Qijiao Liu ^1,2,3,4 Xiaohe Xu ^5,6 Jianjun Jiang ^3,4,7 Wei Peng ^3,4,7 Yuanyi Ji ^8,9 Ruixi Yang ^1,2,3,4 Ming Zhang ^1,2,3,4 Shiying Li ¹⁰ Yuchen Li ¹¹ Qiaolan Liu ^1,2*

• ¹ Department of Health and Social Behavior, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
• ² Sichuan University, Chengdu, China
• ³ Research Center for Palliative Care, Sichuan University, Chengdu, China
• ⁴ West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China
• ⁵ University of Texas at San Antonio, San Antonio, Texas, United States
• ⁶ Department of Sociology, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, Texas, United States
• ⁷ Department of Palliative care, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
• ⁸ West China Fourth Hospital of Sichuan University, Chengdu, Sichuan Province, China
• ⁹ West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
• ¹⁰ Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, Sichuan Province, China
• ¹¹ Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

Methods: A 2-year panel study was conducted among 1,840 adolescents aged 10-18 attending rural junior and senior high schools in Sichuan Province, China. The Center for Epidemiologic Studies-Depression Scale (CES-D) and a global measure of self-reported deliberate self-harm were utilized to examine the relationship between depressive symptoms and deliberate self-harm using both classic and random intercept cross-lagged panel models. Multi-group comparisons were carried out for the gender, pubertal stage, and academic performance subgroups. Results: Positive and statistically significant correlations were found between depressive symptoms and deliberate self-harm both within and across the three waves of the panel survey, after adjusting for covariates, among rural adolescents in western China (Range: 0.05-0.28, p < 0.05). As anticipated, depressive symptoms positively predicted later deliberate self-harm, which in turn reciprocally predicted subsequent depressive symptoms, both between and within individuals. While the cross-lagged effects were invariant by gender and academic performance, the effect of baseline depressive symptoms on later deliberate self-harm was stronger for adolescents in the early pubertal stage (β = 0.19, 95% Confidence Interval: 0.08 to 0.30) than for those in the middle-to-late pubertal stage (β = 0.13, 95% CI: 0.06 to 0.19). Conclusions: There is a causal and reciprocal relationship between depressive symptoms and deliberate self-harm among rural adolescents in China. Not only does this finding lend further credence to a growing body of research on adolescents’ self-harming behaviors but also informs early intervention strategies aimed at improving behavioral health of rural adolescents in western China.