Childhood Emotional Abuse And Non-Suicidal Self-Injury In Adolescents With Depressive Disorders:The Mediating Role Of Resilience And Depression

Objective: To investigate the prevalence of childhood abuse experiences and nonsuicidal self-injury(NSSI)among adolescents with depressive disorders,this study analyzed the association between different types of childhood abuse and NSSI among adolescents with depression.This study also investigated which type of childhood abuse may influence NSSI among adolescents with major depressive disorder.This study will further explore the mediating role of psychological resilience and depression level between childhood abuse experiences and NSSI,to provide some theoretical basis for conducting interventions based on enhancing psychological resilience for individuals who experienced childhood abuse.Methods: Patients aged 12 to 18 years with confirmed depressive disorder were recruited from psychiatric outpatient clinics in 14 psychiatric hospitals or general hospitals in 9 provinces across China.Demographic characteristics of those depressed adolescents were collected using a self-administered questionnaire.The Childhood Trauma Questionnaire Short Form,the Chinese version of Connor–Davidson Resilience Scale,the Patient Health Questionnaire,and the Chinese version of the Functional Assessment of Self-Mutilation were used to obtain information about child abuse experience,psychological resilience,depression,and NSSI.(1)The chi-square test was used to analyze differences in the prevalence of NSSI among adolescents with depression across demographic characteristics.To compare the difference in childhood abuse experiences,psychological resilience,and depression between the NSSI group and the non-NSSI group.After controlling for variables that may influence NSSI,the multivariable logistic regression model was conducted to analyze the relation between different types of childhood abuse and NSSI.(2)This study scored the frequency of NSSI.The Spearman rank correlation analysis was conducted to explore the correlation between childhood emotional abuse,psychological resilience,depression,and NSSI.Structural equation modeling were constructed with childhood emotional abuse as the independent variable,frequency of NSSI as the dependent variable,and psychological resilience and depression as mediating variables.Then Bootstrap method was used to test the mediating effects of psychological resilience and depression in the relation between childhood emotional abuse and NSSI.Results: The prevalence of NSSI among adolescents with depressive disorders was as high as 76.3%,and there were differences in the prevalence of NSSI among adolescents with depressive disorders by age,gender,self-perceived economic status,self-perceived parental relationship,parent-child relationship,only child status,smoking status,and drinking status.The prevalence of childhood abuse among depressed adolescents was 95.8%.The prevalence of different types of childhood abuse experiences among adolescents with depressive disorders was ranked in descending order as follows,emotional neglect(88.1%),physical neglect(78.6%),emotional abuse(64.8%),physical abuse(27.6%),and sexual abuse(20.9%).Among depressed adolescents with NSSI,the prevalence of different types of childhood abuse was ranked from highest to lowest as follows,emotional neglect(90.5%),physical neglect(80.4%),emotional abuse(69.5%),physical abuse(29.5%),and sexual abuse(21.9%).After adjusting the sociodemographic factor associated with NSSI,the multivariable logistic regression model showed that childhood emotional abuse in adolescents with depressive disorders was an independent risk factor for the occurrence of NSSI behaviors(P < 0.05).The results showed that childhood emotional abuse was negatively associated with psychological resilience,and positively associated with depression and frequency of NSSI,psychological resilience was negatively associated with depression and frequency of NSSI,and depression was positively associated with NSSI behaviors(all P < 0.05).To test the chain mediating effects of psychological resilience and depression on childhood emotional abuse and non-suicidal self-injurious behavior,the mediating effects models were established.The results showed that the total effects of childhood emotional abuse on NSSI were 0.612,with a direct effect was 0.477,which accounted for 77.8% of the total effect,and the total indirect effect was 0.136,which accounted for 22.2%.Besides,the results showed that psychological resilience and depression mediated the association between childhood emotional abuse and NSSI frequency,with the mediating effects of 4.2% for psychological resilience,14.3% for depression,and3.7% for chain mediation effects of psychological resilience and depression,respectively.Conclusions: Childhood emotional neglect,physical neglect,and emotional abuse were common in adolescents with depressive disorders.Childhood emotional abuse was an independent risk factor for the occurrence of NSSI among adolescents with depressive disorders.Childhood emotional abuse experiences may have direct effects on depression levels and NSSI,besides,it also may influence NSSI through psychological resilience and depression.Therefore,interventions targeting psychological resilience may help to reduce the long-term adverse effects of childhood emotional abuse on depressive disorders and NSSI.