Association Among Maltreatment, Bullying and Mental Health, Risk Behavior and Sexual Attraction in Chinese Students

OBJECTIVE: To identify the association between sexual attraction, childhood maltreatment and bullying victimization, and mental and behavioral health problems among Chinese adolescents. METHODS: A cross-sectional study among Chinese high school students by multistage stratified cluster sampling was conducted using a self-reported questionnaire. Participants who were same- or both-sex attracted were identified as sexual minorities, and those who were opposite-sex attracted were identified as heterosexuals. Childhood maltreatment was assessed as physical, emotional, and sexual abuse, and bullying was assessed as traditional and cyberbullying. Psychological distress was assessed as depressive and anxiety symptoms, and self-destructive behavior was assessed as suicidal behavior and nonsuicidal self-injury. Logistic regression and path analysis were conducted to analyze the data. RESULTS: There were 1360 sexual minority and 15,020 heterosexual respondents. Sexual minority status was associated with increased risk of maltreatment (adjusted odds ratio [AOR] range: 1.25-2.46) and bullying (AOR range: 1.38-1.77) victimization, and a series of health problems (AOR range: 1.85-3.69). Furthermore, childhood maltreatment could partially explain the association of sexual minority status with psychological distress (indirect effect: beta = 0.026 for boys; beta = 0.086 for girls) and self-destructive behavior (beta = 0.056 for boys; beta = 0.125 for girls), and bullying could partially explain the association between sexual minority status and psychological distress (beta = 0.040 for boys; beta = 0.031 for girls). CONCLUSIONS: Sexual minority adolescents were more likely than heterosexuals to experience different forms of childhood victimization, which may put them at higher risk for mental and behavioral health problems. Interventions based on both family and school are essential.