The effects of alexithymia, experiential avoidance, and childhood sexual abuse on non-suicidal self-injury and suicidal ideation among Chinese college students with a history of childhood sexual abuse

Psychometric properties of the chinese version of multidimensional experiential avoidance questionnaire-30

BACKGROUND

Experiential avoidance represents the tendency to avoid negative internal experiences, which is a key concept in Acceptance and Commitment Therapy. However, existing measures of experiential avoidance (i.e., Acceptance and Action Questionnaire-II, AAQ-II) have some limitations. This study aims to assess the psychometric properties of the Chinese version of Multidimensional Experiential Avoidance Questionnaire-30 (MEAQ-30) and provide evidence for the reliability and validity of this new instrument.

METHODS

Two questionnaire surveys were conducted. The first sample (N = 546) was analyzed using classical test theory (CTT), and the second sample (N = 511) was analyzed using multidimensional item response theory (MIRT).

RESULTS

CTT supported the six-factor structure of MEAQ-30, indicating good internal consistency and measurement invariance across genders. Furthermore, the Chinese version of MEAQ-30 showed satisfactory convergent and discriminant validity. The incremental validity test showed that after controlling for the effects of neuroticism and AAQ-II, the Chinese version of MEAQ-30 could still significantly predict depression, anxiety, and stress. MIRT indicated that 30 items had good discrimination and difficulty, and the six subscales were sufficiently reliable across the continuum of experiential avoidance.

CONCLUSION

The Chinese version of MEAQ-30 has good reliability and validity and is suitable for assessing experiential avoidance among Chinese populations.

Beyond sleepless nights: Unraveling the complexity of alexithymia and suicide risk among university students

BACKGROUND

There is a solid relationship between alexithymia and suicide risk. Nonetheless, the specific impact of alexithymia's distinct subscales on suicide risk has received the attention it deserves. This article presents a comprehensive exploration of suicide risk among university students, focusing on the interconnections among alexithymia, insomnia, and suicidal behavior. Three components of alexithymia including difficulties in describing emotions or feelings (DDF), difficulties in identifying emotions or feelings (DIF), and the externally oriented thinking were considered.

METHODS

The study involved 208 participants from a Persian university sample, examining the significance of incorporating both alexithymia and insomnia in suicide risk assessment and intervention planning. Insomnia was positioned as a pivotal mediator. A secure electronic link in the Telegram application was employed to collect the data. Both linear and nonlinear prediction models were used to explore potential associations among alexithymia, insomnia, and suicide risk.

RESULTS

The study revealed substantial positive correlations between alexithymia and suicide risk, as well as between insomnia and suicide risk. Additionally, specific components of alexithymia exhibited noteworthy links to suicide risk. The inclusion of insomnia scores in suicide risk predictions is critical, as it greatly enhances the precision of risk assessments and facilitates the design of targeted and effective therapeutic interventions. The association between alexithymia and suicide risk showed a significant relationship (r = .29, p < .01). Moreover, a significant correlation was observed between alexithymia and insomnia (r = .32, p < .01). Additionally, insomnia exhibited a significant positive correlation with suicide (r = .35, p < .01). Interestingly, DDF and DIF showed positive correlations with suicide (r = .28, p < .01; r = .33, p < .01).

CONCLUSION

The findings carry profound implications for suicide prevention efforts, providing valuable insights to safeguard the well-being and resilience of university students facing suicide risk challenges.

The effect of childhood sexual abuse on depressive symptoms in female college students: a serial mediation model

Objective

Childhood sexual abuse (CSA) can have a negative impact on women's psychological, emotional and social functioning. The purpose of this study was to explore the relationship between CSA and depressive symptoms in female college students, as well as the mediating roles of negative core schema and experiential avoidance.

Methods

515 female college students responded to the Sexual Abuse subscale of the Childhood Trauma Questionnaire, the Depression subscale of the Depression Anxiety Stress Scale, the Brief Core Schema Scales, and the Acceptance and Action Questionnaire - II. The structural equation modeling was used for the mediation analysis.

Results

There was a significant positive correlation between CSA and depressive symptoms in female college students. The theoretical model was well fitted, χ2/df = 3.422, RMSEA = 0.069, CFI = 0.929, TLI = 0.919. The negative core schema played a mediating role between CSA and depressive symptoms. Experiential avoidance played a mediating role between CSA and depressive symptoms. The negative core schema and experiential avoidance played a serial mediating role between CSA and depressive symptoms.

Conclusion

These results deepen our understanding of the relationship between CSA and depressive symptoms in female college students, and provide theoretical guidance for the prevention of depression in female college students. Attention should be paid to female college students who have experienced CSA, to eliminate the adverse influence of negative core schema on these students. Meanwhile, we should teach female college students to accept themselves as they are, and thereby reduce their use of experiential avoidance strategies.

