Childhood trauma, peer victimization, and non-suicidal self-injury among Chinese adolescents: A latent variable mediation analysis

doi:10.21203/rs.3.rs-2445042/v1

Download PDF

Research Article

Childhood trauma, peer victimization, and non-suicidal self-injury among Chinese adolescents: A latent variable mediation analysis

https://doi.org/10.21203/rs.3.rs-2445042/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 15 Jun, 2023

Read the published version in BMC Psychiatry →

You are reading this latest preprint version

Backgrounds: Childhood and peer experiences can influence adolescents' perceptions of interpersonal relationships, which can, in turn, influence their emotional states and behavior patterns. Non-suicidal self-injury (NSSI) is now a common problem behavior among adolescents. The present study examined the role of childhood trauma and peer victimization in adolescents’ NSSI.

Methods: A cross-sectional survey was conducted among 1783 adolescents (1464 girls and 318 boys) in the psychiatric outpatient clinics or wards of 14 psychiatric hospitals or general hospitals in nine provinces in China. Data were collected using the Multidimensional Peer Victimization Scale (MPVS), Short-form Childhood Trauma Questionnaire(CTQ-SF), and Functional Assessment of Self-Mutilation (FASM). Structural equation modeling (SEM) with latent variables was used to demonstrate the mediating role of peer victimization in the association between childhoodtrauma and NSSI.

Results: The SEM analysis demonstrated that peer victimization plays a partial mediating role in the relationship between childhood trauma and NSSI. . In addition, several covariates (such as age, gender, education level, and place of residence) effectively regulated the relationship between peer victimization and NSSI.

Conclusions: In future studies of NSSI among Chinese adolescents, attention should be paid to the roles of childhood trauma and peer bullying; there is a temporal sequence between these two variables and, to some extent, childhood trauma can have an impact on bullying during adolescence which, in turn, influences NSSI behavior.

Non-suicidal self-injury

Childhood trauma

Peer victimization

Chinese adolescents

Latent variable Mediation model.

Non-suicidal self-injury (NSSI) is defined as the deliberate direct destruction or alteration of body tissue without conscious suicidal intent[1]. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), this diagnosis is denoted as a “ condition for further study”[2]. Globally, the lifetime prevalence of at least one episode of NSSI in adolescence is 17–18%[3] [4]. In China, a recent study reported that 33.7–51% of community youths engage in self-injurious behavior[5]. Moreover, a meta-analysis showed that individuals with mood disorders (anxiety, depression, bipolar, and related disorders) are at higher risk of NSSI compared to normal controls[6]. In an adolescent psychiatric sample, the prevalence of one-time-only NSSI behavior was as high as 60%, and the incidence of recurrent NSSI was approximately 50%[7]. A better understanding of the underlying mechanisms and risk factors for adolescent NSSI is crucial to inform prevention and intervention efforts. Although several risk factors for NSSI have been identified previously[8], there are few published studies on the effects of the external environment on adolescent NSSI. This paper attempts to explore the influence of early family environment and peer relationships on the NSSI of adolescents

Childhood trauma includes abuse and neglect by family members, especially primary caregivers[9], and has been identified as an important risk factor for the occurrence of NSSI[10] [11]. Neglect can be divided into two categories[12]: (1) physical neglect, where the basic requirements for the child’s survival are not met, such as nutrition and shelter; (2) emotional neglect, where the basic psychological needs of the child are neglected or diluted. Abuse can be divided into the following categories: (1) physical abuse, which is intentional and violent physical injury; (2) emotional abuse, which refers to verbal and other mental attacks that harm a child’s health, including attacks on self-confidence, insults, and other behaviors that hinder a child’s normal growth; (3) sexual abuse, defined as an adult using violence, inducement, or other methods to engage in any form of sexual behavior with a child[13] [14].

The interdependent parent-child relationship is a unique feature of Chinese society and family relationships play an irreplaceable role in the lives of Chinese children[15]. According to attachment theory, children function best when in a safe environment created by their parents. However, if a child does not feel safe, a child’s mind attempts to reduce the threats and create safety by fighting, fleeing, or freezing[16]. When adolescents are exposed to danger, decisions are made instantaneously by the brain; this process primarily involves conditioned responses formed during early childhood rather than complex processes performed by higher-order parts of the brain that are not fully formed until early adulthood (i.e., the prefrontal and anterior cingulate cortex, the parts of the brain responsible for language, associative, and regulatory functions)[17]. That is, the early environment also affects adolescents' coping styles and behaviors when facing risks. To sum up, childhood experiences also have a fundamental role in subsequent development that cannot be ignored[15]. Importantly, a recent meta-analysis found that adverse childhood experiences have significant independent effects on self-harm[18] [19]. Further, several studies have indicated that childhood trauma can directly or indirectly lead to the development of NSSI[20] [21]. Although there is a time lag, the association between childhood trauma and NSSI in adolescence is significant.

Peer victimization is when an individual is repeatedly and chronically bullied or victimized by one or more peers[22], including: (1) physical victimization, involving physical attacks by peers; (2) verbal victimization, involving verbal abuse by peers; (3) social victimization, involving bullying by peers in a personal relationship; and (4) property victimization, involving stealing or destruction of property by peers[23]. Individuals who have experienced peer victimization have a greater risk of NSSI[24]. In the highly developed modern society, the psychological growth of adolescents is inseparable from the establishment of social relationships with family members, peers, and teachers; peer relationships account for a large proportion of the life of adolescents[25]. The influence of peer relationships on adolescents should not be ignored. According to interpersonal suicide theory (ITS), the desire to die may increase if a sense of burden and frustrated belonging is perceived in core interpersonal interactions, and this desire then leads to self-injury and suicidal behavior Furthermore, integrative motivation-volition theory (IMV) suggests that negative life events, especially feelings that can be internalized as shame or frustration in interpersonal relationships, can lead to feelings of entrapment and subsequent suicidal thoughts and plans[26]. In a study of depressed adolescents, Vergara GA et al. reported that severe peer victimization and bullying led to NSSI[27]. Similarly, in another study, negative peer experiences were found to predict NSSI trajectories in depressed adolescents[28]. In summary, there is considerable evidence for a causal relationship between peer victimization and NSSI[29] [30].

