Associations of suicidal behaviors with body weight and body weight perception in Chinese adolescents: 2007–2022

Purpose: To estimate the time trend in the prevalence of suicidal behaviors including ideation and attempts in Chinese adolescents; to examine the association between suicidal behaviors and overweight (OW)/obesity (OB) and self-perceived weight status. Methods: Data from Youth Risk Behavior Surveys conducted in Ningbo in 2007, 2012, 2017 and 2022 were used for the study. A multistage sampling procedure was used to select respondents aged 12 to 19 years who participated in each survey. Repeated cross-sectional data of anthropometry, weight perception and suicidal behaviors were collected through self-administered questionnaires. A generalized linear model was used to assess associations of ideation and attempts, and weight status and self-perceived weight status. Results: The sample sizes for each survey wave were 937, 889, 1528 and 2655. The prevalence of ideation increased from 11.95% in 2007 to 18.15% in 2022, while the prevalence of attempts remained stable (4.48%-4.26%). An increasing trend in ideation and attempts was found in adolescents who were OW/obese and self-perceived OW/OB from 2007 to 2022. Self-perceived OW/OB adolescents had a significant increase in ideation. Girls had higher likelihood of ideation and attempts for both weight status and self- perceived weight status. While, adolescents aged 12.0-15.9 years had higher odds of ideation than those aged 16.0-19.9 years. Conclusion: Adolescents’ self-weight perception, rather than actual weight status, is a critical risk factor of increased likelihood of ideation and attempts in Chinese adolescents. Our findings can support to promote self-esteem growth in school-based health education programmes for prevention of suicidality and psychological health problems.