Prevalence and School-Related Factors Associated With Depression and Self-Harm in Children Aged 9 to 10 Years

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This study aimed to determine the prevalence of depression and self-harm among children aged 9–10 years in China and identify associated school-related risk factors. Methods A large-scale cross-sectional study was conducted from September to December 2020 in Chongqing, China. A total of 22,266 children in grades 3–5 completed an online questionnaire. Depression symptoms were assessed using the Children’s Depression Inventory (CDI), with a cutoff score of ≥ 19 indicating clinical significance. Self-harm was measured by a single self-report item. Sociodemographic and school-related factors (peer relationships, bullying, academic pressure, smartphone use) were also evaluated. Multivariable logistic regression analyses were performed to identify factors associated with depression and self-harm. Results The prevalence of depression and self-harm was 16.2% and 13.3%, respectively. Multivariate analyses revealed several significant factors. For depression, the strongest predictors were poor peer relationships (OR = 11.61, 95%CI = 8.90–15.15 for "general" relationships), high academic pressure (OR = 7.01, 95%CI = 6.13–8.03), and self-harm (OR = 4.39, 95%CI = 3.99–4.84). Males had a higher risk than females (OR = 1.33, 95%CI = 1.22–1.45), and rural residence was associated with increased odds (OR = 1.33, 95%CI = 1.19–1.48). For self-harm, the primary predictor was depression (OR = 4.37, 95%CI = 3.97–4.82), followed by high academic pressure (OR = 2.52, 95%CI = 2.19–2.90) and frequent bullying exposure (e.g., OR = 1.77 for frequent bullying, 95%CI = 1.55–2.02). Problematic smartphone use was also significantly associated with both outcomes. Conclusions This study reveals a high prevalence of depression and self-harm among Chinese preadolescents. Modifiable school-related factors, including poor peer relationships, academic pressure, bullying, and digital use, are strongly associated with these mental health difficulties. The findings underscore the urgent need for integrated, school-based interventions that focus on improving the psychosocial environment, mitigating academic stress, and promoting healthy digital habits to support the mental well-being of children. Health sciences/Diseases Health sciences/Health care Biological sciences/Psychology Social science/Psychology Health sciences/Risk factors Depression Self-harm Preadolescent School mental health Academic pressure Bullying Digital use China Introduction Childhood and pre-adolescence are critical developmental periods increasingly associated with significant mental health challenges, including depression and self-harm, which represent major public health concerns due to profound psychosocial impairment, elevated suicide risk, and long-term morbidity[ 1 – 4 ]. While research has often focused on adolescents and older populations, there is growing recognition of the need to address mental health concerns in younger children[ 5 ]. It is also estimated that approximately half of first episodes of depression occur during adolescence[ 6 ], and recent evidence indicates a concerning rise in adolescent depressive symptoms, with point prevalence increasing from 24% during 2001–2010 to 37% during 2011–2020. This burden is distributed unevenly globally, with the highest prevalence observed in the Middle East, Africa, and Asia, and female adolescents consistently showing higher rates than males[ 7 – 9 ]. Early-onset depression (occurring before age 12) is particularly alarming, as it predicts adverse outcomes including chronic depression, academic difficulties, and suicide[ 10 , 11 ]. Concurrently, self-harm-a potent predictor of future suicide attempts—affects 19.1% to 21.3% of adolescents worldwide. However, its prevalence and underlying mechanisms in preadolescent children remain poorly characterized[ 12 , 13 ]. In China specifically, reported youth depression rates range from 18% to 20%, with emerging evidence suggesting self-harm behaviors can manifest as early as ages 9 to 10[ 14 – 17 ].Crucially, depression onset between ages 5–12 years is often severe and associated with poorer long-term outcomes compared to later onset[ 18 ]. Despite occurring during a critical developmental window (ages 9–10 years)—marked by escalating academic demands, increasing social complexity, and neurocognitive vulnerability—robust epidemiological data on depression and self-harm in this specific age group remain scarce[ 19 , 20 ]. Existing literature predominantly focuses on adolescents, overlooking critical developmental precursors. This gap is particularly pronounced in China, where rapid socioeconomic change and intense educational pressures may exacerbate risks. Prior studies are further limited by small sample sizes, regional biases, and methodological heterogeneity, constraining the identification of contextual risk factors[ 21 ]. Elementary school environments represent strategic settings for early risk detection and intervention. Key school-related factors—including academic stress, interpersonal relationships (with peers, teachers, and indirectly influenced by family dynamics), and exposure to bullying-collectively shape mental health trajectories during this period[ 22 , 23 ]. Evidence consistently links these factors to youth depression, with interpersonal stress demonstrating particularly strong associations .Within East Asian educational contexts, exceptional academic pressure correlates with increased self-harm risk, while poor peer relationships exacerbate emotional dysregulation, and bullying exposure significantly elevates self-harm risk in children under 12. Problematic problematic digital use may further compound risks by potentially impairing adaptive coping mechanisms. Critically, schools offer feasible venues for targeting these modifiable risks, consistent with evidence that early intervention during this developmental period can mitigate progression to severe outcomes, including suicide. Chongqing, located in southwestern China with its distinctive geographical features and hot and humid climate, provides an optimal setting for investigating school-based mental health risks due to its pronounced urban-rural disparities and hyper-competitive academic culture. Rapid urbanization has intensified educational inequalities, characterized by resource limitations (e.g., inadequate access to mental health professionals) in rural areas versus extreme academic demands in urban zones-mirroring regional limitations noted in prior research[ 24 ]. Focusing on 9–10 year-olds capitalizes on a key prepubertal developmental period, preceding the confounding neurohormonal changes of adolescence, thereby facilitating a clearer examination of environmental and psychosocial risk factors. This socioeconomic heterogeneity enables a robust investigation of how contextual factors interact with the educational system in China. This study aims to: 1) Establish population-based prevalence estimates for depression and self-harm in Chongqing’s 9-10-year-olds; 2) Identify school-related factors (peer relationships, bullying, academic pressure, digital use) associated with depression and self-harm using multivariate analyses; and 3) Generate actionable evidence for early detection and targeted school-based interventions. Methods Participants This cross-sectional study assessed the psychological well-being of primary school students aged 9-10 years in Chongqing's Shapingba and Gaoxin districts between September and December 2020, adapting methodological protocols from Ai et al[25]. Participants were restricted to grades 3–5 to ensure developmental homogeneity. After exclusions for non-consent (n=1,203), incomplete data (n=894), and inconsistent responses (n=317), the final analytical cohort comprised 22,266 participants. Rigorous data quality control included automated completeness checks and random manual verification (<1.2% missing entries). Passive parental consent and student electronic assent were obtained following ethics approval. No compensation was provided. Measures A 15-30 minute online questionnaire was designed to assess sociodemographic and psychosocial characteristics of the participants. The sociodemographic variables included school, grade (3-5), student ID, sex (1. Female, 2. Male), age, place of household registration (1.Urban, 2.Rural), and peer relationships. The peer relationship variable was assessed using a 3-point Likert scale (1. Good, 2. General, 3. Poor). The questionnaire also addressed academic pressure, rated as 0 (Low), 1 (General), and 2 (High), as well as problematic digital use , measured by frequency of smartphone and internet use (1. Rarely, 2. Occasionally, 3. Frequently). Bullying exposure was assessed with a frequency scale (1. No, 2. Rarely, 3. Several times, 4. Often), with an additional item regarding the recency of bullying (1. Last month, 2. Last six months, 3. Last year, 4. More than a year ago). If participants reported being bullied, they were asked to specify when it occurred. Self-harm behavior was measured with a dichotomous self-report question: “Have you ever hurt yourself when unhappy?” (0. No, 1. Yes). Depressive symptoms were assessed using the 27-item Children's Depression Inventory (CDI), which is based on the Beck Depression Inventory. This self-report scale is specifically designed to evaluate cognitive, affective, somatic, and behavioral indicators of depression in individuals aged 7 to 17 years[26]. The CDI score was derived by assigning values of 0, 1, and 2 to the response options “sometimes”, “often”, and “always”, “respectively”. Participants were instructed to select the option that best reflected their feelings over the preceding two weeks. A threshold score of ≥19 was employed to categorize the presence of depression.The CDI cutoff ≥19 was validated in Chinese children with 84% sensitivity and 82% specificity against clinical diagnosis[27]. In our study, a score of CDI less than 19 indicates no depression symptoms, while a score greater than 19 indicates the presence of depression symptoms. Procedure Ethical approval was obtained from the First Affiliated Hospital of Chongqing Medical University (#2020-879). Written informed consent was secured from guardians; participants provided electronic assent. Trained teachers administered surveys during supervised computer sessions using encrypted logins. Standardized instructions emphasized confidentiality and voluntary participation. The study complied with Declaration of Helsinki principles. Statistical Analysis Data were analyzed using SPSS 27.0 (IBM Corp., Armonk, NY). Descriptive statistics characterized the cohort with categorical variables presented as frequencies and percentages. Bivariate associations between sociodemographic