In China, the saying goes ‘a single silk does not make a thread; a single tree does not make a forest’. Collectivism has always been a prominent characteristic of Chinese culture[31]. Even in modern society, there is a continuing cultural association between collectivism and some life domains[31]. In other words, Chinese people are more connected to the people around them, whether it is their family or friends. Several studies have reported that Chinese people have a higher level of dependency compared to people in Western countries[32]. Therefore, relationships between people are of extraordinary significance to the Chinese. Moreover, childhood trauma and peer victimization can be considered to be two different types of interpersonal trauma in adolescent life[33], both of which involve emotional and physical abuse[34] [23]. Therefore, we hypothesized that childhood trauma and peer victimization may play significant roles in adolescent emotional and behavioral problems.

Although the correlation between childhood trauma and NSSI has been well confirmed in previous studies, to date, few studies have examined the mediating factors and underlying mechanisms of this relationship[35]. One of the existing studies found that adolescents who experienced more childhood abuse were also more likely to report peer victimization. In this prospective study, females who suffered childhood trauma (child sexual abuse) were at increased risk of peer victimization. Still, there is a need to explore in more depth the intrinsic links between childhood trauma, peer victimization, and NSSI. Further, at present, the majority of studies on family relationships, friendships, and NSSI are based on Western samples; these relationships have rarely been explored in the Chinese context. Due to the differences in the construction of society and the influence of traditional culture, there may be important differences between Chinese adolescents’ perceptions of interpersonal relationships and the importance they place on them, as compared to their Western counterparts. The cultural differences between Western and Chinese societies cannot be ignored when exploring the relationships between childhood trauma, peer victimization, and NSSI. In order to explore these relationships in a Chinese sample, this study utilized structural equation modelling (SEM). SEM is a data analysis tool that combines path analysis[36] and the common factor model[37]. It can verify a conceptual model and a study’s research hypotheses by specifying relations among observed entities and hypothesized latent constructs[38]. Latent variable models allow researchers to address research questions that directly compare the viability of dimensional, categorical, and hybrid conceptions of constructs and provide greater validity and generalizability by allowing for the correction of measurement error, as compared to methods based on observed variables[39]. SEM has been widely used as a powerful analysis tool in psychiatric research.

In summary, it was hypothesized that there are links between childhood trauma, peer victimization, and NSSI. Thus, the current study explored the mediation effect of peer victimization on the relationship between childhood trauma and NSSI using SEM.

Participants

The current study used data from the Chinese Adolescent Depression Cohort (CADC). Between December 2020 and December 2021, a total of 1783 adolescents (1464 girls and 318 boys) were recruited from the psychiatric outpatient clinics or wards of 14 psychiatric hospitals or general hospitals in nine provinces in China.

The inclusion criteria included: (1) diagnosis of NSSI according to the DSM-5; (2) aged 12–18 years; (3) ≥ 6 years of education; (4) patient and family members agree to participate in the project and provide written informed consent form. The exclusion criteria included: (1) patients with comorbid severe physical, infectious, and immune system disorders; (2) patients with a history of traumatic brain injury, epilepsy, or other known severe neurological disorders or organic brain disorders; (3) patients with a previous history of severe mental disorders such as schizophrenia or mental retardation (Fig. 1).

The surveys were conducted by trained researchers. Participants were asked to answer the questions truthfully. After completing the survey, the researcher presented the results to the participant and interpreted them accordingly. All participants provided written informed consent before taking part in the study. The study was approved by the Institutional Review Board (IRB) of Shenzhen Kangning Hospital, Ethics Approval No.: 2020-k021-02.

Measures

Functional Assessment of Self-Mutilation (FASM)

The FASM is a widely used tool to assess NSSI among adolescents. It is divided into 11 types of NSSI behavior and 22 functional domains of NSSI components[40]. The FASM was developed by Lloyd et al.[41]. In the current study, the Chinese version of the FASM was used[42], as this is more suitable for Chinese youth. The Cronbach's α for the FASM in this study was 0.65.

Short-form Childhood Trauma Questionnaire (CTQ-SF)

The CTQ scale was developed by Bernstein and Fink to detect experiences of child abuse and neglect[34]. It is divided into five subscales: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. There are 28 questions in total, and each question is scored on a five-point scale, with the total possible score ranging from 28 to 140; higher scores indicate higher levels of trauma exposure[12]. The scale has good reliability; the Cronbach’s α for the CTQ in this study was 0.84. Moreover, the α coefficients for the five sub-scales ranged from 0.70 (physical neglect) to 0.93(sexual abuse), indicating that the scale has good internal consistency.

Multidimensional Peer Victimization Scale (MPVS)

The MPVS was developed by Mynard and Joseph. It is a 16-item self-report scale covering four dimensions of peer victimization: physical victimization, verbal victimization, social manipulation, and attacks on property[43]. Scores on each of the four dimensions range from 0 to 16, with higher scores indicating more incidents of peer victimization. The MPVS has good reliability and is suitable for measuring bullying victimization (internal consistency: Physical victimization = 0.85; Verbal victimization = 0.75; Social manipulation = 0.77; Property attacks = 0.73). The Cronbach’s α for the total MPVS score in this study was 0.89.