Sex differences in the association of childhood sexual abuse severity with premarital sex among Chinese college students in Luzhou, China

PURPOSE

The adverse health consequences of premarital sex and childhood sexual abuse (CSA) are both global public health problems. Based on a random sample of college students from a Chinese city, this study investigated the relationship between CSA severity and premarital sex among students, focusing on sex differences.

METHODS

A total of 2722 college students from 4 schools in Luzhou were recruited by multistage random sampling. Self-administered questionnaires were used to measure CSA experiences and premarital sex. Binary logistic regression analyses were conducted to analyse the relationship between CSA and premarital sex.

RESULTS

The prevalence of CSA was 9.39%, and that of mild, moderate and severe CSA was 4.04%, 2.90% and 2.46%, respectively. The premarital sex reporting rate was 22.42%. After adjusting for confounding variables, CSA was positively associated with premarital sex. Notably, a cumulative effect of CSA on premarital sex was observed among students. Further stratification analyses showed that males who experienced CSA had a higher premarital sex rate than females, and this sex difference was also observed among students with different CSA severities.

CONCLUSION

CSA and its severity were associated with premarital sex among college students. Furthermore, this association was stronger for males than females. Therefore, it is important to emphasize CSA prevention, especially for boys. These findings can promote understanding of the effects of CSA on premarital sex, and CSA prevention and intervention strategies should consider CSA severity and sex differences.

Relationship Between Childhood Trauma and Nonsuicidal Self-Injury Among Adolescents with Depressive Disorder: Mediated by Negative Life Events and Coping Style

Purpose

Nonsuicidal self-injury (NSSI) is related to childhood trauma, negative life events, and coping style, but the interaction among these factors and the mechanism by which they interact in adolescents with depressive disorder remain unclear. This paper explores how these factors interact to influence NSSI and provides evidence to develop prevention efforts and interventions for adolescents with depressive disorder with NSSI.

Patients and Methods

A cross-sectional design and convenient sampling method were used in this study. The Childhood Trauma Questionnaire, Adolescent Self-Rating Life Events Checklist, Trait Coping Style Questionnaire, and Adolescent Nonsuicidal Self-injury Assessment Questionnaire were completed by 540 adolescents with depressive disorder. Descriptive analysis, chi-square tests, t-tests, Pearson correlations, and serial mediation analyses were used in the data analysis.

Results

A total of 398 (79.442%) adolescents with depressive disorders reported experiences of NSSI. The results of serial mediation analyses determined that childhood trauma has a direct (estimate = 0.209, 95% CI: 0.063, 0.334) and indirect (estimate = 0.271, 95% CI: 0.199, 0.371) impact on NSSI. The indirect impact of childhood trauma on NSSI through negative life events alone (estimate = 0.096, 95% CI: 0.007, 0.169), coping styles alone (estimate = 0.088, 95% CI: 0.034, 0.183), and negative life events on coping styles (estimate = 0.086, 95% CI: 0.042, 0.162) was significant.

Conclusion

This study demonstrates that screening for childhood trauma should be considered when preventing and treating NSSI behavior in adolescents with depressive disorder. Managing negative life events and coping style may mitigate the negative impact of childhood trauma on NSSI behavior in adolescents with depressive disorder.

Effects of BPD tendencies and subjective well-being on NSSI in adolescents with PTSD

Background

Severe posttraumatic stress disorder (PTSD) may lead to non-suicidal self-injury (NSSI), and borderline personality disorder (BPD) tendencies may play a role in this process. Secondary vocational students experience more social, familial and other pressures and are more vulnerable to psychological problems. Thus, we explored the effect of BPD tendencies and subjective well-being (SWB) on NSSI in secondary vocational students with PTSD.

Methods

A total of 2,160 Chinese secondary vocational students in Wuhan participated in our cross-sectional investigation. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), criteria for PTSD, NSSI Questionnaire, Personality Diagnostic Questionnaire-4+, subjective well-being scale, and family adaptation, partnership, growth, affection, and resolve (APGAR) Index were used. We conducted a binary logistic regression model and linear regression analysis.

Results

Sex (odds ratio [OR] = 0.354, 95% confidence interval [CI] = 0.171-0.733), BPD tendencies (OR = 1.192, 95% CI = 1.066-1.333) and SWB (OR = 0.652, 95% CI = 0.516-0.824) were independent factors that predicted NSSI in secondary vocational students with PTSD. Spearman's correlation analysis showed that BPD tendencies were positively correlated with NSSI frequency (r = 0.282, P < 0.01). SWB was negatively correlated with NSSI frequency (r = -0.301, P < 0.01). The linear regression showed that BPD tendencies (β = 0.137, P < 0.05 and β = -0.230, P < 0.001) were significantly correlated with NSSI frequency. Spearman's correlation analysis showed that family functioning was positively correlated with SWB (r = 0.486, P < 0.01) and negatively correlated with BPD tendencies (r = -0.296, P < 0.01).