factors and outcomes (depression/self-harm) were examined using Pearson's χ 2 tests (Table 1). Multivariable logistic regression models were constructed separately for each outcome, adjusting for covariates with univariate associations at p< 0.10: the depression model included sex, grade, residence, peer relationships, bullying frequency, academic pressure, and smartphone use (Table 2); the self-harm model incorporated age, grade, peer relationships, bullying frequency , academic pressure, problematic digital use , and depression status (Table 3). Results are reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs), with statistical significance set at two-tailed α=0.05. Results Sample Characteristics Among 22,266 children aged 9-10 years, overall prevalence rates were 16.2% for depression and 13.3% for self-harm. Females exhibited significantly higher self-harm rates than males （14.2% vs.12.3%; χ 2 =17.05, p<0.001 ), while depression prevalence did not differ by sex (16.46% in females vs. 15.94% in males; χ 2 = 1.1, p=0.294) (Table 1).Although unadjusted analyses showed no sex difference in depression prevalence ( χ 2 =1.1, p=0.294), multivariate logistic regression adjusting for covariates (e.g., peer relationships, bullying) revealed significantly higher depression risk in males (OR=1.33, 95%CI=1.22-1.45, p< 0.001; Table 2). Grade-Level Differences Third graders showed the highest prevalence of both self-harm (14.3%) and depression (17.1%), with significantly decreasing rates in higher grades: self-harm prevalence declined from 14.3% in grade 3 to 11.7% in grade 5( χ 2 = 17.1, p=0.001) , while depression rates decreased from 17.1% to 13.9% ( χ 2 =22.25, p< 0.001) (Table 1). Residential and Social Factors Rural residence was associated with significantly higher depression prevalence compared to urban areas (19.6% vs. 15.5%; χ 2 = 36.66, p<0.001 ). Peer relationship quality demonstrated strong predictive value: children with poor relationships had 7.7-fold higher depression rates (77.0% vs. 10.0% in those with good relationships; χ 2 =2270.83, p<0.001 ) and 4.2-fold higher self-harm prevalence (42.0% vs. 9.9%; χ 2 =715.15, p<0.001 ). Frequent bullying exposure was associated with particularly elevated rates of depression (52.9%) and self-harm (35.1%) (both p<0.001 ). Depression predictors Binary logistic regression (Table 2) revealed self-harm as the strongest predictor of depression (OR=4.39, 95%CI=3.99-4.84, p< 0.001), with academic pressure showing a dose-response relationship: high pressure increased odds 7-fold (OR=7.01, 95%CI=6.13-8.03, p< 0.001) and general pressure 67% (OR=1.67, 95%CI=1.51-1.85, p< 0.001). Peer relationships demonstrated a striking risk gradient: children reporting “general” relationships had 11.61-fold higher depression odds (95%CI=8.90–15.15), while those with “poor” relationships had 2.18-fold higher odds (95%CI=1.99–2.38) compared to good relationships (both p< 0.001).Bullying exposure demonstrated graded effects: rare bullying quadrupled odds (OR=4.05, 95%CI=3.22-5.09, p< 0.001), several incidents tripled risk (OR=3.55, 95%CI=2.93-4.31, p< 0.001), and frequent bullying increased odds 56% (OR=1.56, 95%CI=1.36-1.78, p< 0.001). Males had 33% higher risk than females (OR=1.33, 95%CI=1.22-1.45, p< 0.001), and rural residence increased odds 33% (OR=1.33, 95%CI=1.19-1.48, p0.05). Self-harm predictors For self-harm (Table 3), depression was the primary predictor (OR=4.37, 95%CI=3.97-4.82, p< 0.001). Academic pressure exhibited strong effects: high pressure doubled risk (OR=2.52, 95%CI=2.19-2.90, p< 0.001) and general pressure increased odds 52% (OR=1.52, 95%CI=1.37-1.68, p< 0.001). Bullying frequency showed decreasing but significant effects: rare bullying more than doubled odds (OR=2.35, 95%CI=1.87-2.94, p< 0.001), several incidents similarly increased risk (OR=2.31, 95%CI=1.90-2.80, p< 0.001), and frequent bullying elevated odds 77% (OR=1.77, 95%CI=1.55-2.02, p< 0.001). Smartphone use showed usage-dependent risk: rare use increased odds 67% (OR=1.67, 95%CI=1.46-1.91, p< 0.001) and occasional use 11% (OR=1.11, 95%CI=1.01-1.22,p=0.033). Males had higher risk than females (OR=1.12, 95%CI=1.03-1.22,p=0.011), and fourth graders showed 26% higher risk than third graders (OR=1.26, 95%CI=1.09-1.45,p=0.001). Residential location (p=0.204) and bullying timing (p>0.05) were non-significant. Discussion This large-scale study reveals a concerning prevalence of depression (16.2%) and self-harm (13.3%) among Chinese primary school children aged 9–10 years. Key predictors include poor peer relationships, bullying exposure, academic pressure, and problematic digital use , with notable bidirectional associations between depression and self-harm. By focusing on a developmentally pivotal yet understudied age group, our findings bridge gaps in global prepubertal mental health research and highlight the urgency of context-specific interventions in China’s education system. The observed depression prevalence"aligns with Chinese meta-analyses (16.97%–17.2%) but exceeds global estimates (1.7%–5.9%), a discrepancy reflecting the unique interplay of academic pressure and societal change in China[ 28 ]. Notably, the 13.3% self-harm rate addresses a critical data gap: global research has focused on adolescents, with preadolescent estimates rarely exceeding 10%. While lower than pandemic-era rates in Wuhan (22.6%), our findings confirm that mental health vulnerabilities persist under non-crisis conditions, necessitating sustained intervention[ 29 ]. The absence of sex differences in unadjusted depression rates (16.46% females vs. 15.94% males; Table 1 ) contrasts with adolescent female predominance, suggesting prepubertal neuroendocrine and social mechanisms driving later disparities are not yet operational[ 30 – 32 ]. However, multivariate models revealed higher depression risk in males (OR = 1.331; Table 2 ), thereby challenging assumptions of male resilience and highlighting the masking effect of protective psychosocial factors (e.g., peer support) in unadjusted analyses. This aligns with global research indicating prepubertal sex differences in mental health may be context-dependent rather than biologically determined[ 33 , 34 ].The elevated depression risk in boys (OR = 1.33) may reflect under-identification due to gender-specific symptom expression (e.g., externalizing behaviors masking depression) and reduced behaviors help-seeking driven by cultural expectations of male resilience. Rural-urban disparities in depression (19.62% vs. 15.54%; Table 1 ) mirror China’s educational resource inequities, while grade-level declines in depression and self-harm (Grade 3 to Grade 5) may reflect developmental adaptation or selection biases, warranting longitudinal investigation[ 35 , 36 ]. Rural-urban disparities (19.6% vs. 15.5%) mirror inequities in mental health resources: rural schools average 0.3 psychologists per 1,000 students versus 1.2 in urban areas . Poor peer relationships emerged as the strongest social risk factor, with 76.96% depression prevalence in this subgroup (Table 1 ). The 11.61-fold higher depression risk associated with general relationships (Table 2 ) underscores the critical role of social integration in prepubertal mental health. Bullying exposure showed graded effects, with frequent victimization increasing self-harm risk by 77% (Table 3 )—findings that strengthen causal inference for anti-bullying interventions in primary schools[ 37 – 39 ]. These data support the implementation of peer support programs and teacher training to mitigate relational stressors[ 57–59 ]. This is likely linked to the intense pressure of transitioning to better middle schools, where academic performance becomes a growing focus for both parents and students, as academic achievement is highly valued in Chinese society not only as an indicator of individual success but also as a filial duty that impacts the well-being of the family[ 35 , 36 ].Thus, attaining academic achievement is one of the most important tasks for Chinese children[ 40 ].Children in China face significant pressure to excel academically, those who perform well are praised by teachers and respected by their peers, while those who perform poorly are often criticized and rejected[ 41 ]. The dose-response relationship between academic pressure and mental health aligns with East Asian contexts where educational stressors disproportionately impact youth[ 29 ]. This highlights the urgency of policy reforms to reduce excessive homework and exam frequency, as mandated by China’s “Double Reduction” policy, but with greater emphasis on enforcement in rural areas. Frequent smartphone use correlated with elevated depression (36.88%) and self-harm (27.8%) rates (Table 1 ), supporting links between screen time and emotional dysregulation[ 42 – 45 ]. The protective effect of occasional use suggests targeted regulation—rather than blanket restriction—may optimize digital health. School-based digital literacy programs could teach adaptive online behaviors, reducing problematic use[ 46 ]. The strong bidirectional associations reinforce the need for integrated screening. Self-harm as a coping mechanism for emotional distress underscores the importance of school counselors trained to identify early warning signs (e.g., social withdrawal, declining academic performance) and provide immediate support. Limitations and Future Directions The cross-sectional design of this study precludes definitive causal inference, and reliance on self-reported measures may lead to underreporting of sensitive behaviors. Future investigations should adopt longitudinal designs to track developmental trajectories and validate findings through diagnostic interviews. Furthermore, investigating interactions between school- and family-level factors (e.g., parental involvement in academic stressors) may inform the development of holistic intervention strategies[ 47 ]. Despite these limitations, the large sample size and focus on an understudied age group bolster the external validity of our findings. A critical methodological constraint is that self-harm was assessed using a single dichotomous item, which may underestimate frequency and fails to distinguish between non-suicidal self-injury (NSSI) and suicidal behaviors. Future studies should utilize validated standardized scales to comprehensively capture severity, frequency, and intent. Conclusions Our findings highlight a high prevalence of depression and self-harm among Chinese children aged 9–10 years, with modifiable risk factors—including poor peer relationships, bullying victimization, excessive academic pressure, and unregulated smartphone use—acting as key drivers. These risks are further compounded by a bidirectional depression-self-harm relationship and significant rural-urban disparities. To address these challenges, we advocate for