A composite measure of healthy lifestyle and the association with suicidal behaviors in Chinese young people aged 10–24 years: Results from a school-based survey in Zhejiang Province

OBJECTIVES: Smoking, alcohol drinking, dietary habits, physical activity, screen time, and sleep duration have been examined separately in relation to suicidality. Based on these behaviors, this study aimed to develop a composite measure of a healthy lifestyle, and to explore its associations with suicidal behaviors among Chinese young people aged 10-24 years. METHODS: Data were obtained from 2022 Zhejiang Youth Risk Behavior Survey, in which 27,059 students aged 10-24 years completed an anonymous questionnaire designed to assess the health behaviors. A healthy lifestyle score was calculated and categorized into favorable, intermediate, and unfavorable lifestyle categories. Multivariate logistic regression models were employed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for suicidal behaviors. RESULTS: Overall, 21.12% of students followed a favorable lifestyle, 56.67% followed an intermediate lifestyle, and 22.21% followed an unfavorable lifestyle. Compared to unfavorable lifestyle, students with intermediate and favorable lifestyle had lower odds of suicidal ideation, with the OR was 0.67 (95% CI: 0.62-0.72) and 0.40 (0.36-0.45); for suicidal plans, the corresponding OR was 0.61 (0.55-0.67) and 0.37 (0.31-0.44); for suicidal attempts, the corresponding OR was 0.53 (0.45-0.62) and 0.27 (0.20-0.37). CONCLUSIONS: This study suggested that adherence to healthy lifestyles combining seven modifiable lifestyle factors were significantly associated with the lower odds of suicidal behaviors engagement in Chinese young people.