Contextual influences on deliberate self-harm among Chinese university undergraduates: A representative nationwide study

Numerous studies have identified factors associated with deliberate self-harm (DSH), but environmental influences have largely been neglected. This study explored regional and university contextual factors that impact DSH among undergraduate students in China.Subjects in this observational cross-sectional study totaled 5016 undergraduate students, who were identified through multistage survey sampling in 22 Chinese universities. Individual-level data were obtained through a self-administered questionnaire, and environmental variables were extracted from the National Bureau of Statistics database. Multilevel logistic regression models were used to examine regional correlates of DSH.The overall prevalence of self-reported DSH in the study sample was 7.5 % (95 % CI: 4.1 %, 10.9 %). The full multilevel logistic model showed university rank and city size were inversely associated with DSH prevalence (Adjusted Odds Ratio (AOR): 0.24 and 0.55). Regional unemployment rates were positively associated with DSH prevalence (AOR: 1.98, 95 % CI: 1.48, 2.65).Contextual disparities appear to contribute to DSH among Chinese undergraduates. Preventive initiatives must focus on redressing imbalances in the allocation of social and economic resources across universities and regions.