Analytic Procedures

The descriptive statistics were compared between the two groups using Welch’s t-tests and Fisher’s exact tests. Preliminary data analyses were conducted using SPSS 22.0 (IBM, Armonk, NY, USA).

Latent variable SEM was adopted to analyze the mediation effect of multidimensional peer victimization on the relationship between childhood trauma and adolescent NSSI. In this model, childhood trauma and peer victimization were considered “latent” variables with five observed variables (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect)[34] and four observed variables (physical victimization, verbal victimization, social manipulation, and attacks on property)[23], respectively. NSSI was estimated as an “observed” variable. A bootstrapping procedure was used to test the direct and indirect effects of the model. The demographic variables age, gender, education, and residence were used as covariates in this study. All modelling procedures were performed using Mplus 8.4.

The fit of the model was tested using chi-square statistic (CMIN), degrees of freedom (df), comparative fit index (CFI), adjusted goodness-of-fit index (AGFI), goodness-of-fit index (GFI), root mean square error of approximation (RMSEA), and Akaike’s Information Criterion[44].

Descriptive Statistics

As can be seen in Table 1, the study cohort comprised 318 males (17.8%) and 1464 females (82.2%), ranging in age from 12 to 18 years (mean ± SD = 14.85 ± 1.82). Overall, 66.4% of participants were from urban areas and 33.6% were from rural areas. Approximately half of the participants were in junior high school (55.8%), 4.3% were in primary school, and 39.9% were in senior high school or above. Most of the participants’ parents had a middle school education or above (father, 86.9%; mother, 77.1%).

Table 1

Sociodemographic characteristics of participants (N = 1782)
Variable	n	%	M	SD	Significant effects (p < 0.05)
Age			14.85	1.82	c, p
Gender					n
Male	318	17.8
Female	1464	82.2
Residence					c, p, n
Urban	1184	66.4
Rural	598	33.6
Education			9.05	1.75	c, p, n
Primary school	77	4.3
Junior high school	994	55.8
Senior high school or above	711	39.9
CTQ			56.02	13.32
MPVS			36.32	17.21
NSSI			23.10	9.12
Note: c = significant childhood trauma group main effect; p = significant peer victimization group main effect; n = significant non-suicide self-injury group main effect;

The mean total CTQ, MPVS, and NSSI scores were 56.02 (± 13.32), 36.32(± 17.21), and 23.10 (± 9.12), respectively. Further, there were significant differences in NSSI, CTQ, and MPVS as a function of age, gender, residence, and education. Specifically, there were significant differences in childhood trauma and peer victimization scores as a function of age, residence, and education, while there were significant differences in NSSI scores as a function of gender, residence, and education. Thus, these demographic variables were included as covariates in the model.

Mediation Analysis

Latent variable SEM was used to test the mediating role of peer victimization in the relationship between childhood trauma and NSSI (Fig. 2). The hypothetical model fit the data well (n = 1,783, CFI = 0.848, TLI = 0.801, RMSEA = 0.086, X2/df = 14.129). The standardized path coefficients from childhood trauma to peer victimization (β = 0.507, p < 0.001) and from peer victimization to NSSI (β = 0.214, p < 0.001) were statistically significant. Moreover, the direct effect of childhood trauma on NSSI was significant (β = 244, p ༜ 0.001). The total effect in this model was 0.353, and the mediating effect was 0.109, which accounted for 30.9% of the total effect. The detailed effect sizes of all pathways in the model are presented in Table 2 It can be seen that peer victimization mediated the relationship between childhood trauma and NSSI and that childhood trauma still directly affected NSSI. Adolescents with traumatic experiences in childhood are more likely to experience greater peer victimization in adolescence, which may lead to increased NSSI.

Table 2

Structural model assessment
	Path	Estimate	S.E.	Est. / S.E.	Standardized 95% CI Low High		P-value
Direct Effect	CTQ→NSSI	0.243	0.032	7.611	0.181	0.327	༜0.001
Indirect Effects	CTQ→MPVS→NSSI	0.109	0.017	6.265	0.075	0.154	༜0.001
Total Effect		0.352	0.026	13.544	0.302	0.404	༜0.001
Indirect effect (%, total indirect effect/total effect)		0.109 (30.9%)

Note

CTQ, Childhood Trauma Questionnaire; MPVS, Multidimensional peer victimization Scale; NSSI, non-suicide self-injury.

NSSI is a common and serious mental health problem among adolescents. With an increasing body of literature investigating the period of adolescence, the impact of early childhood experiences and peer relationship on adolescent problem behaviors is gaining more attention. While several studies have explored the effects of childhood trauma and peer victimization on NSSI[45] [46], the underlying relationships remain unclear. Further, most studies have measured childhood trauma and peer victimization as observable outcomes [47] [48]; however, there are two types of variables: latent variables and observed variables. Latent variables are composed of a series of factor variables that constitute the latent variable, and if latent variables are treated as observed variables and processed directly, biased results may be obtained[49]. Thus, this study constructed a potential structural model to investigate how childhood trauma and peer victimization influence NSSI among Chinese adolescents. The results revealed that childhood trauma indirectly affected NSSI among Chinese adolescents through peer victimization. These results provide a basis for further exploration of the mechanism underlying NSSI in adolescents.