an integrated, multitiered intervention framework: (1) Universal screening via regular assessments of peer dynamics, bullying exposure, and academic stress; (2) Targeted interventions, such as social skills group therapy for children with peer relationship deficits and trauma-informed counseling for bullied students; and (3) System-level reforms, including curriculum redesign and teacher training to mitigate academic pressure, alongside structured digital regulation (e.g., prohibiting in-class smartphone use while permitting supervised occasional use, complemented by parent-managed home use policies). Addressing these factors during this critical developmental window may mitigate mental health vulnerabilities and improve long-term outcomes for China’s youth. Notably, systemic reforms should prioritize accelerating implementation of China’s “Double Reduction” policy (aimed at reducing homework burden and exam frequency) in rural schools, where academic pressure remains most severe. This effort should be paired with teacher training on alternative assessment methods to ensure policy effectiveness. Declarations Ethics Approval and Consent to Participate This study was approved by the Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (Approval No. #2020-879). Written informed consent was obtained from all guardians of the participants, and electronic assent was provided by the children prior to participation. All methods were performed in accordance with the relevant guidelines and regulations, including the Declaration of Helsinki. Clinical Trial Number Not applicable. (This study is a cross-sectional survey and not a clinical trial.) Funding/Support : This study was supported by the following grants: Joint Project of Science and Health in Chongqing: Medical Research (2022MSXM058, Dr Ai) Natural Science Foundation of Chongqing, China (CSTB2022NSCQ-MSX0053, Dr Ai) Program for Youth Innovation in Future Medicine, Chongqing Medical University (W0138) National Natural Science Foundation of China (81971286, Mrs Kuang) The First Affiliated Hospital of Chongqing Medical University “Discipline Peak Plan” scientific and technological achievement transformation project (cyyy-xkdfjh-cgzh-202304, 2024–2026, Mrs Kuang) Chongqing Higher Education Teaching Reform Research Project (243397, Dr Ai) The funders had no role in the study design, data collection, analysis, interpretation, or manuscript preparation. Role of the Funder/Sponsor : The funders had no role in the design or execution of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Acknowledgements We would like to express our sincere gratitude to the Education Committee of District ShaPingba and GaoXin in Chongqing for their continuous support throughout this project. Our heartfelt thanks go to the students, doctors, and all other individuals who participated in the survey, whose contributions were invaluable. We would also like to extend special appreciation to Chengdu Knowledge Vision Technology Co., Ltd. for their crucial assistance in data access, management, and analysis. Data Availability All data generated or analyzed during this study are included in this published article and its supplementary information files. 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Comparison of Children Aged 9 to 10 Years With and Without Depression and Self-harm According to Sociodemographic Characteristics (n=22,266) Sociodemographic characteristic Non-Self Harm (n=19,309) Self Harm (n=2,957) χ 2 P value Non-depressed(n=18,661) Depressed (n=3,605) χ 2 P value Sex Male 9511 (87.68%) 1336 (12.32%) 17.05 ＜0.001 9062 (83.54%) 1785 (16.46%) 1.1 0.294 Female 9798 (85.8%) 1621 (14.2%) 9599 (84.06%) 1820 (15.94%) Grade Three 5950 (85.73%) 990 (14.27%) 16.03 0.001 5751 (82.87%) 1189 (17.13%) 22.25 ＜0.001 Four 9363 (86.68%) 1439 (13.32%) 9017 (83.48%) 1785 (16.52%) Five 3996 (88.31%) 528 (11.69%) 3893 (86.05%) 631 (13.95%) Age 9 7854 (86.85%) 1189 (13.15%) 0.23 0.631 7553 (83.52%) 1490 (16.48%) 0.92 0.338 10 11455 (86.63%) 1768 (13.37%) 11108 (84.01%) 2115 (15.99%) Residential location Urban 16239 (86.8%) 2469 (13.2%) 0.70 0.404 15801 (84.46%) 2907 (15.54%) 36.66 ＜0.001 Rural 3070 (86.28%) 488 (13.72%) 2860 (80.38%) 698 (19.62%) Relationships with classmates Good 14343 (90.1%) 1576 (9.9%) 715.15 ＜0.001 14332 (90.03%) 1587 (9.97%) 2270.83 ＜0.001 General 4722 (79.68%) 1204 (20.32%) 4232 (71.41%) 1694 (28.59%) Poor 244 (57.96%) 177 (42.04%) 97 (23.04%) 324 (76.96%) Bullied No 11137 (92.47%) 907 (7.53%) 776.85 ＜0.001 11017 (91.47%) 1027 (8.53%) 1201.01 ＜0.001 Rarely 6936 (82.75%) 1446 (17.25%) 6704 (79.98%) 1678 (20.02%) Several times 799 (68.47%) 368 (31.53%) 623 (53.38%) 544 (46.62%) Often 437 (64.93%) 236 (35.07%) 317 (47.1%) 356 (52.9%) Time since the bullying occurred No 11137 (92.47%) 907 (7.53%) 776.85 ＜0.001 11017 (91.47%) 1027 (8.53%) 1201.01 ＜0.001 In the last month 3783 (80.15%) 937 (19.85%) 3484 (73.81%) 1236 (26.19%) In the last six months 1454 (78.68%) 394 (21.32%) 1367 (73.97%) 481 (26.03%) In the last year 806 (76.33%) 250 (23.67%) 733 (69.41%) 323 (30.59%) More than one year ago 2129 (81.95%) 469 (18.05%) 2060 (79.29%) 538 (20.71%) Academic pressure Low 8745 (92.71%) 688 (7.29%) 1224.79 ＜0.001 8722 (92.46%) 711 (7.54%) 2777.34 ＜0.001 General 9351 (85.68%) 1563 (14.32%) 9097 (83.35%) 1817 (16.65%) High 1213 (63.21%) 706 (36.79%) 842 (43.88%) 1077 (56.12%) Smartphone use Rarely 8277 (89.75%) 945 (10.25%) 438.44 ＜0.001 8080 (87.62%) 1142 (12.38%) 729.66 ＜0.001 Occasionally 9593 (86.81%) 1458 (13.19%) 9323 (84.36%) 1728 (15.64%) Frequently 1439 (72.2%) 554 (27.8%) 1258 (63.12%) 735 (36.88%) Depressed No 17138 (91.84%) 1523 (8.16%) 2622.43 ＜0.001 Yes 2171 (60.22%) 1434 (39.78%) The Chi-squared test was used for statistical analysis. Table 2. Binary Logistic Regression Analysis of Sociodemographic and School-Related Factors Associated With Depression in Children Aged 9 to 10 Years Sociodemographic characteristic B SE Wald P OR 95% CI Lower Upper Self-harm No Yes 1.48 0.05 887.373 ＜0.001 4.393 3.985 4.842 Sex Female Male 0.286 0.044 42.992 ＜0.001 1.331 1.222 1.45 Grade Three 5.356 0.069 Four 0.157 0.073 4.642 0.031 1.17 1.014 1.35 Five 0.133 0.062 4.57 0.033 1.142 1.011 1.29 Age 9 10 -0.01 0.05 0.041 0.839 0.990 0898 1.092 Residential location Urban Rural 0.282 0.055 25.796 ＜0.001 1.326 1.189 1.478 Relationships with classmates Good General 2.452 0.136 326.095 ＜0.001 11.612 8.899 15.153 Poor 0.778 0.045 297.119 ＜0.001 2.177 1.992 2.378 Bullied No Rarely 1.398 0.117 143.579 ＜0.001 4.048 3.220 5.088 Several times 1.268 0.099 165.61 ＜0.001 3.553 2.929 4.310 Often 0.443 0.068 42.672 ＜0.001 1.557 1.363 1.779 Time since the bullying occurred In the last month In the last six months 0.119 0.069 2.942 0.086 1.126 0.983 1.291 In the last year 0.087 0.085 1.056 0.304 1.091 0.924 1.289 More than one year ago 0.188 0.1 3.537 0.06 1.206 0.992 1.467 Academic pressure Low General 0.512 0.052 97.888 ＜0.001 1.669 1.508 1.848 High 1.948 0.069 799.763 ＜0.001 7.014 6.128 8.027 Smartphone use Frequently Occasionally -0.693 0.069 99.866 ＜0.001 0.5 0.437 0.573 Rarely -0.619 0.065 89.613 ＜0.001 0.539 0.474 0.612 CI= confidence interval; SE= standard error. Table 3. Binary Logistic Regression Analysis of Sociodemographic and School-Related Factors Associated With Self-harm in Children Aged 9 to 10 Years Sociodemographic characteristic B SE Wald P OR 95% CI Lower Upper Sex Female Male 0.111 0.044 6.509 0.011 1.118 1.026 1.217 Grade Three Four 0.231 0.072 10.212 0.001 1.26 1.093 1.451 Five 0.102 0.062 2.747 0.097 1.108 0.982 1.25 Age 9 10 0.109 0.05 4.675 0.031 1.115 1.010 1.230 Residential location Urban Rural -0.074 0.058 1.613 0.204 0.929 0.828 1.041 Relationships with classmates Good General 0.285 0.117 5.959 0.015 0.752 0.598 0.945 Poor 0.194 0.048 16.565 <0.001 1.214 1.106 1.332 Bullied No Rarely 0.853 0.115 55.25 <0.001 2.346 1.874 2.937 Several times 0.835 0.099 71.762 <0.001 2.305 1.900 2.796 Often 0.57 0.067 71.969 <0.001 1.768 1.550 2.016 Time since the bullying occurred In the last month In the last six months -0.037 0.069 0.288 0.592 0.964 0.843 1.103 In the last year 0.059 0.083 0.492 0.48 1.06 0.901 1.248 More than one year ago 0.064 0.098 0.422 0.514 1.066 0.88 1.292 Academic pressure Low General 0.417 0.052 64.88 <0.001 1.517 1.371 1.679 High 0.924 0.071 169.167 <0.001 2.52 2.193 2.897 Smartphone use Frequently Occasionally 0.103 0.048 4.527 0.033 1.108 1.008 1.218 Rarely 0.512 0.069 55.075 <0.001 1.669 1.458 1.911 Depressed Yes No 1.475 0.05 882.19 ＜0.001 4.37 3.965 4.817 CI= confidence interval; SE= standard error. Additional Declarations No competing interests reported. Supplementary Files RawDatasetAnonymized1.xlsx VariableDescription.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 30 Oct, 2025 Reviews received at journal 27 Oct, 2025 Reviews received at journal 08 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers agreed at journal 02 Oct, 2025 Reviewers invited by journal 02 Oct, 2025 Editor assigned by journal 01 Oct, 2025 Editor invited by journal 26 Sep, 2025 Submission checks completed at journal 23 Sep, 2025 First submitted to journal 23 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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pre-adolescence are critical developmental periods increasingly associated with significant mental health challenges, including depression and self-harm, which represent major public health concerns due to profound psychosocial impairment, elevated suicide risk, and long-term morbidity[\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. While research has often focused on adolescents and older populations, there is growing recognition of the need to address mental health concerns in younger children[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It is also estimated that approximately half of first episodes of depression occur during adolescence[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and recent evidence indicates a concerning rise in adolescent depressive symptoms, with point prevalence increasing from 24% during 2001\u0026ndash;2010 to 37% during 2011\u0026ndash;2020. This burden is distributed unevenly globally, with the highest prevalence observed in the Middle East, Africa, and Asia, and female adolescents consistently showing higher rates than males[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Early-onset depression (occurring before age 12) is particularly alarming, as it predicts adverse outcomes including chronic depression, academic difficulties, and suicide[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Concurrently, self-harm-a potent predictor of future suicide attempts\u0026mdash;affects 19.1% to 21.3% of adolescents worldwide. However, its prevalence and underlying mechanisms in preadolescent children remain poorly characterized[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In