Exploring the profile and risk factors associated with self-harm ideation and behaviors in adolescents with high psychoticism.

Background: As a core personality trait closely linked to mental health outcomes, psychoticism warrants particular attention in adolescent populations. The association between elevated psychoticism levels and self-harm ideation and behaviors (SIB) remained insufficiently characterized, especially regarding specific risk profiles. This study aims to delineate SIB characteristics and identify risk factors among adolescents with high psychoticisme.

Methods: In this large scale cross-sectional study, 6,027 adolescents aged 16-18 years scoring ≥70th percentile on the psychoticism dimension (Revised Short Form of the Eysenck Personality Questionnaire, EPQ-RSC) were recruited from 63 schools. Data on demographic characteristics and SIB patterns were collected via standardized electronic questionnaires through a secure online platform. Binary logistic regression analyses with adjusted odds ratios (aOR) identified significant SIB predictors.

Results: Adolescents with high psychoticism demonstrated striking SIB prevalence patterns: 62.8% reported life meaninglessness, 47.2% expressed death wishes, and 34.7% acknowledged suicidal/NSSI ideation within the past year, with 27% specifically endorsing such ideation within the past month. Actual self-harm rates were 4.7% (lifetime), 1.64% (past year), and 0.37% (past month). Predominant triggers included family conflicts (32.9%), while primary motives centered on pain alleviation (51%). SIB incidence showed significant dose-response relationship with psychoticism severity (p<0.05). Rural residency (aOR=1.32, 95% CI 1.04-1.675) and typical high psychoticism (aOR=1.509, 95% CI 1.16-1.963) emerged as key risk factors. Increasing age conferred significant protection against self-harm ideation (aOR=0.687, 95% CI 0.627-0.753), whereas female sex demonstrated differential risk modulation patterns across SIB (lifetime self-harm behavior aOR=2.053 vs. past-month self-harm ideation aOR=0.648).

Conclusion: Our findings highlight the critical need for targeted interventions addressing modifiable determinants. Prioritizing female adolescents and those with higher psychoticism traits is recommended, supported by evidence-based family psychoeducation programs and enhanced accessibility of community mental health services with specific focus on emotion regulation training.