{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:45:50Z","timestamp":1793727950786,"version":"4.6.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T00:00:00Z","timestamp":1672963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Objective<\/jats:title>\n The purpose of this study was to explore the relationship between academic stress, school bullying and self-harm behaviors among Chinese middle school students and to further explore the impact of anxiety and depression on this relationship.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The students (aged 12\u201316 years) in a middle school in Changsha city were invited to respond to a questionnaire through an online platform. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess the severity of anxiety and depressive symptoms, respectively. The experience of being bullied, academic stress, and self-harm behaviors were assessed using several questions on the basis of previous studies.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 1,313 middle school students completed the study, and 3.40% and 4.10% of them reported suicide attempts (SAs) and non-suicidal self-injury (NSSI), respectively. Univariate logistic regression analysis revealed that anxiety symptoms (OR = 1.23, 95% CI: 1.18\u20131.28; OR = 1.25, 95% CI: 1.19\u20131.31), depressive symptoms (OR = 1.20, 95% CI: 1.16\u20131.25; OR = 1.26, 95% CI: 1.20\u20131.31), school bullying (OR = 3.8, 95% CI: 2.11\u20136.89; OR = 2.76, 95% CI: 1.39\u20135.47), and academic stress (OR = 2.20, 95% CI: 1.27\u20133.80; OR = 3.80, 95% CI: 1.20\u20137.25) were common factors of NSSI and SAs. In addition, depressive symptoms showed a mediating effect on the association of school bullying and academic stress with SAs or NSSI, and anxiety symptoms showed a mediating effect on the association of school bullying and academic stress with NSSI only.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Appropriate strategies are needed to reduce academic pressure and prevent school bullying. Meanwhile, negative emotions such as depression and anxiety should be evaluated and intervened in to prevent self-harm behaviors among middle school students.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2022.1049051","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T12:12:43Z","timestamp":1673007163000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":49,"title":["Influence of academic stress and school bullying on self-harm behaviors among Chinese middle school students: The mediation effect of depression and anxiety"],"prefix":"10.3389","volume":"10","author":[{"given":"Hui","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijuan","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiali","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianliang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusheng","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huajia","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoping","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiansong","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"101883","DOI":"10.1016\/j.ajp.2019.101883","article-title":"Depression and deliberate self-harm among Chinese left-behind adolescents: a dual role of resilience","volume":"48","author":"Xiao","year":"2020","journal-title":"Asian J Psychiatr."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.1016\/j.jaac.2021.03.010","article-title":"Two Pathways to self-harm in adolescence","volume":"60","author":"Uh","year":"2021","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"key":"B3","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1093\/eurpub\/ckaa042","article-title":"Change in prevalence of self-harm from 2002 to 2018 among Norwegian adolescents","volume":"30","author":"T\u00f8rmoen","year":"2020","journal-title":"Eur J Public Health."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e12916","DOI":"10.1097\/MD.0000000000012916","article-title":"Prevalence of nonsuicidal self-injury in Chinese middle school and high school students: a meta-analysis","volume":"97","author":"Lang","year":"2018","journal-title":"Medicine."},{"key":"B5","doi-asserted-by":"publisher","first-page":"561","DOI":"10.30773\/pi.2021.0024","article-title":"Clinical characteristics associated with suicidal attempt and non-suicidal self-injury in Korean adolescents","volume":"18","author":"Lee","year":"2021","journal-title":"Psychiatry Investig."},{"key":"B6","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1016\/S2352-4642(18)30170-6","article-title":"Suicidal behaviour among children and adolescents in China","volume":"2","author":"Chen","year":"2018","journal-title":"Lancet Child Adolesc Health."},{"key":"B7","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1016\/j.jad.2018.12.103","article-title":"Does bullying victimization really influence adolescents' psychosocial problems? 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