China specifically, reported youth depression rates range from 18% to 20%, with emerging evidence suggesting self-harm behaviors can manifest as early as ages 9 to 10[\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].Crucially, depression onset between ages 5\u0026ndash;12 years is often severe and associated with poorer long-term outcomes compared to later onset[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite occurring during a critical developmental window (ages 9\u0026ndash;10 years)\u0026mdash;marked by escalating academic demands, increasing social complexity, and neurocognitive vulnerability\u0026mdash;robust epidemiological data on depression and self-harm in this specific age group remain scarce[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Existing literature predominantly focuses on adolescents, overlooking critical developmental precursors. This gap is particularly pronounced in China, where rapid socioeconomic change and intense educational pressures may exacerbate risks. Prior studies are further limited by small sample sizes, regional biases, and methodological heterogeneity, constraining the identification of contextual risk factors[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eElementary school environments represent strategic settings for early risk detection and intervention. Key school-related factors\u0026mdash;including academic stress, interpersonal relationships (with peers, teachers, and indirectly influenced by family dynamics), and exposure to bullying-collectively shape mental health trajectories during this period[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Evidence consistently links these factors to youth depression, with interpersonal stress demonstrating particularly strong associations .Within East Asian educational contexts, exceptional academic pressure correlates with increased self-harm risk, while poor peer relationships exacerbate emotional dysregulation, and bullying exposure significantly elevates self-harm risk in children under 12. Problematic problematic digital use may further compound risks by potentially impairing adaptive coping mechanisms. Critically, schools offer feasible venues for targeting these modifiable risks, consistent with evidence that early intervention during this developmental period can mitigate progression to severe outcomes, including suicide.\u003c/p\u003e\u003cp\u003eChongqing, located in southwestern China with its distinctive geographical features and hot and humid climate, provides an optimal setting for investigating school-based mental health risks due to its pronounced urban-rural disparities and hyper-competitive academic culture. Rapid urbanization has intensified educational inequalities, characterized by resource limitations (e.g., inadequate access to mental health professionals) in rural areas versus extreme academic demands in urban zones-mirroring regional limitations noted in prior research[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Focusing on 9\u0026ndash;10 year-olds capitalizes on a key prepubertal developmental period, preceding the confounding neurohormonal changes of adolescence, thereby facilitating a clearer examination of environmental and psychosocial risk factors. This socioeconomic heterogeneity enables a robust investigation of how contextual factors interact with the educational system in China.\u003c/p\u003e\u003cp\u003eThis study aims to: 1) Establish population-based prevalence estimates for depression and self-harm in Chongqing\u0026rsquo;s 9-10-year-olds; 2) Identify school-related factors (peer relationships, bullying, academic pressure, digital use) associated with depression and self-harm using multivariate analyses; and 3) Generate actionable evidence for early detection and targeted school-based interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study assessed the psychological well-being of primary school students aged 9-10 years in Chongqing\u0026apos;s Shapingba and Gaoxin districts between September and December 2020, adapting methodological protocols from Ai et al[25]. Participants were restricted to grades 3\u0026ndash;5 to ensure developmental homogeneity. After exclusions for non-consent (n=1,203), incomplete data (n=894), and inconsistent responses (n=317), the final analytical cohort comprised 22,266 participants. Rigorous data quality control included automated completeness checks and random manual verification (\u0026lt;1.2% missing entries). Passive parental consent and student electronic assent were obtained following ethics approval. No compensation was provided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 15-30 minute online questionnaire was designed to assess sociodemographic and psychosocial characteristics of the participants. The sociodemographic variables included school, grade (3-5), student ID, sex (1. Female, 2. Male), age, place of household registration (1.Urban, 2.Rural), and peer relationships. The peer relationship variable was assessed using a 3-point Likert scale (1. Good, 2. General, 3. Poor). The questionnaire also addressed academic pressure, rated as 0 (Low), 1 (General), and 2 (High), as well as \u003cem\u003eproblematic digital use\u003c/em\u003e, measured by frequency of smartphone and internet use (1. Rarely, 2. Occasionally, 3. Frequently). Bullying exposure was assessed with a frequency scale (1. No, 2. Rarely, 3. Several times, 4. Often), with an additional item regarding the recency of bullying (1. Last month, 2. Last six months, 3. Last year, 4. More than a year ago). If participants reported being bullied, they were asked to specify when it occurred. Self-harm behavior was measured with a dichotomous self-report question: \u0026ldquo;Have you ever hurt yourself when unhappy?\u0026rdquo; (0. No, 1. Yes).\u003c/p\u003e\n\u003cp\u003eDepressive symptoms were assessed using the 27-item Children\u0026apos;s Depression Inventory (CDI), which is based on the Beck Depression Inventory. This self-report scale is specifically designed to evaluate cognitive, affective, somatic, and behavioral indicators of depression in individuals aged 7 to 17 years[26]. The CDI score was derived by assigning values of 0, 1, and 2 to the response options \u0026ldquo;sometimes\u0026rdquo;, \u0026ldquo;often\u0026rdquo;, and \u0026ldquo;always\u0026rdquo;, \u0026ldquo;respectively\u0026rdquo;. Participants were instructed to select the option that best reflected their feelings over the preceding two weeks. A threshold score of \u0026ge;19 was employed to categorize the presence of depression.The CDI cutoff \u0026ge;19 was validated in Chinese children with 84% sensitivity and 82% specificity against clinical diagnosis[27]. In our study, a score of CDI less than 19 indicates no depression symptoms, while a score greater than 19 indicates the presence of depression symptoms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProcedure\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the First Affiliated Hospital of Chongqing Medical University (#2020-879). Written informed consent was secured from guardians; participants provided electronic assent. Trained teachers administered surveys during supervised computer sessions using encrypted logins. Standardized instructions emphasized confidentiality and voluntary participation. The study complied with Declaration of Helsinki principles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS 27.0 (IBM Corp., Armonk, NY). Descriptive statistics characterized the cohort with categorical variables presented as frequencies and percentages. Bivariate associations between sociodemographic factors and outcomes (depression/self-harm) were examined using Pearson\u0026apos;s \u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e tests (Table 1). Multivariable logistic regression models were constructed separately for each outcome, adjusting for covariates with univariate associations at \u003cem\u003ep\u0026lt;\u003c/em\u003e0.10: the depression model included sex, grade, residence, peer relationships, bullying frequency, academic pressure, and smartphone use (Table 2); the self-harm model incorporated age, grade, peer relationships, \u003cem\u003ebullying frequency\u003c/em\u003e, academic pressure, \u003cem\u003eproblematic digital use\u003c/em\u003e, and depression status (Table 3). Results are reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs), with statistical significance set at two-tailed \u0026alpha;=0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSample Characteristics\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Among 22,266 children aged 9-10 years, overall prevalence rates were 16.2% for depression and 13.3% for self-harm. Females exhibited significantly higher self-harm rates than males\u0026nbsp;（14.2% vs.12.3%; \u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=17.05, \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e), while depression prevalence did not differ by sex (16.46% in females vs. 15.94% in males; \u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e= 1.1, p=0.294) (Table 1).Although unadjusted analyses showed no sex difference in depression prevalence (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=1.1, p=0.294), multivariate logistic regression adjusting for covariates (e.g., peer relationships, bullying) revealed significantly higher depression risk in males (OR=1.33, 95%CI=1.22-1.45, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001; Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrade-Level Differences\u003c/strong\u003e\u003cbr\u003eThird graders showed the highest prevalence of both self-harm (14.3%) and depression (17.1%), with significantly decreasing rates in higher grades: self-harm prevalence declined from 14.3% in grade 3 to 11.7% in grade 5( \u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e= 17.1, p=0.001) , while depression rates decreased from 17.1% to 13.9% (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=22.25, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResidential and Social Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRural residence was associated with significantly higher depression prevalence compared to urban areas (19.6% vs. 15.5%; \u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e= 36.66, \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e). Peer relationship quality demonstrated strong predictive value: children with poor relationships had 7.7-fold higher depression rates (77.0% vs. 10.0% in those with good relationships; \u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=2270.83, \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e) and 4.2-fold higher self-harm prevalence (42.0% vs. 9.9%; \u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e=715.15, \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e). Frequent bullying