Childhood trauma and depressive level among non-clinical Chinese college students: the roles of rumination and perceived stress

doi:10.21203/rs.3.rs-2456088/v1

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Childhood trauma and depressive level among non-clinical Chinese college students: the roles of rumination and perceived stress

https://doi.org/10.21203/rs.3.rs-2456088/v1

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Background: Childhood trauma is one of major risk factors to depression, and the incidence of depression among college students has been increasing. Previous studies have validated the effect of childhood trauma on depressive level. But few studies based on the Diathesis-stress theory to investigate the role of perceived stress in the pathway between childhood trauma and depressive level, as well as considering the role of rumination.

Methods: We recruited 995 non-clinical Chinese college students and ask them to finish four self-report questionnaires, including Childhood Trauma Questionnaire-Short Form (CTQ-SF), Perceived Stress Scale (PSS), the 22-item Ruminative Responses Scale (RSS-22), and Beck Depression Scale-II (BDI-II). Then we conducted the multiple mediation analyses and multiple linear regression analyses.

Results: Results revealed that perceived stress played a mediation role between childhood trauma and depressive level, and rumination played a moderation role between childhood trauma and perceived stress and between childhood trauma and depressive level.

Limitations: This is a cross-sectional study and based on subjective reports of measures.

Conclusions: These findings provided multi-dimensional indications for reducing the effect of childhood trauma on depressive level in college students, which would help them to improve their mental health.

Childhood trauma

Depressive level

Rumination

Perceived stress

Chinese college students

Depression is one of the most common causes of disability around the world and it is estimated that more than 350 million people suffer from it according to the World Health Organization (Smith and De Torres, 2014). In college student, more than one half have one or more mental disorders (Zivin et al., 2009), and depression is one of the most common ones (Auerbach et al., 2018), which is also true in China (Gao et al., 2020; Ibrahim et al., 2013). Depression in college students may not only influence their academic attainments (Kessler et al., 2014), but also affect their interpersonal relationship (Cox et al., 2020), and worse, may lead to suicide (Ho et al., 2021). Therefore, given the high prevalence and serious consequences of depression, it is necessary to identify its influential factors among college students.

In college students, previous studies (Tao et al., 2021; Wang et al., 2020) indicated that childhood trauma is correlated with the risk of depression, and some studies (Chu et al., 2022; Li et al., 2021; Mall et al., 2018) further found that childhood trauma could predict depression. For the mechanism of this effect, some studies (Hammen et al., 2000; Kendler et al., 2004; LeMoult et al., 2020) found that individuals who experienced trauma were more sensitive to future adversity or negative events, and thus, some minor events may also trigger their depressive reactions. In other words, childhood trauma, a distal stressor, would increase individuals’ sensitivity for stress, which would then lower their threshold to suffer from depression (Heim et al., 2008). These findings were consistent with the Diathesis-stress theory (Monroe and Simons, 1991), which revealed that stress may activate a vulnerability, and in turn raise the prevalence of depression (Hammen et al., 2000). In total, these studies mentioned above revealed a fact that individuals with childhood trauma may have a potential characteristic of vulnerability, which may be activated by daily stress and further increase the risk of depression. Thus, the stress may play a vital role in the relationship between childhood trauma and depressive level.