These findings are consistent with prior research indicating that trauma has a significant independent effect on NSSI[50]. Different dimensions of childhood trauma may have different effects on NSSI. Child maltreatment, including emotional abuse, physical abuse, sexual abuse, physical neglect, and emotional neglect, have been confirmed to be significantly associated with NSSI[51] [52] [53] [54], among which, physical and sexual abuse are more likely to increase the risk of suicide attempts[55]. In another study, emotional neglect and emotional abuse were identified as key factors in NSSI[56]. Childhood abuse affects the normal psychological development of adolescents and has been found to be associated with both depressive and NSSI behavior in adolescence[20]. Another study found that traumatic childhood experiences can lead to psychological dysfunction, which can trigger NSSI[57]. Traumatic experiences in childhood not only have profound significance for individual psychological well-being and life quality, but also for the development of cognitive function. Several neurobiological studies have confirmed that individual exposure to childhood trauma may lead to a weakened hypothalamic-adrenal axis response[58], and NSSI has a moderating effect on the relationship between childhood trauma and hypothalamic-pituitary-adrenal axis function[59]. In summary, childhood trauma can cause psychological damage to individuals and can affect the structure and function of the brain, leading to long-lasting effects.

Chinese traditional culture emphasizes one’s moral character, which is formed through the early childhood environment and education. An individual’s thoughts, behaviors, and emotions are inevitably influenced by their past educational environment. In a traditional Chinese story, Mencius' mother moves her residence three times in order to provide a good learning environment for her child, Mencius. Mencius eventually learned six arts and gained a reputation as a Confucian philosopher[60]. On the other hand, there are the sayings ‘Children are what the mothers are’ and ‘Example is better than precept’[61]. This reminds us that children will imitate their parents' habits and patterns of interaction and, to a large extent, will form their own outlook on life using their parents as a model. Children will learn non-adaptive behaviors in the same way, which can affect the establishment of relationships with others. It is worth noting that some children who have suffered childhood abuse are not only more likely to be bullied, but also to become bullies. Studies have found that these children exhibit higher levels of aggression and antisocial behavior[62], which makes them more likely to hurt others or themselves. Several studies have also confirmed that a higher burden of adverse childhood experiences is associated with a higher risk of many adverse health, behavioral, psychological, and social outcomes[63].

In the current study, the latent variable mediation model indicated that childhood trauma can further affect the NSSI of adolescents by influencing their experience of peer victimization. In fact, several scholars have demonstrated that poor childhood experiences (experiencing caregiver mistreatment) are among the strongest predictors of peer victimization outside the home during adolescence and later in adulthood[64] [65] [66] [67]. The first potential explanation for this finding is that children who have experienced childhood trauma will repeat these patterns of interaction from their past family environment in their future interpersonal interactions. D. W. Winnicott, a leading psychologist, argued that the formation and development of interpersonal relationships are largely affected by the relationship between the child and their main caregivers in early childhood[68]. Several recent studies have also reported that childhood trauma (maltreatment) in the family context is associated with later peer victimization[69] [70]. Adolescents who have experienced childhood trauma may generalize the non-adaptive behaviors they learned from childhood to their extra-familial interactions, resulting in them being regarded as targets for bullying by peer groups[71]. Another explanation is that childhood trauma can affect adolescents' perceptions of interpersonal relationships, resulting in inappropriate behavioral responses. The pioneer of object relation theory, Melanie Klein, found that childhood attachment to family not only affects post-adult relationships, but also alters the way an individual feels and reacts when in the presence of negativity[72]. Disorganized-disoriented parent-child attachment patterns shape an insecure avoidant attachment style; an individual with this attachment pattern tends to exhibit characteristics of jealousy, aggression, and sensitivity to negative stimuli in the process of interpersonal communications, which makes them feel unfulfilled and hurt in the relationship[73]. Certain characteristics, like indecisiveness, sensitivity, unconditional compliance, and so on can make a victimized children more likely to be the target of other forms of assault[71].

Previous studies have also noted significant gender differences in the effects of childhood trauma on peer victimization. A prospective study reported that females who suffered child sexual abuse were at increased risk of peer victimization compared to males [74]. However, in the present study, no gender differences were found, which may be due to the unbalanced ratio of males to females in the current study sample. Some studies also found that there are no gender differences in physical violence in childhood trauma, i.e., both boys and girls who are physically abused in childhood are at increased risk of peer intimidation and physical assault in adolescence [75].This could be explored further in future studies.

Peer victimization is a significant predictor of NSSI[76]. In the general stress theory of Agnew, personal pressure or extra-personal stressors can lead to negative emotions and behaviors, and some teenagers could adopt dangerous behaviors such as NSSI in order to release these bad feelings[77] [78]. Moreover, peer victimization is a major source of stress[77], and adolescents who have been bullied often have difficulty adjusting to school or society, which may increase the risk of them engaging in self-hurt behaviors. The interpersonal model proposes that NSSI can be used by teenagers as a negative coping strategy to reduce stress or tension caused by adverse interpersonal events[41]. However, as NSSI increases, peer bullying may be more prevalent and can lead to more subsequent NSSI[79].

Childhood trauma and peer victimization can be seen as injuries from the outside while NSSI, by definition, is a form of self-inflicted injury[80]. Actions play a key role in providing 'meaning' for the feelings[81]; in other words, self-injury behavior reflects, to some extent, the individual’s inner feelings after experiencing external abuse and harm. Hence, an understanding of the interaction between these three types of injury may have important implications for further understanding of the true psychological state of adolescents with NSSI, and thus, appropriate psychological interventions. Although there is still much room for further exploration of the internal mechanisms underlying the connections between the three concepts, several available studies offer potential explanations for the relationships observed in the current study. For example, several recent studies have demonstrated that adolescents who are exposed to negative parents may learn that they are inferior, have vulnerable self-esteem, and may become less able to express their true feelings[82]. Coupled with the experience of peer victimization, this can make it difficult for such adolescents to obtain sufficient social support for their psychological issues, resulting in the adoption of negative coping behaviors, such as NSSI, to express their anger[83]. Studies also indicate that both peer victimization and childhood trauma are associated with negative long-term and short-term psychiatric, educational, and medical outcomes and increased risk of self-injurious behavior[84] [85]. In conclusion, childhood trauma and peer victimization are among the antecedent factors that contribute to the development of NSSI. Thus, it is important that both researchers and clinicians pay attention to the impact of the early environment and current circumstances on the mental health of adolescents. Timely interventions will be needed to shift the trajectory of development in a positive direction, providing beneficial effects on the physical and mental health of adolescents.