exposure was associated with particularly elevated rates of depression (52.9%) and self-harm (35.1%) (both \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepression predictors\u003c/strong\u003e\u003cbr\u003eBinary logistic regression (Table 2) revealed self-harm as the strongest predictor of depression (OR=4.39, 95%CI=3.99-4.84, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001), with academic pressure showing a dose-response relationship: high pressure increased odds 7-fold (OR=7.01, 95%CI=6.13-8.03, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001) and general pressure 67% (OR=1.67, 95%CI=1.51-1.85, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001). Peer relationships demonstrated a striking risk gradient: children reporting \u0026ldquo;general\u0026rdquo; relationships had 11.61-fold higher depression odds (95%CI=8.90\u0026ndash;15.15), while those with \u0026ldquo;poor\u0026rdquo; relationships had 2.18-fold higher odds (95%CI=1.99\u0026ndash;2.38) compared to good relationships (both \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001).Bullying exposure demonstrated graded effects: rare bullying quadrupled odds (OR=4.05, 95%CI=3.22-5.09, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001), several incidents tripled risk (OR=3.55, 95%CI=2.93-4.31, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001), and frequent bullying increased odds 56% (OR=1.56, 95%CI=1.36-1.78, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001). Males had 33% higher risk than females (OR=1.33, 95%CI=1.22-1.45, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001), and rural residence increased odds 33% (OR=1.33, 95%CI=1.19-1.48, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001). Age showed no association (p=0.839), and bullying timing was non-significant (p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-harm predictors\u003c/strong\u003e\u003cbr\u003eFor self-harm (Table 3), depression was the primary predictor (OR=4.37, 95%CI=3.97-4.82, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001). Academic pressure exhibited strong effects: high pressure doubled risk (OR=2.52, 95%CI=2.19-2.90, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001) and general pressure increased odds 52% (OR=1.52, 95%CI=1.37-1.68, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001). Bullying frequency showed decreasing but significant effects: rare bullying more than doubled odds (OR=2.35, 95%CI=1.87-2.94, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001), several incidents similarly increased risk (OR=2.31, 95%CI=1.90-2.80, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001), and frequent bullying elevated odds 77% (OR=1.77, 95%CI=1.55-2.02, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001). Smartphone use showed usage-dependent risk: rare use increased odds 67% (OR=1.67, 95%CI=1.46-1.91, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.001) and occasional use 11% (OR=1.11, 95%CI=1.01-1.22,p=0.033). Males had higher risk than females (OR=1.12, 95%CI=1.03-1.22,p=0.011), and fourth graders showed 26% higher risk than third graders (OR=1.26, 95%CI=1.09-1.45,p=0.001). Residential location (p=0.204) and bullying timing (p\u0026gt;0.05) were non-significant.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThis large-scale study reveals a concerning prevalence of depression (16.2%) and self-harm (13.3%) among Chinese primary school children aged 9\u0026ndash;10 years. Key predictors include poor peer relationships, bullying exposure, academic pressure, and \u003cem\u003eproblematic digital use\u003c/em\u003e, with notable bidirectional associations between depression and self-harm. By focusing on a developmentally pivotal yet understudied age group, our findings bridge gaps in global prepubertal mental health research and highlight the urgency of context-specific interventions in China\u0026rsquo;s education system.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe observed depression prevalence\"aligns with Chinese meta-analyses (16.97%\u0026ndash;17.2%) but exceeds global estimates (1.7%\u0026ndash;5.9%), a discrepancy reflecting the unique interplay of academic pressure and societal change in China[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Notably, the 13.3% self-harm rate addresses a critical data gap: global research has focused on adolescents, with preadolescent estimates rarely exceeding 10%. While lower than pandemic-era rates in Wuhan (22.6%), our findings confirm that mental health vulnerabilities persist under non-crisis conditions, necessitating sustained intervention[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe absence of sex differences in unadjusted depression rates (16.46% females vs. 15.94% males; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) contrasts with adolescent female predominance, suggesting prepubertal neuroendocrine and social mechanisms driving later disparities are not yet operational[\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, multivariate models revealed higher depression risk in males (OR\u0026thinsp;=\u0026thinsp;1.331; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), thereby challenging assumptions of male resilience and highlighting the masking effect of protective psychosocial factors (e.g., peer support) in unadjusted analyses. This aligns with global research indicating prepubertal sex differences in mental health may be context-dependent rather than biologically determined[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].The elevated depression risk in boys (OR\u0026thinsp;=\u0026thinsp;1.33) may reflect under-identification due to gender-specific symptom expression (e.g., externalizing behaviors masking depression) and reduced behaviors help-seeking driven by cultural expectations of male resilience.\u003c/p\u003e\u003cp\u003eRural-urban disparities in depression (19.62% vs. 15.54%; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) mirror China\u0026rsquo;s educational resource inequities, while grade-level declines in depression and self-harm (Grade 3 to Grade 5) may reflect developmental adaptation or selection biases, warranting longitudinal investigation[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Rural-urban disparities (19.6% vs. 15.5%) mirror inequities in mental health resources: rural schools average 0.3 psychologists per 1,000 students versus 1.2 in urban areas .\u003c/p\u003e\u003cp\u003ePoor peer relationships emerged as the strongest social risk factor, with 76.96% depression prevalence in this subgroup (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The 11.61-fold higher depression risk associated with general relationships (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) underscores the critical role of social integration in prepubertal mental health. Bullying exposure showed graded effects, with frequent victimization increasing self-harm risk by 77% (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u0026mdash;findings that strengthen causal inference for anti-bullying interventions in primary schools[\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. These data support the implementation of peer support programs and teacher training to mitigate relational stressors[\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e57\u0026ndash;59\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis is likely linked to the intense pressure of transitioning to better middle schools, where academic performance becomes a growing focus for both parents and students, as academic achievement is highly valued in Chinese society not only as an indicator of individual success but also as a filial duty that impacts the well-being of the family[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].Thus, attaining academic achievement is one of the most important tasks for Chinese children[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].Children in China face significant pressure to excel academically, those who perform well are praised by teachers and respected by their peers, while those who perform poorly are often criticized and rejected[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The dose-response relationship between academic pressure and mental health aligns with East Asian contexts where educational stressors disproportionately impact youth[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This highlights the urgency of policy reforms to reduce excessive homework and exam frequency, as mandated by China\u0026rsquo;s \u0026ldquo;Double Reduction\u0026rdquo; policy, but with greater emphasis on enforcement in rural areas.\u003c/p\u003e\u003cp\u003eFrequent smartphone use correlated with elevated depression (36.88%) and self-harm (27.8%) rates (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), supporting links between screen time and emotional dysregulation[\u003cspan additionalcitationids=\"CR43 CR44\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The protective effect of occasional use suggests targeted regulation\u0026mdash;rather than blanket restriction\u0026mdash;may optimize digital health. School-based digital literacy programs could teach adaptive online behaviors, reducing problematic use[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe strong bidirectional associations reinforce the need for integrated screening. Self-harm as a coping mechanism for emotional distress underscores the importance of school counselors trained to identify early warning signs (e.g., social withdrawal, declining academic performance) and provide immediate support.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLimitations and Future Directions\u003c/h2\u003e\u003cp\u003eThe cross-sectional design of this study precludes definitive causal inference, and reliance on self-reported measures may lead to underreporting of sensitive behaviors. Future investigations should adopt longitudinal designs to track developmental trajectories and validate findings through diagnostic interviews. Furthermore, investigating interactions between school- and family-level factors (e.g., parental involvement in academic stressors) may inform the development of holistic intervention strategies[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Despite these limitations, the large sample size and focus on an understudied age group bolster the external validity of our findings.\u003c/p\u003e\u003cp\u003eA critical methodological constraint is that self-harm was assessed using a single dichotomous item, which may underestimate frequency and fails to distinguish between non-suicidal self-injury (NSSI) and suicidal behaviors. Future studies should utilize validated standardized scales to comprehensively capture severity, frequency, and intent.