College students are stressful because they are facing lots of pressure, such as continuing study pressure, family pressure, or employment pressure (Acharya et al., 2018; Maykrantz and Houghton, 2020). Meanwhile, high levels of stress also could affect students’ interest in learning (Pereira S., 2019), general health, physical function (Heruti et al., 2018) and even increase their depressive levels (Brown et al., 1987; Hammen, 2005; Slavich and Irwin, 2014). Further, consistent with the theory of Diathesis-stress mentioned above, many studies on stress have suggested that individuals who have adversity experiences in childhood may have higher perceived stress levels, which might increase the risk of depression (Mishra et al., 2020; Sousa et al., 2018; Weissman et al., 2020). Meanwhile, some studies have validated the mediation role of stress between different types of childhood trauma and depressive level in various populations. A longitudinal study (Sousa et al., 2018) indicated that cumulative environmental stress mediated the relationship between cumulative child abuse and depressive symptoms no matter individuals were at 8, 18 or 36 years old. Two previous studies (Mayer et al., 2021; Vranceanu et al., 2007) on women showed that daily stress mediated the relationship between childhood maltreatment and depression. Another study (Aura et al., 2020) on middle age has discovered that perceived stress partially mediated the relationship between child maltreatment and depressive symptoms. Besides, a study (Zheng et al., 2022) on clinical patients evidenced that daily stress partially mediated the association between childhood trauma and depression. For college students, only a study (Kelifa et al., 2020) in Eritrea found that stress events partially mediated the relationship between child abuse and depressive symptoms. However, few studies focused on the mediation role of perceived stress between childhood trauma and depressive level among Chinese college students. Perceived stress refers to a subjective evaluation and assessment of the stress level for an objective event that individuals experienced (Cohen et al., 1983). Previous studies (Ravindran, Matheson, Griffiths, Merali, & Anisman, 2002) suggested that individuals with higher perceived stress levels would report more depressive symptoms than those with lower perceived stress levels when faced with the same stress event, which means that perceived stress may determine the severity and impact of stress.

Nevertheless, some studies (Chang et al., 2021; Watters, et al., 2021) discovered that individuals who had childhood traumatic experiences may not report more symptoms of depression. Thus, there may be a moderation factor in the relationship between childhood trauma and depression. Rumination was defined as ‘the process of thinking about one’s negative and distressing feelings and bad consequences repeatedly and passively, rather than actively solving problems’ (Nolen-Hoeksema, 1991). Many previous studies (Deguchi et al., 2021; Kim et al., 2017; Mansueto et al., 2021; Munoz and Hanks, 2021) have revealed that rumination was correlated with childhood trauma and depression. Specifically, firstly, several studies (Deguchi et al., 2021; Mansueto et al., 2021; Munoz and Hanks, 2021) discovered that rumination may be more common in individuals with childhood traumatic experiences, which means that individuals with childhood traumatic experiences were more likely to have a ruminative tendency. Secondly, a study (Ruscio et al., 2015) on Philadelphia community and students of a private university showed that individuals who reported higher levels of rumination during a stressful event would report higher levels of depressive symptoms in the following days and weeks. Thirdly, previous studies (Deguchi et al., 2021; Kim et al., 2017; Raes and Hermans, 2008) have found that rumination mediated the relationship between childhood trauma and depression, that is higher childhood traumatic experiences lead to higher depressive levels via increasing their rumination levels. In total, these studies above emphasized the positive correlations between higher rumination level with childhood traumatic experience and depression, while the correlations between lower rumination level with childhood traumatic experience and depression were not clear. In other words, it is not clear whether high and low rumination levels can bring the different effects of childhood trauma on depression. Thus, it is necessary to investigate the moderation role of rumination in the pathway between childhood trauma and depressive level to compare the roles of high and low rumination level.

Based on the Diathesis-stress theory and the above studies, this study aimed to set up a comprehensive model to investigate the possible pathway between childhood trauma and depressive level in non-clinical Chinese college students, focusing on the role of perceived stress and rumination. Specifically, this study hypothesized that perceived stress played a mediation role between childhood trauma and depressive level (Hypothesis 1); and rumination played a moderation role in the pathway between childhood trauma and depressive level (Hypothesis 2).

2.1 Participants

A total of 1,212 college students were recruited from universities in Guangzhou, China from October to December 2021. The study was approved by the ethical committee of the School of Public Administration in Guangdong University of Foreign Studies, and written informed consent was obtained from each participant. For all participants, they were asked to fulfill four questionnaires according to their real situation, and were paid for their participation. One participant would be excluded from this study if they met one of these following criteria: (1) The answer time was below the average time (4 min); (2) The answers of items in the questionnaires conflicted or contradicted with each other obviously; (3) The answers of polygraph questions were completely inconsistent (The polygraph question was set up to repeat an item at a certain interval of time to test whether the participants' choice was consistent). At last, 995 participants (306 males and 689 females) were included in this study and participants were between 19 and 26 years old (SD = 1.99; M = 19.89).