In conclusion, this study used SEM to model the relationship between the latent variables of childhood trauma (c1, emotional abuse; c2, physical abuse; c3, sexual abuse; c4, emotional neglect; c5, physical neglect) and peer victimization (p1, physical victimization; p2, verbal victimization; p3, social manipulation; p4, attacks on property). The SEM analysis demonstrated that peer victimization mediates the relationship between childhood trauma and NSSI. In addition, several covariates (such as age, gender, education level, and place of residence) regulated the relationship between peer victimization and NSSI. These results suggest that researchers and clinicians should pay attention to the associations between childhood trauma, peer victimization, and NSSI, as well as the influences of age, gender, education level, and place of residence on adolescent problem behaviors. This may help to inform the development of interventions for adolescent psychological and behavioral problems.

Finally, there are several limitations of this study that should be noted. First, the demographic distribution of the same was uneven; the proportion of female subjects was much larger than that of male subjects, and the proportion of urban subjects was much larger than that of rural subjects. This may have had an impact on the findings and the effects of the covariates. Second, given the cross-sectional design of this study, causal relationships between childhood trauma, peer victimization, and NSSI cannot be inferred. Third, there is a long period of time between childhood and young adulthood, and during this time there are likely many other influences on the development of NSSI that have not been explored in this study. Nonetheless, this study provides an evidence base for further investigation of the risk factors for NSSI. In the future, longitudinal studies should explore the causal mechanisms underlying the influence of childhood trauma on NSSI and the potential roles of other important risk factors.

Acknowledgements

The authors would like to thank Shenzhen Kangning Hospital, the Affiliated Kangning Hospital of Wenzhou Medical University and other 12 psychiatric hospitals or general hospitals in nine provinces in China for their dedication in creating the Chinese Adolescent Depression Cohort (CADC). In addition, we are grateful to participants who actively cooperated with the researchers to collect data.

Authors’ contributions

KZ and ST made great contributions to the conception, design, data acquisition, manuscript writing, and modification of this study. KY, TZ and KZ organized the database. ST conducted the statistical analysis. ST, WY, YX, LH, ZF and JZ were responsible for collecting and pretreating the data. ST and SY wrote the first draft of the manuscript. All authors reviewed the final version of the manuscript.

Funding

This study was supported by Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties (No.SZGSP013) and Shenzhen Science and technology research and Development Fund for Sustainable development project (No.KCXFZ20201221173613036).

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to limitations of ethical approval involving the patient data and anonymity but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study procedures were carried out in accordance with the Declaration of Helsinki. The study was approved by the Institutional Review Board (IRB) of Shenzhen Kangning Hospital, Ethics Approval No. 2020-k021-02. All subjects were informed about the study, and all provided informed consent.

Consent for publication

Not Applicable.

Competing interests

There are no conficts of interest or competing interests associated to this study.

Author details

¹ School of Mental Health, Wenzhou Medical University, Wenzhou, China.

² The Third Hospital of Quzhou, Quzhou, China.

³ The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China.

⁴ The Second People's Hospital of Lishui, Lishui, China.

⁵Shenzhen Mental Health Center, Shenzhen, Guangdong, China.

⁶Shenzhen Kangning Hospital, Shenzhen, Guangdong, China.