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur findings highlight a high prevalence of depression and self-harm among Chinese children aged 9\u0026ndash;10 years, with modifiable risk factors\u0026mdash;including poor peer relationships, bullying victimization, excessive academic pressure, and unregulated smartphone use\u0026mdash;acting as key drivers. These risks are further compounded by a bidirectional depression-self-harm relationship and significant rural-urban disparities. To address these challenges, we advocate for an integrated, multitiered intervention framework: (1) Universal screening via regular assessments of peer dynamics, bullying exposure, and academic stress; (2) Targeted interventions, such as social skills group therapy for children with peer relationship deficits and trauma-informed counseling for bullied students; and (3) System-level reforms, including curriculum redesign and teacher training to mitigate academic pressure, alongside structured digital regulation (e.g., prohibiting in-class smartphone use while permitting supervised occasional use, complemented by parent-managed home use policies). Addressing these factors during this critical developmental window may mitigate mental health vulnerabilities and improve long-term outcomes for China\u0026rsquo;s youth.\u003c/p\u003e\u003cp\u003eNotably, systemic reforms should prioritize accelerating implementation of China\u0026rsquo;s \u0026ldquo;Double Reduction\u0026rdquo; policy (aimed at reducing homework burden and exam frequency) in rural schools, where academic pressure remains most severe. This effort should be paired with teacher training on alternative assessment methods to ensure policy effectiveness.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (Approval No. #2020-879). Written informed consent was obtained from all guardians of the participants, and electronic assent was provided by the children prior to participation. All methods were performed in accordance with the relevant guidelines and regulations, including the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. (This study is a cross-sectional survey and not a clinical trial.)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support\u003c/strong\u003e: This study was supported by the following grants:\u003c/p\u003e\n\u003cp\u003eJoint Project of Science and Health in Chongqing: Medical Research (2022MSXM058, Dr Ai)\u003c/p\u003e\n\u003cp\u003eNatural Science Foundation of Chongqing, China (CSTB2022NSCQ-MSX0053, Dr Ai)\u003c/p\u003e\n\u003cp\u003eProgram for Youth Innovation in Future Medicine, Chongqing Medical University (W0138)\u003c/p\u003e\n\u003cp\u003eNational Natural Science Foundation of China (81971286, Mrs Kuang)\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Chongqing Medical University \u0026ldquo;Discipline Peak Plan\u0026rdquo; scientific and technological achievement transformation project (cyyy-xkdfjh-cgzh-202304, 2024\u0026ndash;2026, Mrs Kuang)\u003c/p\u003e\n\u003cp\u003eChongqing Higher Education Teaching Reform Research Project (243397, Dr Ai)\u003c/p\u003e\n\u003cp\u003eThe funders had no role in the study design, data collection, analysis, interpretation, or manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRole of the Funder/Sponsor\u003c/strong\u003e: The funders had no role in the design or execution of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to the Education Committee of District ShaPingba and GaoXin in Chongqing for their continuous support throughout this project. Our heartfelt thanks go to the students, doctors, and all other individuals who participated in the survey, whose contributions were invaluable. We would also like to extend special appreciation to Chengdu Knowledge Vision Technology Co., Ltd. for their crucial assistance in data access, management, and analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMcGorry, P.D., et al., \u003cem\u003eThe Lancet Psychiatry Commission on youth mental health.\u003c/em\u003e Lancet Psychiatry, 2024. \u003cstrong\u003e11\u003c/strong\u003e(9): p. 731-774.\u003c/li\u003e\n\u003cli\u003eHerrman, H., et al., \u003cem\u003eTime for united action on depression: a Lancet-World Psychiatric Association Commission.\u003c/em\u003e Lancet, 2022. \u003cstrong\u003e399\u003c/strong\u003e(10328): p. 957-1022.\u003c/li\u003e\n\u003cli\u003eDeVille, D.C., et al., \u003cem\u003ePrevalence and Family-Related Factors Associated With Suicidal Ideation, Suicide Attempts, and Self-injury in Children Aged 9 to 10 Years.\u003c/em\u003e JAMA Network Open, 2020. \u003cstrong\u003e3\u003c/strong\u003e(2).\u003c/li\u003e\n\u003cli\u003eZhang, Y., et al., \u003cem\u003eChange in the global burden of depression from 1990-2019 and its prediction for 2030.\u003c/em\u003e J Psychiatr Res, 2024. \u003cstrong\u003e178\u003c/strong\u003e: p. 16-22.\u003c/li\u003e\n\u003cli\u003eGeoffroy, M.-C., et al., \u003cem\u003ePrevalence of suicidal ideation and self-harm behaviours in children aged 12 years and younger: a systematic review and meta-analysis.\u003c/em\u003e The Lancet Psychiatry, 2022. \u003cstrong\u003e9\u003c/strong\u003e(9): p. 703-714.\u003c/li\u003e\n\u003cli\u003eKessler, R.C., et al., \u003cem\u003ePrevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication.\u003c/em\u003e Archives of General Psychiatry, 2005. \u003cstrong\u003e62\u003c/strong\u003e(6): p. 617-627.\u003c/li\u003e\n\u003cli\u003eShorey, S., E.D. 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Hacker, \u003cem\u003eAssociations between problematic mobile phone use and psychological parameters in young adults.\u003c/em\u003e Int J Public Health, 2012. \u003cstrong\u003e57\u003c/strong\u003e(2): p. 437-41.\u003c/li\u003e\n\u003cli\u003eSantos, R.M.S., et al., \u003cem\u003eThe associations between screen time and mental health in adolescents: a systematic review.\u003c/em\u003e BMC Psychol, 2023. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 127.\u003c/li\u003e\n\u003cli\u003eCarter, B., et al., \u003cem\u003e\u0026apos;There\u0026apos;s more to life than staring at a small screen\u0026apos;: a mixed methods cohort study of problematic smartphone use and the relationship to anxiety, depression and sleep in students aged 13-16 years old in the UK.\u003c/em\u003e BMJ Ment Health, 2024. \u003cstrong\u003e27\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eAi, M., et al., \u003cem\u003eImpact of parental marital status on self-harm in Chinese primary school students: the mediating role of depression and the moderating effect of classmate relationships.\u003c/em\u003e PeerJ, 2025. \u003cstrong\u003e13\u003c/strong\u003e: p. e19307.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Comparison of Children Aged 9 to 10 Years With and Without Depression and Self-harm According to Sociodemographic Characteristics (n=22,266)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"109%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eSociodemographic characteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eNon-Self Harm\u003c/p\u003e\n \u003cp\u003e(n=19,309)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eSelf Harm\u003cbr\u003e\u0026nbsp;(n=2,957)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eNon-depressed(n=18,661)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eDepressed\u003c/p\u003e\n \u003cp\u003e(n=3,605)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e9511\u003c/p\u003e\n \u003cp\u003e(87.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1336\u003c/p\u003e\n \u003cp\u003e(12.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e17.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e9062\u003c/p\u003e\n \u003cp\u003e(83.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1785\u003c/p\u003e\n \u003cp\u003e(16.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e9798\u003c/p\u003e\n \u003cp\u003e(85.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1621\u003c/p\u003e\n \u003cp\u003e(14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e9599\u003c/p\u003e\n \u003cp\u003e(84.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1820\u003c/p\u003e\n \u003cp\u003e(15.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eGrade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eThree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5950\u003c/p\u003e\n \u003cp\u003e(85.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e990\u003c/p\u003e\n \u003cp\u003e(14.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e16.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e5751\u003c/p\u003e\n \u003cp\u003e(82.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1189\u003c/p\u003e\n \u003cp\u003e(17.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e22.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eFour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e9363\u003c/p\u003e\n \u003cp\u003e(86.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1439\u003c/p\u003e\n \u003cp\u003e(13.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e9017\u003c/p\u003e\n \u003cp\u003e(83.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1785\u003c/p\u003e\n \u003cp\u003e(16.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eFive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3996\u003c/p\u003e\n \u003cp\u003e(88.31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e528\u003c/p\u003e\n \u003cp\u003e(11.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3893\u003c/p\u003e\n \u003cp\u003e(86.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e631\u003c/p\u003e\n \u003cp\u003e(13.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e7854\u003c/p\u003e\n \u003cp\u003e(86.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1189\u003c/p\u003e\n \u003cp\u003e(13.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e7553\u003c/p\u003e\n \u003cp\u003e(83.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1490\u003c/p\u003e\n \u003cp\u003e(16.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e11455\u003c/p\u003e\n \u003cp\u003e(86.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1768\u003c/p\u003e\n \u003cp\u003e(13.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e11108\u003c/p\u003e\n \u003cp\u003e(84.01%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2115\u003c/p\u003e\n \u003cp\u003e(15.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eResidential location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e16239\u003c/p\u003e\n \u003cp\u003e(86.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2469\u003c/p\u003e\n \u003cp\u003e(13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e15801\u003c/p\u003e\n \u003cp\u003e(84.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2907\u003c/p\u003e\n \u003cp\u003e(15.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e36.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3070\u003c/p\u003e\n \u003cp\u003e(86.28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e488\u003c/p\u003e\n \u003cp\u003e(13.