID-19 pandemic remain unknown, particularly among Japanese school-aged adolescents. Therefore, in this study, we examined changes in socioeconomic inequalities in school-aged adolescents' health behaviours, including physical activity (PA), screen time (ST), sleep duration, breakfast consumption, and bowel movement frequency, before and after the pandemic. METHODS: This three-wave repeated cross-sectional study utilised data from the 2019, 2021, and 2023 National Sports-Life Survey of Children and Young People in Japan, analysing data from 766, 725, and 604 participants aged 12-18 years, respectively. Favourable health behaviours were defined as moderate-to-vigorous PA of ≥60 min/day, ST <2 h/day, sleep duration of 8-10 h, daily breakfast consumption, and bowel movements at least every 3 days. Absolute and relative socioeconomic inequalities were quantified using the slope index of inequality (SII) and the relative index of inequality (RII). Temporal changes were analysed using quadratic trend analyses, employing interaction terms between socioeconomic status and survey year. RESULTS: Significant quadratic trends indicated that socioeconomic inequalities in breakfast consumption decreased substantially from 2019 (SII: 20.7%, RII: 5.09) to 2021 (SII: -0.1%, RII: 0.95) but resurged in 2023 (SII: 16.2%, RII: 3.70). This resurgence may have been primarily driven by changes among those in the moderately low-income (poverty level II) and higher-income groups, which had a breakfast consumption rate of 81.0, 87.0, and 76.4% in 2019, 2021, and 2023, and 88.7, 82.1, and 87.5%, respectively. Among low-income households, adherence to PA recommendations significantly declined from 18.6% to 5.3%, and ST adherence worsened over the study period. No significant inequalities or trends were observed for sleep duration or bowel movement frequency across survey years. CONCLUSIONS Socioeconomic disparities in breakfast consumption among Japanese school-aged adolescents resurfaced after initially narrowing during the pandemic, likely driven by changes in moderately low-income and higher-income groups. Among low-income households, adherence to PA and ST guidelines declined over time. However, at the population level, socioeconomic inequalities in PA did not exhibit a consistent trend of widening or narrowing. This study highlights the need for sustained public health initiatives to address these socioeconomic disparities.
Adolescent ; Child ; Female ; Humans ; Male ; Breakfast ; COVID-19/psychology* ; Cross-Sectional Studies ; Exercise ; Health Behavior ; Japan/epidemiology* ; Screen Time ; Sleep ; Socioeconomic Factors ; East Asian People

BACKGROUND: Long screen time hours may be associated with behavioral problems in children. To better understand the relationship between children's behavioral problems and screen time, it the associated risk factors must be subdivided based on the purpose underlying screen use. This study examined the relationship between screen time based on intended usage and behavioral problems in Japan. METHODS: This study included 3,332 children aged between 7-17 years from the Hokkaido Study on Environment and Children's Health. From October 2020 to October 2021, the children and their parents answered questionnaires on the children's screen use duration (never used, <30 min, ≥30 min & <1 hour, ≥1 h & <2 h, ≥2 h) based on seven intended usage categories: watching television/video, video gaming, reading books/comics, sending/receiving e-mail/messages, browsing/posting on social networking services, studying for classes/homework, drawing/editing pictures/photos/videos, along with the Strengths and Difficulties Questionnaire (SDQ). Logistic regression was used to analyze the association between screen time, purpose of children's screen use, and behavioral problems across the 13 SDQ total scores. RESULTS: The mean ± standard deviation age of the participants was 12.4 ± 2.4-years-old, 487 (14.6%) children were determined to have behavioral problems, and the duration of screen time increased with their age. The children's primary purposes for screen use were watching television/video, video gaming, sending/receiving e-mail/messages, and browsing/posting on social networking services. Children who reported playing video games for ≥2 hours on weekdays had higher odds of problematic total difficulties scores than never user (Odds Ratio: 2.10, 95% confidence interval: 1.45-3.06). CONCLUSION Long video gaming screen time is associated with behavioral issues, hyperactivity/inattention, and prosocial behaviors in children. Conversely, watching television and videos for 30 min-1 h per day, using e-mail or messaging, and using social networking services were significantly association with reduced odds ratio for peer relationship problems as compared to children who never engaged in these activities. Longitudinal follow-up is needed to further examine screen time and problem behaviors.
Humans ; Screen Time ; Child ; Japan/epidemiology* ; Male ; Female ; Adolescent ; Problem Behavior/psychology* ; Surveys and Questionnaires ; Child Behavior ; Television/statistics & numerical data* ; Video Games/statistics & numerical data*

