Mediating Effect Of Psychological Symptoms,Coping Styles And Impulsiveness On The Relationship Between Childhood Abuses And Self-injuries Among Middle School Students

ObjectiveTo investigate the prevalence of non-suicidal self-injuries(NSSI)among middle school students,as well as to explore the mediating effects of psychological symptoms,coping styles and impulsiveness on relationship between childhood abuse and(NSSI),so that to provide a reference for the prevention and intervention of NSSI.MethodsA cross-sectional survey was conducted in Zhengzhou and Guiyang,and the clustering sampling method was used to select One in urban key middle schools,one in general junior high schools,one in key high schools and one in ordinary senior high schools,and two in rural middle schools,one for senior middle schools and one for key high schools,and a total of 15 schools.At each school,4~6 classes of all students were selected by random sampling method in the survey.A total of 9 704 junior and senior high school students were selected to conduct a questionnaire survey.The Childhood Trauma Questionnaire(CTQ-SF),Non-Suicidal Self-Injury Questionnaire,Multidimensional Sub-health Questionnaire of Adolescents(MSQA),Trait Coping Style Questionnaire(TCSQ)and Barratt Impulsiveness Scale(BIS-11)were used to measure childhood abuse assessment,NSSI frequency,psychological symptoms,coping styles and impulsiveness scores.EpiData 3.1 software and SPSS 23.0 were used to establish a data-base and analyze data.Chi-square test was used to compare the frequency of childhood abuse and NSSI among different groups.Using the multivariate logistic regression models were to analyze the effects of different CA,psychological symptoms,coping styles and impulsiveness on NSSI.Pearson's correlation analysis was used in analyzing the relationship,Bootstrap method and PROCESS software were applied to examine the mediating effects.ResultsOf 9 704 participants,there were 3 740 students had NSSI,the prevalence was 38.5% and 26.0% students had NSSI repeatedly.The top three self-injury behaviors of NSSI were intentional strikes or fist hits of 23.4%,deliberately hitting themselves 18.3% and deliberately pinching themselves or scratching themselves 15.3%.4 326(44.6%)students had experienced childhood abuse,including 3 568 persons with emotional abuse(36.8%),1 652 with physical abuse(17.0%),990 with sexual abuse(10.2%).The overall prevalence of childhood abuse in girls was 45.9%,higher than boys(43.1%).The analysis of the influencing factors of NSSI indicated that the risk of NSSI was significantly lower in girls(OR=0.72,95% CI: 0.66-0.79),senior secondary students(OR=0.63,95%CI: 0.66-0.79).Students in Guiyang(OR=1.64,95% CI: 1.50-1.79),or with a higher self-rated learning burden(OR=1.11,95% CI: 1.10-1.21)had a higher risk of NSSI.The students with childhood abuse(OR=1.63,95%CI: 1.49-1.78)and psychological symptoms(OR=1.84,95% CI: 1.65-2.05),and who responded positive coping style to the lower scores(OR=1.194,95%CI: 1.062-1.319),higher negative coping style scores(OR=1.619,95%CI: 1.452-1.807)and higher impulsiveness scores(OR=1.196,95%CI: 1.076-1.329),the risk of NSSI were significantly increased.With the increase of passive coping style and impulse control scores,the risk of occurrence of NSSI in middle school students is on the rise.With the increase in positive response scores,the risk of NSSI is decreased(P<0.01).Psychological symptoms,coping styles and impulsiveness scores were significantly correlated with childhood abuse scores and NSSI frequency of middle school students(P<0.01).The results of Bootstrap mediation test showed that when psychological symptoms,positive coping styles and negative coping styles and impulsiveness were included respectively in the analysis model as a single factor,the results demonstrated that each mediation variable had a significant mediating effect between CA and NSSI associations.These mediating effects persisted after controlling for grade,residence area,self-perceived family SES and learning burden,the single mediating effect was 39.35%(male 47.24% vs female 33.48%),0.71%(male 0.28% vs female 1.16%),22.45%(male 30.07% vs female 20.09%),14.08%(male 19.09% vs 10.92% of females).The analysis of multiple mediation effect test revealed that,psychological symptoms,positive coping styles and negative coping styles and impulsiveness had significant direct effects as well as indirect effects which through CA on NSSI(P<0.05),the mediating effect proportion of each mediator was 33.41%(male 40.94% vs female 25.11%),0.49%(male 0.19% vs female 0.70%),14.87%(male 19.58% vs female 10.69%),3.48%(male 2.86% vs female 3.74%),95%CI did not contain 0,the mediation effect was statistically significant.ConclusionsNSSI was common among among middle school students.CA is a risk factor for increasing non-suicide self-injury.Psychological symptoms,coping styles and impulsiveness play a mediating role in the correlation between CA and NSSI.Reducing psychological symptoms,negative coping styles and the occurrence of impulsiveness will be beneficial to prevent and control the NSSI of middle school students who have childhood abuse.