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2860\u003c/p\u003e\n \u003cp\u003e(80.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e698\u003c/p\u003e\n \u003cp\u003e(19.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eRelationships with classmates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e14343\u003c/p\u003e\n \u003cp\u003e(90.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1576\u003c/p\u003e\n \u003cp\u003e(9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e715.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e14332\u003c/p\u003e\n \u003cp\u003e(90.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1587\u003c/p\u003e\n \u003cp\u003e(9.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e2270.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4722\u003c/p\u003e\n \u003cp\u003e(79.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1204\u003c/p\u003e\n \u003cp\u003e(20.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4232\u003c/p\u003e\n \u003cp\u003e(71.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1694\u003c/p\u003e\n \u003cp\u003e(28.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e244\u003c/p\u003e\n \u003cp\u003e(57.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003cp\u003e(42.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003cp\u003e(23.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e324\u003c/p\u003e\n \u003cp\u003e(76.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eBullied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e11137\u003c/p\u003e\n \u003cp\u003e(92.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e907\u003c/p\u003e\n \u003cp\u003e(7.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e776.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e11017\u003c/p\u003e\n \u003cp\u003e(91.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1027\u003c/p\u003e\n \u003cp\u003e(8.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1201.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e6936\u003c/p\u003e\n \u003cp\u003e(82.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1446\u003c/p\u003e\n \u003cp\u003e(17.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e6704\u003c/p\u003e\n \u003cp\u003e(79.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1678\u003c/p\u003e\n \u003cp\u003e(20.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eSeveral times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e799\u003c/p\u003e\n \u003cp\u003e(68.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003cp\u003e(31.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e623\u003c/p\u003e\n \u003cp\u003e(53.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e544\u003c/p\u003e\n \u003cp\u003e(46.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eOften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e437\u003c/p\u003e\n \u003cp\u003e(64.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003cp\u003e(35.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003cp\u003e(47.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e356\u003c/p\u003e\n \u003cp\u003e(52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eTime since the bullying occurred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e11137\u003c/p\u003e\n \u003cp\u003e(92.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e907\u003c/p\u003e\n \u003cp\u003e(7.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e776.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e11017\u003c/p\u003e\n \u003cp\u003e(91.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1027\u003c/p\u003e\n \u003cp\u003e(8.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1201.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eIn the last month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3783\u003c/p\u003e\n \u003cp\u003e(80.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e937\u003c/p\u003e\n \u003cp\u003e(19.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3484\u003c/p\u003e\n \u003cp\u003e(73.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1236\u003c/p\u003e\n \u003cp\u003e(26.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eIn the last six months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1454\u003c/p\u003e\n \u003cp\u003e(78.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e394\u003c/p\u003e\n \u003cp\u003e(21.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1367\u003c/p\u003e\n \u003cp\u003e(73.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e481\u003c/p\u003e\n \u003cp\u003e(26.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eIn the last year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e806\u003c/p\u003e\n \u003cp\u003e(76.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003cp\u003e(23.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e733\u003c/p\u003e\n \u003cp\u003e(69.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e323\u003c/p\u003e\n \u003cp\u003e(30.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eMore than one year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2129\u003c/p\u003e\n \u003cp\u003e(81.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e469\u003c/p\u003e\n \u003cp\u003e(18.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2060\u003c/p\u003e\n \u003cp\u003e(79.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e538\u003c/p\u003e\n \u003cp\u003e(20.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eAcademic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e8745\u003c/p\u003e\n \u003cp\u003e(92.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e688\u003c/p\u003e\n \u003cp\u003e(7.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1224.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e8722\u003c/p\u003e\n \u003cp\u003e(92.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e711\u003c/p\u003e\n \u003cp\u003e(7.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e2777.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e9351\u003c/p\u003e\n \u003cp\u003e(85.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1563\u003c/p\u003e\n \u003cp\u003e(14.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e9097\u003c/p\u003e\n \u003cp\u003e(83.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1817\u003c/p\u003e\n \u003cp\u003e(16.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1213\u003c/p\u003e\n \u003cp\u003e(63.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e706\u003c/p\u003e\n \u003cp\u003e(36.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e842\u003c/p\u003e\n \u003cp\u003e(43.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1077\u003c/p\u003e\n \u003cp\u003e(56.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eSmartphone use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e8277\u003c/p\u003e\n \u003cp\u003e(89.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e945\u003c/p\u003e\n \u003cp\u003e(10.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e438.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e8080\u003c/p\u003e\n \u003cp\u003e(87.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1142\u003c/p\u003e\n \u003cp\u003e(12.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e729.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e9593\u003c/p\u003e\n \u003cp\u003e(86.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1458\u003c/p\u003e\n \u003cp\u003e(13.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e9323\u003c/p\u003e\n \u003cp\u003e(84.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1728\u003c/p\u003e\n \u003cp\u003e(15.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eFrequently\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1439\u003c/p\u003e\n \u003cp\u003e(72.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e554\u003c/p\u003e\n \u003cp\u003e(27.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1258\u003c/p\u003e\n \u003cp\u003e(63.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e735\u003c/p\u003e\n \u003cp\u003e(36.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eDepressed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e17138\u003c/p\u003e\n \u003cp\u003e(91.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1523\u003c/p\u003e\n \u003cp\u003e(8.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2622.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2171\u003c/p\u003e\n \u003cp\u003e(60.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1434\u003c/p\u003e\n \u003cp\u003e(39.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;The Chi-squared test was used for statistical analysis.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Binary Logistic Regression Analysis of Sociodemographic and School-Related Factors Associated With Depression in Children Aged 9 to 10 Years\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 209px;\"\u003e\n \u003cp\u003eSociodemographic characteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 122px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eSelf-harm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e887.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e4.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e3.985\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4.842\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e42.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eGrade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eThree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e5.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eFour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e4.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eFive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0898\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eResidential location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e25.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.478\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eRelationships with classmates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e2.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e326.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e11.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e8.899\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e15.153\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e297.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e2.177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.992\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e2.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eBullied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e143.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e4.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e3.220\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e5.