EClinicalMedicine: Don't be obsessed with blind boxes, and have a high risk of suicide

Suicide is an increasingly common public health problem and one of the leading causes of
death among young people worldwide.
The relationship between gambling and suicide has been highlighted by previous studies in Sweden, Spain, Canada, China and South Korea, with about 20% of suicide victims having gambling behavior, and more than 80% of university counseling centers reporting an increased mental health risk among college students, with gambling and suicide attempts being common
。

A previous UK study showed that after controlling for influencing factors such as sociodemographic factors, alcohol use, video games, impulsivity and life satisfaction, there was still a significant association
between problem gambling and suicide attempts among young people aged 16-24.
In addition, suicidal ideation and suicidal behavior in women are more likely to be associated with
gambling problems than in men.
Gambling appears to be an independent risk factor for
suicide among young people worldwide.
A blind box is a collectible toy that is randomly packed in a box, which has certain similarities with gambling and is loved by young people
.

Dr.
Chen Runsen's team at Tsinghua University published important research results
in eClinicalMedicine.
They found that excessive blind box consumption was associated
with an increased risk of suicide among young people.
Excessive blind box consumption was associated with a 121% increased risk of suicide among male college students and 64% increased suicide risk among female college students compared to those who did not participate in blind box purchases, and this association remained
after adjusting for influencing factors.
This is the first study to examine the relationship between blind box participation and suicide risk among young people, who are the main consumer group
of blind boxes.

The study was part of a large-scale cross-sectional study conducted from October 26 to November 18, 2021, It covers all university students
in Jilin Province, China.
A total of 73,206 participants completed the study's valid data survey (male: N = 28,762; Female: N = 44444; Average age = 19.
59 years).

Participants were assessed for blind box participation, suicide risk, depression, anxiety, alcohol consumption, smoking habits, and sociodemographic characteristics
.
First, univariate and multivariate binary logistic regression models were used to examine the relationship between
blind box participation and suicide risk in all participants.
Second, it tested whether depression and anxiety mediated the relationship between
blind box participation and suicide risk.
Third, "frequency (i.
e.
, frequency of blind box participation)" and "stakes (i.
e.
, spending more on blind boxes than can afford)" were analyzed , "tolerance (i.
e.
, degree of addiction)", "borrowing" (i.
e.
the amount of money borrowed for blind box participation "The relationship with
the risk of suicide in groups with a history of blind box participation.
"

4195 participants (5.
73%) participated in the blind box, of which 3255 women (77.
59%) and 940 men ( 22.
41%)
。

1.
In a univariate model, binary logistic regression showed that blind box participation was associated with suicide risk in both male and female participants (male: OR = 2.
21, 95% CI = 1.
86 -2·63; Female: OR = 1.
64, 95% CI = 1.
50 to 1.
78).

2.
In multivariate models, blind box participation was still associated with transgender suicide risk after controlling for age, subjective socioeconomic status, per capita disposable income, and drinking and smoking habits (males: OR = 2.
25, 95% CI = 1.
89 to 2.
68; Female: OR = 1.
58, 95% CI = 1.
45 - 1.
73).

Adjusted odds ratios (ORs) for suicide risk in male blind box participants

Adjusted odds ratios (ORs) for suicide risk in female blind box participants

3.
Depression (males: indirect effects = 0.
31, SE = 0.
04, p < 0.
001; Women: indirect effects = 0.
20, SE = 0.
02, p <0.
001) and anxiety (men: indirect effects = 0.
26, SE = 0.
03, p <0.
001; Women: indirect effects = 0.
13, SE = 0.
02, p<0.
001) moderated the association between
blind box participation and suicide risk.

Gender-modulated models of depression and anxiety

4.
In the blind box participation group, forward binary logistic regression showed that "tolerance" was associated with suicide risk in both men and women (p = 0.
001); "Borrowing" alone (p = 0.
019) was associated
with suicide risk in male participants.

The findings suggest that blind box overspending is positively associated with suicide risk in young men and women, and this association persists
after adjusting for influencing factors.
Despite the study's limitations (e.
g.
, cross-section, convenience sampling), the current findings could help policymakers develop regulations for such a thriving youth-led consumer industry while protecting the mental health
of youth globally.

Original source

Duan Y, Xu S, Wang Y, Zhang Y, Wang Y, Chen R.
Blind box over-engagement and suicide risk among adolescents and young adults: Results of a large-scale survey.
EClinicalMedicine.
2022 Jul 18; 51:101575.
doi: 10.
1016/j.
eclinm.
2022.
101575.
PMID: 35875818; PMCID: PMC9304904.