2.2 Measures

2.2.1 Childhood Trauma Questionnaire-Short Form

The Childhood Trauma Questionnaire-Short Form (CTQ-SF) was used to evaluate traumatic experiences before 16 years old (Bernstein et al., 2003). The scale was a 28-item (including 25 clinical items and 3 valid items) self-report scale which contained five subscales: emotional neglect, physical neglect, sexual abuse, emotional abuse, and physical abuse. Each item was presented in a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always). The total score of this scale ranged from 25 to 125, with higher score indicating greater level of abuse or neglect experienced by the participant. The Chinese version of CTQ-SF has been proven to have high internal reliability and test-retest reliability (Li et al., 2021; He et al., 2019). The Cronbach’s alpha of the CTQ-SF in this study was 0.87.

2.2.2 Perceived Stress Scale

The Perceived Stress Scale (PSS) was used to assess the college students’ perceived stress in the last month (Cohen et al., 1983). It was a self-report scale including 14 items and adopted a 5-point Likert scale, ranging from 0 (almost never) to 4 (almost always). The total score of this score ranged from 0 to 56, with higher score indicating greater level of perceived stress of the participant (Remor, 2006). The Chinese version of PSS has been validated to be a reliable and valid measurement in rating stress among college students (Huang et al., 2020). Its Cronbach’s alpha coefficient in this study was 0.86.

2.2.3 The 22-item Ruminative Responses Scale

The 22-item Ruminative Responses Scale (RRS-22), a self-report rumination measure, was mainly used to measure how often one participant think or do each item when they are feeling down, sad, or depressed (e.g., “Think why do I have problems other people do not have?”) (Nolen-Hoeksema and Morrow, 1991). The scale consisted of 22 items, which was rated on a 4-point Likert scaling from 1 (almost never) to 4 (almost always), with higher score indicating higher frequency of ruminative tendencies (Schoofs et al., 2010). Previous studies (Liu et al., 2017; Wang et al., 2011) have shown that the Chinese version of the RRS-22 has excellent convergent validity and internal consistency. Its Cronbach’s alpha in this study was 0.93.

2.2.4 Beck Depression Inventory-II

The Beck Depression Inventory-II (BDI-II), a widely used measurement of depressive symptoms, was primarily used to rate participants’ depressive symptoms and their severity in the past seven days (Beck, Steer, Ball, and Ranieri, 1996; Bjelland, Dahl, Haug, and Neckelmann, 2002). The scale consisted of 21 items with a 4-point response scale ranging from 0 (almost never) to 3 (almost always). The total score of this scale ranged from 0 to 63 with higher score indicating higher severity of depression (Beck et al., 1996). Previous studies (Sun et al., 2017; Wang et al., 2021) have demonstrated that the Chinese version of the BDI-II has excellent reliability and validity. The Cronbach’s alpha of BDI-II in this study was 0.88.

2.2.5 Statistical analysis

According to the data of all samples included in this study, SPSS 25.0 and a PROCESS macro were used for data analysis. First of all, descriptive analyses and correlation analyses were used to examine the relationship among all variables. Then, multiple mediation analyses were conducted to test the mediation effect of perceived stress between childhood trauma and depressive level with gender and age as covariates. Further, multiple linear regression analyses were used to assess the moderation effects of rumination between childhood trauma and perceived stress as well as between childhood trauma and depressive level. In this study, childhood trauma was an independent variable (X), perceived stress was a mediation variable (M), rumination was a moderation variable (W), and depressive level was a dependent variable (Y). Besides, 95% confidence interval based on 5,000 bootstrap times was used to obtain accurate confidence limits.