Whitlock J, Muehlenkamp J, Eckenrode J, Purington A, Baral Abrams G, Barreira P, Kress V: Nonsuicidal self-injury as a gateway to suicide in young adults. J Adolesc Health 2013, 52(4):486-492.
Kim H, Ryu JM, Kim HW: Characteristics and Trends of Suicide Attempt or Non-suicidal Self-injury in Children and Adolescents Visiting Emergency Department. J Korean Med Sci 2020, 35(33):e276.
Muehlenkamp JJ, Claes L, Havertape L, Plener PL: International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health 2012, 6:10.
Swannell SV, Martin GE, Page A, Hasking P, St John NJ: Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav 2014, 44(3):273-303.
Liu Y, Xiao Y, Ran H, He X, Jiang L, Wang T, Yang RX, Xu X, Yang G, Lu J: Association between parenting and non-suicidal self-injury among adolescents in Yunnan, China: a cross-sectional survey. PeerJ 2020, 8:e10493.
Akram B, Batool M, Rafi Z, Akram A: Prevalence and Predictors of Non-Suicidal Self-Injury among Children with Autism Spectrum Disorder. Pak J Med Sci 2017, 33(5):1225-1229.
Kaess M, Parzer P, Mattern M, Plener PL, Bifulco A, Resch F, Brunner R: Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth. Psychiatry Res 2013, 206(2-3):265-272.
Ballard E, Bosk A, Pao M: Invited commentary: understanding brain mechanisms of pain processing in adolescents' non-suicidal self-injury. J Youth Adolesc 2010, 39(4):327-334.
Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, Sapareto E, Ruggiero J: Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 1994, 151(8):1132-1136.
Brown RC, Plener PL: Non-suicidal Self-Injury in Adolescence. Curr Psychiatry Rep 2017, 19(3):20.
Klonsky ED, Moyer A: Childhood sexual abuse and non-suicidal self-injury: meta-analysis. Br J Psychiatry 2008, 192(3):166-170.
Xiang Z, Liu Z, Cao H, Wu Z, Long Y: Evaluation on Long-Term Test-Retest Reliability of the Short-Form Childhood Trauma Questionnaire in Patients with Schizophrenia. Psychol Res Behav Manag 2021, 14:1033-1040.
Arseneault L, Cannon M, Fisher HL, Polanczyk G, Moffitt TE, Caspi A: Childhood trauma and children's emerging psychotic symptoms: A genetically sensitive longitudinal cohort study. Am J Psychiatry 2011, 168(1):65-72.
Rosenberg SD, Lu W, Mueser KT, Jankowski MK, Cournos F: Correlates of adverse childhood events among adults with schizophrenia spectrum disorders. Psychiatr Serv 2007, 58(2):245-253.
Dale LP, O'Hara EA, Keen J, Porges SW: Infant regulatory disorders: temperamental, physiological, and behavioral features. J Dev Behav Pediatr 2011, 32(3):216-224.
Blackman-Nandi J: Building the Bonds of Attachment: awakening love in deeply traumatized children. Therapy Today 2018, 29(8):17-17.
Schore AN: Attachment and the regulation of the right brain. Attach Hum Dev 2000, 2(1):23-47.
Yates TM, Carlson EA, Egeland B: A prospective study of child maltreatment and self-injurious behavior in a community sample. Dev Psychopathol 2008, 20(2):651-671.
Liu RT, Scopelliti KM, Pittman SK, Zamora AS: Childhood maltreatment and non-suicidal self-injury: a systematic review and meta-analysis. Lancet Psychiatry 2018, 5(1):51-64.
Wen Y, Zhang X, Xu Y, Qiao D, Guo S, Sun N, Yang C, Han M, Liu Z: Cognitive Impairment in Adolescent Major Depressive Disorder With Nonsuicidal Self-Injury: Evidence Based on Multi-indicator ERPs. Front Hum Neurosci 2021, 15:637407.
Taş Torun Y, Gul H, Yaylali FH, Gul A: Intra/interpersonal Functions of Non-suicidal Self-injury in Adolescents with Major Depressive Disorder: The Role of Emotion Regulation, Alexithymia, and Childhood Traumas. Psychiatry 2022, 85(1):86-99.
Wang Q: Association of Childhood Intrafamilial Aggression and Childhood Peer Bullying With Adult Depressive Symptoms in China. JAMA Netw Open 2020, 3(8):e2012557.
Eastman ML, Moore AA, Cecilione J, Hettema JM, Roberson-Nay R: Confirmatory factor structure and psychometric properties of the Multidimensional Peer Victimization Scale. J Psychopathol Behav Assess 2018, 40(4):725-735.
Jantzer V, Haffner J, Parzer P, Resch F, Kaess M: Does parental monitoring moderate the relationship between bullying and adolescent nonsuicidal self-injury and suicidal behavior? A community-based self-report study of adolescents in Germany. BMC Public Health 2015, 15:583.
Demerval R, Cartierre N, Coulon N: The Effects of Family and School Disaffiliation on the Health of Adolescents. 2003.
O'Connor, Rory, C., Kirtley, Olivia, J.: The integrated motivational-volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society of London, Series B Biological Sciences 2018, 373(1754).
Vergara GA, Stewart JG, Cosby EA, Lincoln SH, Auerbach RP: Non-Suicidal self-injury and suicide in depressed Adolescents: Impact of peer victimization and bullying. J Affect Disord 2019, 245:744-749.
Giletta M, Prinstein MJ, Abela JR, Gibb BE, Barrocas AL, Hankin BL: Trajectories of suicide ideation and nonsuicidal self-injury among adolescents in mainland China: Peer predictors, joint development, and risk for suicide attempts. J Consult Clin Psychol 2015, 83(2):265-279.
Claes L, Luyckx K, Baetens I, Van de Ven M, Witteman C: Bullying and Victimization, Depressive Mood, and Non-Suicidal Self-Injury in Adolescents: The Moderating Role of Parental Support. Journal of Child and Family Studies 2015, 24(11):3363-3371.
Moore SE, Norman RE, Suetani S, Thomas HJ, Sly PD, Scott JG: Consequences of bullying victimization in childhood and adolescence: A systematic review and meta-analysis. World J Psychiatry 2017, 7(1):60-76.