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eSeveral times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e165.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e3.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.929\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eOften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e42.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.363\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.779\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eTime since the bullying occurred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eIn the last month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eIn the last six months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e2.942\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.291\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eIn the last year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e1.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.289\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eMore than one year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e3.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAcademic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e97.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.508\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.848\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e799.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e7.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e6.128\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e8.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSmartphone use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eFrequently\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e99.866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e89.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eCI= confidence interval; SE= standard error.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Binary Logistic Regression Analysis of Sociodemographic and School-Related Factors Associated With Self-harm in Children Aged 9 to 10 Years\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 209px;\"\u003e\n \u003cp\u003eSociodemographic characteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 122px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e6.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.026\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eGrade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eThree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eFour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e10.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eFive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e2.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e4.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.010\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eResidential location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e1.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.828\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eRelationships with classmates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eGood\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eGeneral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e5.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.945\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003ePoor\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e16.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.106\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eBullied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e55.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e2.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.874\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e2.937\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eSeveral times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e71.762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e2.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.900\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e2.796\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eOften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e71.969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.550\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e2.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eTime since the bullying occurred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eIn the last month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eIn the last six months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eIn the last year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eMore than one year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAcademic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e64.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.371\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e169.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e2.193\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e2.897\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSmartphone use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eFrequently\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e4.527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.008\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e55.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e1.458\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.911\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eDepressed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 118px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e882.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e3.965\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4.817\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eCI= confidence interval; \u0026nbsp;SE= standard error. \u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Depression, Self-harm, Preadolescent, School mental health, Academic pressure, Bullying, Digital use, China","lastPublishedDoi":"10.21203/rs.3.rs-7515755/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7515755/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDepression and self-harm in preadolescent children are significant public health concerns but remain understudied, especially within the context of China's unique socioeducational environment. This study aimed to determine the prevalence of depression and self-harm among children aged 9\u0026ndash;10 years in China and identify associated school-related risk factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA large-scale cross-sectional study was conducted from September to December 2020 in Chongqing, China. A total of 22,266 children in grades 3\u0026ndash;5 completed an online questionnaire. Depression symptoms were assessed using the Children\u0026rsquo;s Depression Inventory (CDI), with a cutoff score of \u0026ge;\u0026thinsp;19 indicating clinical significance. Self-harm was measured by a single self-report item. Sociodemographic and school-related factors (peer relationships, bullying, academic pressure, smartphone use) were also evaluated. Multivariable logistic regression analyses were performed to identify factors associated with depression and self-harm.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe prevalence of depression and self-harm was 16.2% and 13.3%, respectively. Multivariate analyses revealed several significant factors. For depression, the strongest predictors were poor peer relationships (OR\u0026thinsp;=\u0026thinsp;11.61, 95%CI\u0026thinsp;=\u0026thinsp;8.90\u0026ndash;15.15 for \"general\" relationships), high academic pressure (OR\u0026thinsp;=\u0026thinsp;7.01, 95%CI\u0026thinsp;=\u0026thinsp;6.13\u0026ndash;8.03), and self-harm (OR\u0026thinsp;=\u0026thinsp;4.39, 95%CI\u0026thinsp;=\u0026thinsp;3.99\u0026ndash;4.84). Males had a higher risk than females (OR\u0026thinsp;=\u0026thinsp;1.33, 95%CI\u0026thinsp;=\u0026thinsp;1.22\u0026ndash;1.45), and rural residence was associated with increased odds (OR\u0026thinsp;=\u0026thinsp;1.33, 95%CI\u0026thinsp;=\u0026thinsp;1.19\u0026ndash;1.48). For self-harm, the primary predictor was depression (OR\u0026thinsp;=\u0026thinsp;4.37, 95%CI\u0026thinsp;=\u0026thinsp;3.97\u0026ndash;4.82), followed by high academic pressure (OR\u0026thinsp;=\u0026thinsp;2.52, 95%CI\u0026thinsp;=\u0026thinsp;2.19\u0026ndash;2.90) and frequent bullying exposure (e.g., OR\u0026thinsp;=\u0026thinsp;1.77 for frequent bullying, 95%CI\u0026thinsp;=\u0026thinsp;1.55\u0026ndash;2.02). Problematic smartphone use was also significantly associated with both outcomes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study reveals a high prevalence of depression and self-harm among Chinese preadolescents. Modifiable school-related factors, including poor peer relationships, academic pressure, bullying, and digital use, are strongly associated with these mental health difficulties. The findings underscore the urgent need for integrated, school-based interventions that focus on improving the psychosocial environment, mitigating academic stress, and promoting healthy digital habits to support the mental well-being of children.\u003c/p\u003e","manuscriptTitle":"Prevalence and School-Related Factors Associated With Depression and Self-Harm in Children Aged 9 to 10 Years","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 14:24:57","doi":"10.21203/rs.3.rs-7515755/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-30T09:15:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T07:19:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T17:18:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119247372612398432835548404008535900479","date":"2025-10-07T02:35:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"196777779554894571234887722113962956257","date":"2025-10-02T06:01:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-02T05:52:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-01T08:32:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-26T14:35:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-23T18:25:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-23T15:29:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1185f937-05e1-47ba-adc5-676dd40eb219","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":56147748,"name":"Health sciences/Diseases"},{"id":56147749,"name":"Health sciences/Health care"},{"id":56147750,"name":"Biological sciences/Psychology"},{"id":56147751,"name":"Social science/Psychology"},{"id":56147752,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-04-12T06:23:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 14:24:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7515755","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7515755","identity":"rs-7515755","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}