3.1 Common method of deviation test

All variables in this study were collected by self-report questionnaires which may pose the risk of common method bias. Therefore, Harman's single factor test was used to conduct exploratory factor analyses on all variables. The results extracted 22 factors with a characteristic of value greater than 1. The maximum factor variance explained 21.52%, which was far less than 40%. Thus, the influence of common method deviations on the results of this study can be excluded.

3.2 Correlation analyses

As shown in Table 1, significant correlations were found among childhood trauma, perceived stress, rumination, and depressive level. Specifically, childhood trauma was positively correlated with depressive level (r = 0.28, p < 0.01), perceived stress (r = 0.18, p < 0.01), and rumination (r = 0.17, p < 0.01). Meanwhile, depressive level was positively correlated with perceived stress (r = 0.65, p < 0.01), and rumination (r = 0.53, p < 0.01). Besides, perceived stress was also positively correlated with rumination (r = 0.48, p < 0.01). Other related relationships could be found in Table 1.

Table 1

Means, standard deviations, and correlations of all variables in this study.
	Mean	SD	1	2	3	4	5
1. Gender	-	-	-
2. Age	19.89	1.99	-0.12^**	-
3. Childhood Trauma	1.71	0.47	0.03	-0.05	-
4. Depressive Level	1.44	0.38	0.02	0.03	0.28^**	-
5. Perceived Stress	2.66	0.59	0.04	0.02	0.18^**	0.65^**	-
6. Rumination	2.24	0.56	0.08^**	-0.01	0.17^**	0.53^**	0.48^**
Notes: N = 995. SD, standard deviations. ^**p < 0.01.

3.3 Mediation effect test

The Model 4 of the PROCESS macro (Hayes, 2017) was used to test the mediation effect between childhood trauma and depressive level, which were shown in Fig. 1 and Table 2. As shown in Table 2, in the first step (Model 1), the positive predictive effect of childhood trauma on depressive level was significant (β = 0.22, p < 0.001); in the second step (Model 2), childhood trauma had a significant positive predictive effect on perceived stress (β = 0.23, p < 0.001); and in the third step (Model 3), perceived stress had a significant positive predictive effect on depressive level (β = 0.40, p < 0.001). Moreover, when the mediation variable was added, the direct predictive effect of childhood trauma on depressive level was still significant, as shown in Model 3 (β = 0.13, p < 0.001). In addition, the corresponding 95% confidence interval for the direct influence path from childhood trauma to depressive level and the mediation effect of perceived stress were [0.09, 0.17] and [0.06, 0.12], excluding 0, which indicated that its direct effect and mediation effect were both significant. The mediation effect accounted for 41.06% of the total effect, which suggested that perceived stress played a partial mediation role in the relationship between childhood trauma and depressive level.

Table 2

Testing the mediation effect of childhood trauma on depressive level.
Variables	Model 1 (Y)			Model 2 (M)			Model 3 (Y)
	β	SE	95%CI	β	SE	95%CI	β		SE	95%CI
Independent Variables
X	0.22^***	0.03	0.18, 0.27	0.23^***	0.04	0.15, 0.31	0.13^***		0.02	0.10, 0.17
Mediator
M							0.40^***		0.02	0.37, 0.43
Gender	0.02	0.03	-0.03, 0.07	0.04	0.04	-0.04, 0.12	0.00		0.02	-0.04, 0.04
Age	0.01	0.01	-0.01, 0.02	0.01	0.01	-0.01, 0.03	0.01		0.00	-0.00, 0.01
R²	0.08^***			0.04^***				0.45^***
F	28.38			12.22				201.54
Notes: β, standardized regression coefficient; SE, standard error; 95% CI, the lower and upper limit of 95% confidence interval; X, childhood trauma; M, perceived stress; Y, depressive level. All the coefficients were standardized. ^*** p < 0.001.