Hamamura T, Chen Z, Chan CS, Chen SX, Kobayashi T: Individualism with Chinese characteristics? Discerning cultural shifts in China using 50 years of printed texts. Am Psychol 2021, 76(6):888-903.
Wei M, Su JC, Carrera S, Lin SP, Yi F: Suppression and interpersonal harmony: a cross-cultural comparison between Chinese and European Americans. J Couns Psychol 2013, 60(4):625-633.
Yoo Y, Park HJ, Park S, Cho MJ, Cho SJ, Lee JY, Choi SH, Lee JY: Interpersonal trauma moderates the relationship between personality factors and suicidality of individuals with posttraumatic stress disorder. PLoS One 2018, 13(1):e0191198.
Petrikova M, Kascakova N, Furstova J, Hasto J, Tavel P: Validation and Adaptation of the Slovak Version of the Childhood Trauma Questionnaire (CTQ). Int J Environ Res Public Health 2021, 18(5).
Serafini G, Canepa G, Adavastro G, Nebbia J, Belvederi Murri M, Erbuto D, Pocai B, Fiorillo A, Pompili M, Flouri E et al: The Relationship between Childhood Maltreatment and Non-Suicidal Self-Injury: A Systematic Review. Front Psychiatry 2017, 8:149.
Wright S: The method of path coefficient analysis. 1934.
Sellbom M, Tellegen A: Factor analysis in psychological assessment research: Common pitfalls and recommendations. Psychol Assess 2019, 31(12):1428-1441.
Brandmaier AM, von Oertzen T, McArdle JJ, Lindenberger U: Structural equation model trees. Psychol Methods 2013, 18(1):71-86.
Miettunen J, Nordström T, Kaakinen M, Ahmed AO: Latent variable mixture modeling in psychiatric research--a review and application. Psychol Med 2016, 46(3):457-467.
Young R, Sproeber N, Groschwitz RC, Preiss M, Plener PL: Why alternative teenagers self-harm: exploring the link between non-suicidal self-injury, attempted suicide and adolescent identity. BMC Psychiatry 2014, 14:137.
Lloyd-Richardson EE, Perrine N, Dierker L, Kelley ML: Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med 2007, 37(8):1183-1192.
Qu D, Wang Y, Zhang Z, Meng L, Zhu F, Zheng T, He K, Zhou Y, Li C, Bu H et al: Psychometric Properties of the Chinese Version of the Functional Assessment of Self-Mutilation (FASM) in Chinese Clinical Adolescents. Front Psychiatry 2021, 12:755857.
Mynard H, Joseph S: Development of the multidimensional peer-victimization scale. Aggressive Behavior 2000, 26(2):169-178.
Schermelleh-Engel K, Kerwer M, Klein AG: Evaluation of model fit in nonlinear multilevel structural equation modeling. Front Psychol 2014, 5:181.
Modrowski CA, Chaplo SD, Kerig PK, Mozley MM: Trauma exposure, posttraumatic overmodulation and undermodulation, and nonsuicidal self-injury in traumatized justice-involved adolescents. Psychol Trauma 2019, 11(7):743-750.
Stewart JG, Valeri L, Esposito EC, Auerbach RP: Peer Victimization and Suicidal Thoughts and Behaviors in Depressed Adolescents. J Abnorm Child Psychol 2018, 46(3):581-596.
Wang X, Yang J, Wang P, Zhang Y, Li B, Xie X, Lei L: Deviant Peer Affiliation and Bullying Perpetration in Adolescents: The Mediating Role of Moral Disengagement and the Moderating Role of Moral Identity. J Psychol 2020, 154(3):199-213.
Zhang L, Ma X, Yu X, Ye M, Li N, Lu S, Wang J: Childhood Trauma and Psychological Distress: A Serial Mediation Model among Chinese Adolescents. Int J Environ Res Public Health 2021, 18(13).
Bollen KA: Latent variables in psychology and the social sciences. Annu Rev Psychol 2002, 53:605-634.
Barbosa LP, Quevedo L, da Silva Gdel G, Jansen K, Pinheiro RT, Branco J, Lara D, Oses J, da Silva RA: Childhood trauma and suicide risk in a sample of young individuals aged 14-35 years in southern Brazil. Child Abuse Negl 2014, 38(7):1191-1196.
Brown RC, Heines S, Witt A, Braehler E, Fegert JM, Harsch D, Plener PL: The impact of child maltreatment on non-suicidal self-injury: data from a representative sample of the general population. BMC Psychiatry 2018, 18(1):181.
Martin J, Bureau JF, Yurkowski K, Fournier TR, Lafontaine MF, Cloutier P: Family-based risk factors for non-suicidal self-injury: Considering influences of maltreatment, adverse family-life experiences, and parent-child relational risk. J Adolesc 2016, 49:170-180.
Vieira AI, Machado BC, Moreira CS, Machado PPP, Brandão I, Roma-Torres A, Gonçalves S: Eating disorders and non-suicidal self-injury: Structural equation modelling of a conceptual model. Eur Eat Disord Rev 2018, 26(5):431-437.
Paul E, Ortin A: Correlates of Suicidal Ideation and Self-harm in Early Childhood in a Cohort at Risk for Child Abuse and Neglect. Arch Suicide Res 2019, 23(1):134-150.
Guvendeger Doksat N, Zahmacioglu O, Ciftci Demirci A, Kocaman GM, Erdogan A: Association of Suicide Attempts and Non-Suicidal Self-Injury Behaviors With Substance Use and Family Characteristics Among Children and Adolescents Seeking Treatment for Substance Use Disorder. Subst Use Misuse 2017, 52(5):604-613.
Thomassin K, Shaffer A, Madden A, Londino DL: Specificity of childhood maltreatment and emotion deficit in nonsuicidal self-injury in an inpatient sample of youth. Psychiatry Res 2016, 244:103-108.
Huang C, Yuan Q, Ge M, Sheng X, Yang M, Shi S, Cao P, Ye M, Peng R, Zhou R et al: Childhood Trauma and Non-suicidal Self-Injury Among Chinese Adolescents: The Mediating Role of Psychological Sub-health. Front Psychiatry 2022, 13:798369.
Klaassens ER, van Noorden MS, Giltay EJ, van Pelt J, van Veen T, Zitman FG: Effects of childhood trauma on HPA-axis reactivity in women free of lifetime psychopathology. Prog Neuropsychopharmacol Biol Psychiatry 2009, 33(5):889-894.