OBJECTIVES: Non-suicidal self-injury (NSSI) is a common mental health and behavioral issue among adolescents. This study aims to investigate the developmental trajectory of adolescent NSSI and gender differences, providing a foundation for better prevention and intervention. METHODS: A longitudinal study was conducted using the Adolescent Self-Injury Scale (ASIS) in a cohort of 1 042 junior high school students from 3 middle schools in Zhangjiajie, Hunan Province. Participants were surveyed 3 times at 6-month intervals. A latent growth curve model was constructed using Mplus8.0 to examine the development trajectory of NSSI, and multi-group comparisons were used to assess gender differences. RESULTS: Detection rates of NSSI at the 3 time points were 43.95%, 44.43%, and 38.36%, respectively. Mean of the intercept factor of the LGCM for adolescent NSSI behavior was 9.540 (P<0.001), and the mean slope was -2.297 (P<0.001). Both the variances of the intercept (σ²=169.431, P<0.001) and slope (σ²=141.981, P<0.001) were significant, with a significant negative correlation between intercept and slope (r=-0.559, P<0.001). There were no statistically significant gender differences in initial level or rate of change of NSSI behaviors (P>0.05). CONCLUSIONS NSSI is relatively prevalent among adolescents, with female adolescents experiencing more severe NSSI. Individual differences exist in both the initial level and rate of change of NSSI, and overall, adolescent NSSI shows a decreasing trend over time. No significant gender differences were found in the trajectory of change.
Humans ; Self-Injurious Behavior/psychology* ; Adolescent ; Male ; Female ; Longitudinal Studies ; Sex Factors ; Adolescent Behavior/psychology* ; China/epidemiology* ; Surveys and Questionnaires ; Students/psychology*

INTRODUCTION: The understanding of gender dysphoria (GD) in children and adolescents is limited in Singapore. This study aims to review the presentation of GD in an outpatient psychiatric clinic, to gain insights into its prevalence and associated factors. METHOD: We conducted a retrospective review of medical records for patients diagnosed with GD according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth and Fifth editions, at the clinic between 1 January 2017 and 31 December 2021. We collected and analysed demographic, medical and other GD-specific clinical variables. RESULTS: The study included 107 participants (mean age 16.6 years), comprising 47 natal males and 60 natal females. The prevalence of GD was found to be 1:5434 (0.019%). Incidence rates increased from 2.17 to 5.85 per 100,000 population between 2017 and 2021. The mean age of diagnosis was 15.6 years, with an average delay of 5 years between experiencing gender identity-related concerns and seeking formal assistance. Approximately 45% of participants reported social and physical transitions, and 20.6% reported self-harm or suicidal thoughts. CONCLUSION The study highlights the presentation of GD in an under-researched Asian setting. Supporting individuals with GD in Asia requires sensitivity to cultural and societal factors with a holistic approach to individual well-being.
Humans ; Singapore/epidemiology* ; Adolescent ; Gender Dysphoria/psychology* ; Retrospective Studies ; Female ; Male ; Suicidal Ideation ; Child ; Prevalence ; Incidence ; Self-Injurious Behavior/psychology*