3.4 Moderated mediation effect test

The results on the moderation role of rumination were displayed in Fig. 1 and Table 3. As shown in Table 3, we can see the significant interaction effects between childhood trauma and rumination on perceived stress (β = -0.17, SE = 0.06, p < 0.01, 95% CI = [-0.28, -0.06]) and on depressive level (β = 0.10, SE = 0.03, p < 0.01, 95% CI = [0.04, 0.15]). Specifically, rumination not only moderated the association between childhood trauma and perceived stress (β = 0.50, t = 16.61, p < 0.001), but also moderated the relationship between childhood trauma and depressive level (β = 0.18, t = 10.22, p < 0.001). This study calculated the simple slopes to test whether childhood trauma was associated with perceived stress and depressive level at one SD below the mean and one SD above the mean of rumination (Fig. 2a and Fig. 2b). Firstly, as shown in Fig. 2a, simple slope test showed that compared with those college students who have a higher level of rumination, the positive link between childhood trauma and perceived stress was stronger when college students had a lower level of rumination (β_simple = 0.24, t = 4.90, p < 0.001). However, for individuals with high levels of rumination, the relationship between childhood trauma and depressive level was non-significant (β_simple = 0.05, t = 1.23, p = 0.22). These results indicated that the indirect effect of childhood trauma on perceived stress was moderated by low levels of rumination. Secondly, as shown in Fig. 2b, simple slope test suggested that childhood trauma was associated with depressive level no matter individuals’ levels of rumination were low or high, but the predictive function of childhood trauma on depressive level was stronger for individuals with high levels of rumination (β_simple = 0.16, t = 6.98, p < 0.001) than individuals with low levels of rumination (β_simple = 0.05, t = 2.11, p < 0.05).

Table 3

Results of moderated regression analyses for predicting perceived stress and depressive level.
Variables	M			Y
	β	SE	95%CI	β	SE	95%CI
Independent Variables
X	0.15^***	0.04	0.08, 0.22	0.11^***	0.02	0.07, 0.14
Mediator
M				0.32^***	0.02	0.29, 0.35
Moderator
W	0.50^***	0.03	0.44, 0.56	0.18^***	0.02	0.14, 0.21
Interaction Term
X*W	-0.17^**	0.06	-0.28, -0.06	0.10^**	0.03	0.04, 0.15
Gender	-0.01	0.04	-0.08, 0.06	-0.01	0.02	-0.05, 0.02
Age	0.01	0.01	-0.01, 0.02	0.01	0.00	-0.00, 0.01
R²	0.25^***			0.51^***
F	64.89			172.33
Notes: β, standardized regression coefficient; SE, standard error; 95% CI, the lower and upper limit of 95% confidence interval; X, childhood trauma; M, perceived stress; W, rumination; Y, depressive level. All the coefficients were standardized. ^* p < 0.001; ^ p < 0.01.
Ravindran, A. V., Matheson, K., Griffiths, J., Merali, Z., & Anisman, H. (2002). Stress, coping, uplifts, and quality of life in subtypes of depression: a conceptual frame and emerging data. J Affect Disord, 71(1–3), 121–130.
Rocha, H. A., Sudfeld, C. R., Leite, Á. J., Rocha, S. G., Machado, M. M., Campos, J. S.,. .. Correia, L. L. (2021). Adverse childhood experiences and child development outcomes in Ceará, Brazil: a population-based study. American journal of preventive medicine, 60(4), 579–586.

In addition, a study (Preacher et al., 2007) suggested that when the direct and indirect pathways connecting independent and dependent variables were moderated by a variable, the direct and indirect effects of these pathways were also moderated by this variable. Therefore, the direct and indirect effects of childhood trauma on depressive level were also moderated by rumination. In other words, the indirect and direct effects of childhood trauma on depressive level were both significant for a lower level of rumination, the indirect effect of childhood trauma on depressive level through perceived stress was significant (β = 0.08, SE = 0.02, 95% CI = [0.04, 0.11]); similarly, the direct effect of childhood trauma on depressive level also was significant (β = 0.05, SE = 0.03, 95% CI = [0.00, 0.11]). In addition, for a higher level of rumination, the direct effect was significant (β = 0.16, SE = 0.02, 95% CI = [0.12, 0.21]); while the indirect effect was not significant (β = 0.02, SE = 0.01, 95% CI = [− 0.01, 0.05]).

