A network analysis of risk and protective factors for suicidality among Chinese early adolescents: Based on a social-ecological perspective

Abstract Background Early adolescence is a period with the sharp increase in suicidality, especially in China. Understanding risk factors for suicidality in this critical period is a priority to inform suicide intervention strategies. This study aimed to explore a broad range of risk and protective factors for suicidality among Chinese early adolescents based on the ideation-to-action framework from the social ecology perspective. Methods A stratified random cluster sampling approach was used to select 5,724 middle school students in Anhui Province, China, in November 2020. We used network analysis to examine the potential associations between putative correlates (sex, academic performance, serious physical illness/disability, history of self-harm, depression, impulsivity, sleep problems, resilience, family economic status, relationship with mother, relationship with father, family violence, childhood abuse, parental mental illness, relationship with teachers, relationship with classmates, school bullying victimization and perpetration, social support, satisfaction with society) and suicidal ideation, plans, and attempts. Results In the sample, 37.9%, 19.0%, and 5.5% of students reported suicidal ideation, plans, and attempts, respectively. The estimated network revealed that suicidal ideation, plans, and attempts were all significantly associated with individual- (history of self-harm, sleep problems), family- (childhood abuse), and school-level (school bullying victimization) factors. Based on centrality analysis, the most influential nodes in the network were childhood abuse and depression. Notably, the network results showed unique correlates of suicidal ideation (sex, impulsivity, family violence, relationship with teachers, school bullying perpetration), plans (social support), and attempts (relationship with mother, parental mental illness). Conclusions This study findings have important implications for suicide prevention in Chinese early adolescents: 1) focusing on the key risk factors for suicidality in the network; 2) separately exploring risk and protective factors for specific suicidality; and 3) highlighting the importance of joint interventions across multiple sectors when developing suicide intervention strategies.