Previous studies have demonstrated the link between individual unhealthy behaviors and self-harm, but little is known about the influence of multiple unhealthy behaviors on self-harm among adolescents. This study aims to identify the potential patterns of unhealthy behaviors and to examine their associations with self-harm, which may become a useful tool for the screening of self-harm in adolescents. A total of 22,628 middle school students (10,990 males and 11,638 females) in six cities was enrolled in this study by multistage stratified cluster sampling from November 2015 to January 2016. Latent class analysis (LCA) was performed based on five kinds of unhealthy behaviors (unhealthy losing weight (ULW), tobacco use (TU), alcohol use (AU), screen time (ST), and mobile phone dependence (MPD)). Multivariate logistic regressions were used to examine associations between identified subgroups and self-harm. Four subgroups of unhealthy behaviors were identified. Class 1 (71.2%) had the lowest engagement in unhealthy behaviors. Class 2 ((ULW/MPD), 22.3%) had a relatively high prevalence of ULW and MPD. Class 3 ((TU/AU/ST), 3.2%) had a relatively high prevalence of TU, AU, and ST. Class 4 (3.3%) consistently engaged in unhealthy behaviors. Compared to class 1, class 2 (ULW/MPD), class 3 (TU/AU/ST), and class 4 showed OR (95%CI) values of 2.101 (1.964–2.248), 2.153 (1.839–2.520), and 3.979 (3.407–4.645) (p < 0.001 for each), respectively. Class 1, class 2 (ULW/MPD), and class 3 (TU/AU/ST) engagement in unhealthy behaviors was associated with increased self-harm. These findings strongly suggested that self-harm prevention efforts focusing on multiple unhealthy behaviors should be seriously considered for early detection of self-harm.
Latent Class Analysis of Self-directed Violence and Indirect Self-harm Behaviors