This study constructed a moderated mediation model to analyze the possible pathways between childhood trauma and depressive level in non-clinical Chinese college students with considering the mediation role of perceived stress and the moderation role of rumination. Results first revealed that perceived stress mediated the relationship between childhood trauma and depressive level, which supported the Hypothesis 1. Results also indicated that rumination moderated the influence of childhood trauma on perceived stress and on depressive level, which supported the Hypothesis 2.

As predicted, this study first validated the negative effect of childhood trauma on depressive level in college students (Table 1 and Fig. 1), which means that those with childhood traumatic experiences were more likely to report high depressive levels. This result was consistent with prior studies focusing on other populations, such as college students in African (Mall et al., 2018) and Eritrea (Kelifa et al., 2020), adolescents (Copeland et al., 2021), adults (Poole et al., 2017; Sheikh, 2018; Stern and Thayer, 2019), elders (Xiang and Wang, 2021), or clinical patients (Huh et al., 2017). The possible reason for this maybe that individuals who with traumatic experiences possessed more negative emotions, distorted cognition or personality deficits, which might lead to a social and psychological vulnerability in children (Wang et al., 2018). Neurobiologically, the reason maybe that the experience of childhood trauma can reduce individuals’ volume of gray matter in the frontal lobe, which may hinder their developmental processes and further lead to cognitive or personality deficits (Begemann et al., 2021). Thus, the childhood trauma may be a stable and significant predictive factor of the prevalence of depression, which required us to pay more attention to the effects of childhood trauma on depression and further take measures to prevent and intervene depression.

Meanwhile, our results revealed that perceived stress mediated the relationship between childhood trauma and depressive level (Table 2), which was in line with previous studies (Hazel et al., 2008; Kelifa et al., 2020; Aura et al., 2020). In other words, childhood trauma would result in individuals’ depression by enhancing their sensitivity to stress or heightening their perceived stress levels (Betz et al., 2021; Hammen et al., 2000; Seitz et al., 2019). The potential reason for this maybe that high sensitivity to stress was conceptualized as lasting functional adaptations to childhood trauma, constituting a potential mechanism by which childhood trauma would induce some mental illness, including anxiety and depression disorders (Betz et al., 2021; Isvoranu et al., 2016). Neurobiologically, the reason for this maybe that individuals with early adverse experiences would lead to lasting changes in hippocampus (Teicher et al., 2012; Weissman et al., 2020) and amygdala (Hoy et al., 2012; Nogovitsyn et al., 2020), which may lead to the breakdown of their stress regulation mechanisms and lower their thresholds for future stressors (McLaughlin, 2016; McLaughlin et al., 2010). Based on these studies above, we could find that distal trauma was an important and remarkable predictor for proximal stress levels, both of which can result in depression. These findings could be explained by the theory of Diathesis-stress, proposing that psychological or social stress could act on a vulnerability to trigger depressive symptoms (Zheng et al., 2022). In other words, childhood trauma hindered the development of children's self-structuring and enhanced their psychological susceptibility to future stressors, which would lead to more depressive symptoms (Rocha et al., 2021). In total, our results revealed that childhood trauma affected depression not only directly but also indirectly through perceived stress, which reminded us to pay more attention to the perceived stress when taking measures to alleviate the effects of childhood trauma on depression.

