Exacerbation Model of Cumulative Adverse Experiences: Prevalence, Characteristics, and Risk Factors of Self-Harm and Suicidality among Chinese Migrant Workers

Tang Jiayi^1,2Mengting Wang¹Wenqian Jian¹Hong Pan¹Xinyu Hu¹Yanlong Liu^1*Li Chen^1,3*Linhui Liu^4*

• ¹Wenzhou Medical University, Wenzhou, China
• ²Cixi Institute of Biomedicine, Wenzhou Medical University, Cixi, China
• ³Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
• ⁴Lishui Second People's Hospital, Lishui, Zhejiang, China

Background: Self-harm and suicidality represent critical public health issues, particularly among migrant workers in China, who often confront adverse living and working conditions. This study aimed to investigate the prevalence and characteristics of self-harm and suicidality, explore the risk factors associated with adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs), and elucidate the relationship models between cumulative risk factors and selfharm and suicidality among Chinese migrant workers.Methods: We conducted a cross-sectional survey involving 2,739 rural-to-urban migrant workers across China. Participants completed a structured questionnaire assessing self-harm, suicidality, ACEs, AAEs, and sociodemographic characteristics. Data analysis involved descriptive statistics, cross-tabulation, independent samples t-tests, logistic regression, and stepwise regression.Results: Among the participants, the prevalence of self-harm and suicidality was 12.6% and 10.4%, respectively. Both ACEs and AAEs showed significant associations with self-harm and suicidality. Individuals reporting ACEs, such as parental divorce, childhood exposure to community violence, and school dropout, as well as AAEs including adult poverty, divorce intention, parentchild conflict, work burnout, and workplace discrimination, exhibited increased tendencies toward self-harm and suicidality. Moreover, a significant positive correlation was found between the cumulative risk index and self-harm and suicidality among Chinese migrant workers, with a critical threshold identified at 4-5 risk factors, indicating an exacerbation model.This study underscores the high prevalence of self-harm and suicidality among Chinese migrant workers, highlighting the significant impact of cumulative ACEs and AAEs on these outcomes. The findings emphasize the necessity for targeted interventions that address the identified risk factors to enhance the mental health and well-being of this vulnerable population.