OBJECTIVES: To investigate the interaction between catechol-O-methyltransferase (COMT) gene polymorphisms and childhood trauma in adolescents with non-suicidal self-injury (NSSI), and to provide a basis for the prevention and intervention of NSSI among adolescents. METHODS: A total of 84 adolescents with NSSI and 87 healthy controls were enrolled in this study. Oral saliva samples were collected for genotyping of the COMT gene at rs4680 and rs165599. Childhood Trauma Questionnaire, Behavioral Function Assessment Scale of Non-suicidal Self-injury in Adolescents, and Patient Health Questionnaire-9 Items were used for mental health assessment. A hierarchical linear regression analysis was used to examine the main effect and interactive effect of COMT gene polymorphisms at rs4680 and rs165599 and childhood trauma on NSSI. The Johnson-Neyman technique was used to identify the regions where the moderating variables had a significant impact. RESULTS: The interaction between COMT gene polymorphisms at rs165599 and the subtype of emotional neglect in childhood trauma could predict NSSI in adolescents (β=0.251, t=2.329, P=0.022). As for the adolescents carrying the G/G genotype at rs165599, the high emotional neglect group had a significantly higher NSSI score than the low emotional neglect group (F=4.579, P=0.049). CONCLUSIONS Adolescents carrying the G/G genotype at rs165599 of the COMT gene may have an increase in susceptibility to NSSI in case of high emotional neglect in childhood.
Humans ; Catechol O-Methyltransferase/genetics* ; Adolescent ; Male ; Female ; Self-Injurious Behavior/psychology* ; Polymorphism, Single Nucleotide ; Child ; Polymorphism, Genetic

OBJECTIVES: Adolescents are at high risk of non-suicidal self-injury (NSSI). Currently, there is no clinical assessment tool for adolescent NSSI behaviors measurement with global consistency. The Ottawa Self-injury Inventory (OSI) is considered as a relatively comprehensive assessment tool for NSSI, but the questionnaire is discussed with excessive content and timecostly, which may affect the reliability of the measurement results for adolescent.Thus, this study, based on OSI, aims to revise the assessment tool for adolescent with NSSI that is suitable for both clinically and scientifically, referring to the diagnostic criteria for NSSI in the 5th Diagnostic and Statistical Manual of Mental Disorder (DSM-5). METHODS: This study was led by the Second Xiangya Hospital of Central South University and collaborated with 6 mental health service institutions in China from August to December 2020. Adolescent aged from 12 to 24 years old who had self-injury behavior and met the DSM-5 diagnostic criteria for NSSI were continuously recruited in the psychiatric outpatient department or ward. After clinical diagnosis by an experienced attending psychiatrist or above, the general information and OSI were collected by questionnaires. SPSS 24.0 and AMOS structural equation model statistical softwares were used to conduct item analysis and exploratory factor analysis on the obtained data to complete the revision of the scale. Cronbach's alpha coefficient, split-half reliability, test-retest reliability, and content validity and structure validity were performed to analyze the reliability and validity and confirmatory factor analysis was carried out to test the structure validity for the revised scale. RESULTS: A total of 234 adolescent with NSSI were enrolled, including 33 (14.1%) males and 201 (85.9%) females with the mean age of (16.2±2.6) years old. The most common clinical diagnoses were depression disorder (57.4%), bipolar disorder (20.9%), adolescent mood disorder (17.1%), etc. Nine items (item 2, 7, 11, 13, 23, 24, 10, 17, 18) in the functional scale of OSI were deleted according to extreme grouping method, correlation analysis, and principal component analysis in exploratory factor analysis. The revised functional scale for NSSI consisted of 15 items. The reliability analysis showed that the Cronbach's alpha coefficients of NSSI thought and behavior frequency, addiction characteristics, and function scales were 0.799, 0.798, and 0.835, respectively, and the split-half coefficients were 0.714, 0.727, and 0.852, respectively. The test-retest coefficients of the latter 2 scales were 0.466 and 0.560, respectively. The correlation coefficient between sub-items and total scores in each part of the scale showed good content validity. The exploratory factor analysis showed that a component was extracted from the frequency of thoughts and behaviors of NSSI, one component was extracted from the addictive characteristics, and three components were extracted from the functional part. The three functional subscales were social influence, external emotion regulation, and internal emotion regulation. The factor load of each item was >0.400. CONCLUSIONS The revised Chinese version OSI targeted the adolescent patients with mental disorders has relatively ideal reliability and validity. The scale shows high stability, dependability, and a reasonable degree of fit. It is a suitable assessment tool for clinical and scientific research on adolescent with NSSI.
Adolescent ; Adult ; Child ; Factor Analysis, Statistical ; Female ; Humans ; Male ; Mental Disorders/diagnosis* ; Psychometrics/methods* ; Reproducibility of Results ; Self-Injurious Behavior/psychology* ; Surveys and Questionnaires ; Young Adult

