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| Association between depressive and anxiety symptoms and suicidal ideation or behaviors among middle school students |
| LI Chen1, WANG Yong1, YU Mingfang1, ZHENG Tian1, WANG Meng2
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1. Jiashan County Center for Disease Control and Prevention (Jiashan County Institute of Public Health Supervision), Jiashan, Zhejiang 314100, China;
2. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China |
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Abstract Objective To analyze the association between depressive and anxiety symptoms and suicidal ideation or behavior among middle school students, so as to provide the evidence for mental health promotion in this population. Methods From April to May 2022, a multistage stratified random cluster sampling method was used to select students from 9 middle schools in Jiashan County, Zhejiang Province as survey participants. Data on sex, age, self-reported academic performance, self-reported health status, and suicidal ideation or behavior were collected through a questionnaire survey. The Patient Health Questionnaire?9 and the Generalized Anxiety Disorder-7 were used to assess depressive symptoms and anxiety symptoms, respectively. Multivariable logistic regression model was used to analyze the association between depressive and anxiety symptoms and suicidal ideation or behavior among middle school students. Results A total of 915 middle school students were surveyed, including 484 boys (52.90%) and 431 girls (47.10%). The median age was 15.00 (interquartile range, 3.00) years. Depressive symptoms were detected in 268 students, with a detection rate of 29.29%. Anxiety symptoms were detected in 188 students, with a detection rate of 20.55%. Among them, 114 students (12.46%) had depressive symptoms only, 34 students (3.72%) had anxiety symptoms only, and 154 students (16.83%) had both depressive and anxiety symptoms. Suicidal ideation or behavior was detected in 266 students, with a detection rate of 29.07%. The results of multivariable logistic regression analysis showed that, after adjusting for sex, self-reported academic performance, and self-reported health status, students with depressive symptoms only (OR=5.277, 95%CI: 3.342-8.333) and those with both depressive and anxiety symptoms (OR=9.663, 95%CI: 6.165-15.145) had a higher likelihood of suicidal ideation or behavior. Conclusion Both depressive symptoms only and the coexistence of depressive and anxiety symptoms can increase the risk of suicidal ideation or behavior among middle school students.
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Received: 13 February 2026
Revised: 08 June 2026
Published: 22 June 2026
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