In addition, this study also discovered that rumination not only moderated the link between childhood trauma and perceived stress (Fig. 2a and Table 3) but also moderated the association between childhood trauma and depressive level (Fig. 2b and Table 3). Rumination was characterized by repetitive negative thinking, which might result in various forms of mental health problems, such as anxiety, depression, and even self-injurious behaviors (Aldao et al., 2010; Hilt et al., 2008; Verstraeten et al., 2011). Previous studies (Aldao et al., 2010; Deguchi et al., 2021) have discovered that individuals with traumatic experiences in childhood would report higher levels of rumination in adulthood. This was because that they viewed rumination as a regulation strategy trying to understand their negative emotions and solve their mental problems. But, in fact, rumination was more likely to lead to an opposite effect, creating a vicious cycle of negative thinking that led to increased emotional and depressive disorders (Mansueto et al., 2021). Previous studies have confirmed that rumination can heighten individuals’ sensitivity to stress (Ruscio et al., 2015; Verkuil et al., 2010), and ultimately lead to higher levels of depressive symptoms (Munoz and Hanks, 2021; Rushton et al., 2002). In our study, on the one hand, we detected the moderation role of rumination between childhood trauma and perceived stress (Fig. 2a). First of all, individuals who reported higher levels of both childhood trauma and rumination possessed the highest levels of perceived stress, suggesting that both of them had huge negative impact on perceived stress (Karatekin and Ahluwalia, 2020; Kovács et al., 2021). Secondly, individuals who reported relatively lower levels of childhood trauma while relatively higher levels of rumination also reported higher levels of perceived stress, which indicated that, compared with childhood trauma, rumination may have a greater negative impact on perceived stress. And finally, compared to those with higher levels of rumination, individuals with lower levels of rumination would have lower levels of perceived stress no matter their childhood trauma levels were low or high, which supported a previous study (Rushton et al., 2002), indicating that the adolescents with low levels of rumination would report perceived stress which below the average levels. Also, another study (Kovács et al., 2021) evidenced that rumination was still a great risk factor of perceived stress, even after controlling for multiple potential factors, such as sex, age and some physical diseases. Of note, an intervention study (Hoorelbeke et al., 2015) on rumination have validated that individuals could alleviate their stress reactivity by reducing their levels of rumination. Overall, this study has showed that rumination has a great impact on the perceived stress levels of college students and can increase the negative indirect effect of childhood trauma on depressive level. On the other hand, we discovered the moderation role of rumination between childhood trauma and depressive level (Fig. 2b). Firstly, individuals with higher childhood traumatic experiences would report more depressive symptoms no matter their rumination levels were high or low. This result was in line with previous studies (Husain et al., 2021; Racine et al., 2021), which showed that childhood trauma could significantly affect depressive symptoms and further increase the likelihood of suffering from depression. Secondly, individuals with higher rumination level had higher depressive level than those with lower rumination level no matter their childhood traumatic experiences were high or low. Of note, individuals who reported higher levels of both childhood trauma and rumination had the highest levels of depressive level. Thirdly, the predictive effect of higher childhood traumatic experience on depressive level was stronger when college students had a higher level of rumination. The possible reason may be that for individuals with higher childhood traumatic experiences, relatively higher rumination levels will make them more worried about their status quo (e.g., their traumatic experiences and the corresponding consequence), thus increasing the risk and severity of depression (Roley et al., 2015). Overall, this study has validated that rumination had a great negative effect on college students’ depressive levels, and can moderate the direct effect of childhood trauma on depressive level. To sum up, these findings indicated the significance of rumination for mental health among college students and further gave us indications that more actions should be taken to alleviate their levels of rumination.

In general, in theory, our study revealed a pathway on how childhood trauma affects the depressive level of college students, by combining a mediation effect of perceived stress and the moderation effect of rumination, based on a moderated mediation model. In practice, our study gave implications to alleviate depressive levels of non-clinical Chinese college students, especially for those with childhood traumatic experience. First, parents or caregivers should try their best to reduce the children’s traumatic experience, such as giving them love and respect, rather than discrimination, abuse or corporal punishment. Second, for those with childhood traumatic experiences, we could prevent and reduce students’ depressive levels by alleviating their perceived stress levels. Specifically, we could take some actions to improve students’ ability to cope with stress (e.g., encouraging them to participate community activity and competitions), which would not only help reduce their perceived stress levels, but also further alleviate their depressive symptoms. Last but not least, we should also pay more attention to students’ levels of rumination and take some other interventions to reduce their rumination levels, such as mindfulness, attention control exercises, cognitive reappraisal, and cognitive control training (Cohen et al., 2015; Munoz and Hanks, 2021; Pan et al., 2020).