OBJECTIVES: To investigate the differences in non-suicidal self-injury (NSSI) behaviors between only-child and non-only-child adolescents with mood disorders. METHODS: A three-stage sampling method was used to perform a cross-sectional survey of 529 adolescents, aged 12-18 years, who had mood disorders and NSSI behaviors. These adolescents were sampled from the outpatient service of 20 mental hospitals in 9 provinces of China from August to November 2020. A self-made questionnaire was used to collect general demographic data. The Functional Assessment of Self-Mutilation, Beck Scale for Suicide Ideation, Kessler Psychological Distress Scale, Stress Mindset Measure-General, Multidimensional Scale of Perceived Social Support, Multidimensional Students' Life Satisfaction Scales, and Rosenberg Self-Esteem Scale were used to collect the information on self-injury behaviors and psychological factors in these adolescents. RESULTS: A total of 529 adolescents with mood disorders and NSSI behaviors were surveyed, among whom 375 were only-child adolescents and 154 were non-only-child adolescents. Compared with the non-only-child group, the only-child group had a significantly higher total score of Functional Assessment of Self-Mutilation (P<0.05) .The type and frequency of self-injury in the only-child group were significantly higher than those in the non-only-child group (P<0.05). Psychological analysis showed that compared with the non-only-child group, the only-child group had a significantly lower score of self-esteem (P<0.05) and significantly higher scores of psychological distress and depressive symptoms (P<0.05). The multiple linear regression analysis showed that the score of suicidal ideation was positively correlated with the frequency of NSSI behaviors in both only-child and non-only-child adolescents with mood disorders (P<0.05); in the only-child adolescents, the level of self-esteem was negatively correlated with the frequency of NSSI behaviors (P<0.05), and the score of stress perception was positively correlated with the frequency of NSSI behaviors (P<0.05); in the non-only-child adolescents, the score of anxious emotion was positively correlated with the frequency of NSSI behaviors (P<0.05). CONCLUSIONS Among the adolescents with mood disorders and NSSI behaviors, the only-child adolescents tend to have a higher frequency of self-injury and poorer mental health, and therefore, the only-child adolescents with mood disorders and NSSI behaviors need more attention.
Adolescent ; Cross-Sectional Studies ; Humans ; Mood Disorders ; Risk Factors ; Self Mutilation ; Self-Injurious Behavior/psychology* ; Suicide, Attempted/psychology*

BACKGROUND: Suicidal behaviors are seriously social issues among adolescents in the world. Exposed to smoking and being bullied are risk factors of suicidal behaviors. The present study was aimed to examine the interaction of smoking and being bullied on suicidal behaviors among Chinese adolescents. METHODS: A total of 18,900 students were involved in the questionnaire study, in four cities of China from November 2017 to January 2018. Suicidal behaviors, smoking, and being bullied were measured by self-reported validated instruments. Chi-square tests and logistic regression were used to analyze the associations of suicidal ideation (SI)/suicidal plan (SP)/suicidal attempt (SA), smoking, and being bullied. RESULTS: The prevalence of smoking, being bullied, SI/SP/SA, were 3.1%, 20.6%, 26.4%, 13.2%, and 5.2% respectively. Interaction analysis indicated that being bullied was associated with a greater increase in the likelihood of suicidal behaviors for adolescents with smoking than for those without smoking. CONCLUSIONS These finding suggest that smoking exacerbates the association between being bullied and suicidal behaviors. Future research should explore how and why smoking appears to more bully-victims than for those without smoking and how to mitigate it.
Adolescent ; Adolescent Behavior/psychology* ; Bullying/psychology* ; Child ; China/epidemiology* ; Cross-Sectional Studies ; Humans ; Prevalence ; Smoking/psychology* ; Students/statistics & numerical data* ; Suicidal Ideation