New-onset and persistent suicidal ideation and non-suicidal self-injury among Chinese university students: A one-year longitudinal study

Suicidal ideation (SI) and non-suicidal self-injury (NSSI) are clinically important mental health concerns among university students, yet longitudinal evidence distinguishing new-onset and persistent patterns remains limited. This one-year longitudinal study examined changes in SI and NSSI and baseline factors associated with their new onset and persistence among Chinese university students. A total of 672 students completed baseline and follow-up assessments. McNemar tests and Firth logistic regression analyses were performed. The prevalence of SI increased from 8.0% to 10.9%, and the prevalence of NSSI increased from 6.3% to 11.8%. New-onset and persistent SI occurred in 6.4% and 4.5% of participants, respectively; the corresponding proportions for NSSI were 7.3% and 4.5%. In the parsimonious multivariable models, single-parent family structure, left-behind experience, and depression were associated with new-onset SI, whereas single-parent family structure, depression, and anxiety were associated with new-onset NSSI. Persistent-outcome analyses were based on small baseline-positive subgroups and were considered exploratory. These findings provide preliminary evidence of outcome-specific longitudinal associations and require confirmation in larger multicenter studies before informing targeted screening or intervention strategies.