Limitations

There were still some limitations in this study. Firstly, because this study is based on a cross-sectional design, it cannot reveal the casual relationship among childhood trauma, rumination, perceived stress, and depressive level. Therefore, a future longitudinal study should be conducted to verify the causal relationship among the above variables. Secondly, we regarded the childhood trauma as a whole to investigate its role in the model of this study and did not distinguish the different subtypes. Previous studies (Curran et al., 2021; Mandelli et al., 2015) have reported that different childhood trauma subtypes may result in different levels of depression, so we further considered whether this model can be applied in different subtypes. Results revealed that this model can be applied only in subtypes of emotional neglect (See Tables S9, S14 and Figures S6, S11 in Supplementary materials) and physical neglect (See Tables S10, S15 and Figures S7, S12 in Supplementary materials). Future studies could further investigate the reason why various childhood trauma subtypes have different effects. Thirdly, the number of males and females recruited in this study were not matched. Thus, in order to test whether the gender would bias the results in this study, we used 307 males and 307 females to re-analyze the model. Results revealed that this model can also be applied when the number of males and females were matched (See Tables S2 - S4 and Figures S1 – S2 in Supplementary materials). Finally, this study only recruited non-clinical college students, and it was unclear whether our results can be applied in clinical patients. Future researches should recruit clinical patients to test the replicability of this model in our study.

Conclusions

In general, this study revealed a potential pathway of how childhood trauma affects the depressive level among non-clinical college students. The findings further give us multi-dimensional (perceived stress, and rumination among college students) indications for reducing the negative effects of childhood trauma on depressive level, which will be helpful for improving their mental health.

Acknowledgement

We thank the funding supports from the National Natural Science Foundation of China (81801685) and the Guangdong University of Foreign Studies Graduate Research Innovation Project (21GWCXXM-050 and 22GWCXXM-056). Also, we thank all the participants for participating in this study.

Funding

This work was supported by the National Natural Science Foundation of China (81801685), and the Guangdong University of Foreign Studies Graduate Research Innovation Project (21GWCXXM-050 and 22GWCXXM-056).

Availability of data and materials

The datasets generated or analyzed during the current study are not publicly available due to ethic issues involving participant’s data and privacy but are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

Participants gave their informed consent under the condition of complete anonymity, voluntary provision of information, and the option to leave whenever they wanted without any consequences. And participants agreed to the aggregated data analysis for the research study purpose. All methods in this study were carried out in accordance with the ethical committee of the School of Public Administration in Guangdong University of Foreign Studies. And all procedures performed were in accordance with the 1964 Helsinki declaration and its later amendments.

Competing interests

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Consent for publication

Not applicable.

Authors’ contributions

Junjing Wang: Conceptualization, Supervision, Writing - Review & Editing, Project administration, Funding acquisition. Qian Liang: Methodology, Writing - original draft, review & editing, Investigation, Data Curation, Funding acquisition. Yueqi Ma: Investigation, Data Curation. Yi Zhang: Investigation, Data Curation.

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Childhood trauma and depressive level among non-clinical Chinese college students: the roles of rumination and perceived stress

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Abstract

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1 Introduction

2 Methods

2.1 Participants

2.2 Measures

2.2.1 Childhood Trauma Questionnaire-Short Form

2.2.2 Perceived Stress Scale

2.2.3 The 22-item Ruminative Responses Scale

2.2.4 Beck Depression Inventory-II

2.2.5 Statistical analysis

3 Results

3.1 Common method of deviation test

3.2 Correlation analyses

3.3 Mediation effect test

3.4 Moderated mediation effect test

4 Discussion

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References

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