Reichl C, Heyer A, Brunner R, Parzer P, Völker JM, Resch F, Kaess M: Hypothalamic-pituitary-adrenal axis, childhood adversity and adolescent nonsuicidal self-injury. Psychoneuroendocrinology 2016, 74:203-211.
孙德善, 段波: "孟母三迁"与环境育人的思考. 三峡大学学报：人文社会科学版 2001, 23(4):3.
吴景荣: 新时代汉英大词典 = New Age Chinese-English Dictionary: 新时代汉英大词典 = New Age Chinese-English Dictionary; 2000.
Wodarski JS, Kurtz PD, Gaudin JM, Jr., Howing PT: Maltreatment and the school-age child: major academic, socioemotional, and adaptive outcomes. Soc Work 1990, 35(6):506-513.
Sonu S, Post S, Feinglass J: Adverse childhood experiences and the onset of chronic disease in young adulthood. Prev Med 2019, 123:163-170.
Bowes L, Maughan B, Ball H, Shakoor S, Ouellet-Morin I, Caspi A, Moffitt TE, Arseneault L: Chronic bullying victimization across school transitions: the role of genetic and environmental influences. Dev Psychopathol 2013, 25(2):333-346.
Classen CC, Palesh OG, Aggarwal R: Sexual revictimization: a review of the empirical literature. Trauma Violence Abuse 2005, 6(2):103-129.
Lereya ST, Wolke D: Prenatal family adversity and maternal mental health and vulnerability to peer victimisation at school. J Child Psychol Psychiatry 2013, 54(6):644-652.
Widom CS, Czaja SJ, Dutton MA: Childhood victimization and lifetime revictimization. Child Abuse Negl 2008, 32(8):785-796.
Dell'Orto S, Caruso E: [W. D. Winnicott and the transitional object in infancy]. Pediatr Med Chir 2003, 25(2):106-112.
Martín-Babarro J, Toldos MP, Paredes-Becerra L, Abregu-Crespo R, Fernández-Sánchez J, Díaz-Caneja CM: Association of Different Forms of Child Maltreatment With Peer Victimization in Mexican Children and Adolescents. Front Psychol 2021, 12:662121.
Cunningham S, Goff C, Bagby RM, Stewart JG, Larocque C, Mazurka R, Ravindran A, Harkness KL: Maternal- versus paternal-perpetrated maltreatment and risk for sexual and peer bullying revictimization in young women with depression. Child Abuse Negl 2019, 89:111-121.
Lereya ST, Samara M, Wolke D: Parenting behavior and the risk of becoming a victim and a bully/victim: a meta-analysis study. Child Abuse Negl 2013, 37(12):1091-1108.
Spanish AI: [Our adult world and its roots in childhood]. Rev Psicoanal 1961, 18.
KLEIN: On the development of mental functioning. The International journal of psycho-analysis 2000.
Kennedy RS, Font SA, Haag AC, Noll JG: Childhood Sexual Abuse and Exposure to Peer Bullying Victimization. J Interpers Violence 2022, 37(19-20):Np18589-np18613.
Benedini KM, Fagan AA, Gibson CL: The cycle of victimization: The relationship between childhood maltreatment and adolescent peer victimization. Child Abuse Negl 2016, 59:111-121.
Wolff J, Frazier EA, Esposito-Smythers C, Burke T, Sloan E, Spirito A: Cognitive and social factors associated with NSSI and suicide attempts in psychiatrically hospitalized adolescents. J Abnorm Child Psychol 2013, 41(6):1005-1013.
Jennings WG, Maldonado-Molina MM, Reingle J: General Strain Theory. In: Encyclopedia of Adolescence. edn. Edited by Levesque RJR. New York, NY: Springer New York; 2011: 1158-1162.
Walters GD, Espelage DL: From victim to victimizer: Hostility, anger, and depression as mediators of the bullying victimization-bullying perpetration association. J Sch Psychol 2018, 68:73-83.
Kim YS, Leventhal BL, Koh YJ, Boyce WT: Bullying increased suicide risk: prospective study of Korean adolescents. Arch Suicide Res 2009, 13(1):15-30.
Wang Y, Zhou X, Cao B, Chen L, Wang R, Qi L, Meng L, Zeng L, Liu X, Wang W et al: The psychological characteristics and risk factors of suicidal attempt among mood disorders adolescents accompany with non-suicidal self-injury: A multi-center study. J Affect Disord 2022, 298(Pt A):301-307.
Bernroider G, Panksepp J: Mirrors and feelings: have you seen the actors outside? Neurosci Biobehav Rev 2011, 35(9):2009-2016.
Dong H, Zhang W: The Impact of Family on Bullies and Victims. Journal of Shandong Normal University(Social Science Edition) 2005.
Kim Y, Lee H, Park A: Patterns of adverse childhood experiences and depressive symptoms: self-esteem as a mediating mechanism. Soc Psychiatry Psychiatr Epidemiol 2022, 57(2):331-341.
Green JG, McLaughlin KA, Berglund PA, Gruber MJ, Sampson NA, Zaslavsky AM, Kessler RC: Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry 2010, 67(2):113-123.
Takizawa R, Maughan B, Arseneault L: Adult health outcomes of childhood bullying victimization: evidence from a five-decade longitudinal British birth cohort. Am J Psychiatry 2014, 171(7):777-784.

No competing interests reported.

Download PDF

Journal Publication

published 15 Jun, 2023

Read the published version in BMC Psychiatry →

Editorial decision: Major revision
08 Feb, 2023
Reviews received at journal
04 Feb, 2023
Reviewers agreed at journal
27 Jan, 2023
Reviewers invited by journal
20 Jan, 2023
Editor assigned by journal
06 Jan, 2023
Editor invited by journal
06 Jan, 2023
Submission checks completed at journal
06 Jan, 2023
First submitted to journal
04 Jan, 2023

You are reading this latest preprint version

Childhood trauma, peer victimization, and non-suicidal self-injury among Chinese adolescents: A latent variable mediation analysis

Status:

Journal Publication

Version 1

Abstract

Figures

Introduction

Methods

Participants

Measures

Functional Assessment of Self-Mutilation (FASM)

Short-form Childhood Trauma Questionnaire (CTQ-SF)

Multidimensional Peer Victimization Scale (MPVS)

Analytic Procedures

Results

Descriptive Statistics

Mediation Analysis

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1