Conclusion

In adolescents, PTSD in response to stressful events could lead to NSSI, and BPD tendencies promote the intensity of NSSI, while SWB diminishes its intensity. Improvement in family functioning may actively guide the development of mental health and improve SWB; such steps may constitute interventions to prevent or treat NSSI.

The relationship between emotional neglect and non-suicidal self-injury among middle school students in China: the mediating role of social anxiety symptoms and insomnia

 BACKGROUND: Non-suicidal self-injury (NSSI) is a vital public concern around the world, and it often starts in adolescence. Emotional neglect (EN) has been considered a distal risk factor for NSSI, but the effects of social anxiety symptoms (SA) and insomnia on this relationship have remained unclear. This study aimed to investigate the potential pathways from EN to NSSI, examining the role of SA and insomnia in this association.

METHODS

One thousand three hundred thirty seven Chinese middle school students (M_age = 13.040, SD = 0.981, 50.2% males) in China were enrolled in this cross-sectional study. Participants completed the Emotional Neglect sub-scale of Childhood Trauma Questionnaire (CTQ-SF), the Social Anxiety Scale for Adolescent (SAS-A), Athens Insomnia Scale (AIS) and non-suicidal self-injury assessment. Structural equation modelling (SEM) was used to test the possible mediation model among these variables.

RESULTS

231(17.3%) students reported NSSI history during last year and 322 (24.1%) participants reported experiences of EN. Students who experienced EN have higher rates of NSSI compared to students without EN history (29.2% vs 13.5%). EN, SA, insomnia and NSSI were positively related to each other. Furthermore, both SA and insomnia played a mediating role in the relationship between EN and NSSI, the series mediating effect of SA and insomnia on this association was also significant after controlling for demographics. Indirect effects accounted for 58.26% of the total effects (EN → NSSI).

CONCLUSIONS

Our study revealed that EN was associated with NSSI, SA and insomnia play indirect roles in the association between EN and NSSI. The findings of our research may have implications for clinicians, families, and schools in their efforts to lower the risk of NSSI in adolescents.

Associations between non-suicidal self-injury and experiential avoidance: A systematic review and Robust Bayesian Meta-analysis

OBJECTIVES

Non-suicidal self-injury (NSSI) is the intentional and deliberate damage to an individual's own body tissue without the intent to suicide. Individuals who have higher self-reported levels of experiential avoidance are more likely to report a history of NSSI. The current study systematically reviewed the literature and meta-analysed studies assessing associations between experiential avoidance and self-injury.

METHOD

An extensive review was conducted of several databases (including ProQuest, Joanna Briggs, Web of Science, PsychArticles, PubMed, Scopus, and Ovid). Nineteen articles (two dissertations) met the inclusion criteria for the systematic review and 14 were analysed in a Robust Bayesian Meta-analysis. This review was registered through PROSPERO (CRD42020198041).

RESULTS

There was a small to medium, pooled effect size (d = 0.48, 95 % Credibility Interval 0.00-0.85). There was strong evidence for this effect size (Bayes Factor = 12.16), although there was considerable heterogeneity between studies (τ =0.68, 95 % CI [0.44, 0.1.05]). The analysis testing whether these findings may be due to publication bias was inconclusive (Bayes Factor = 2.45).

LIMITATIONS

The majority of studies included were cross-sectional, in English, and most studies were of university students. While some studies reported on recency/frequency of NSSI there was not enough data to conduct meta-analysis.

CONCLUSION

These results suggest there is a robust association between history of NSSI and experiential avoidance. However, as most studies operationalise avoidance as a unidimensional construct, it is not clear which aspects of avoidance differentiate individuals with and without a history of NSSI.

Association of sociodemographic, proximal, and distal clinical factors with current suicidal ideation: Findings from a nonclinical sample of young adults

BACKGROUND

Accumulating evidence indicates that a variety of distal and proximal factors might impact a risk of suicide. However, the association between both groups of factors remains unknown. Therefore, in the present study, we aimed to investigate the interplay between distal and proximal correlates of the current suicidal ideation.

METHODS

A total of 3,000 individuals (aged 18-35 years, 41.7% males), who had reported a negative history of psychiatric treatment, were enrolled through an online computer-assisted web interview. Self-reports were administered to measure: (a) distal factors: a history of childhood trauma (CT), reading disabilities (RDs), symptoms of attention-deficit/hyperactivity disorder (ADHD), lifetime history of non-suicidal self-injury (NSSI), lifetime problematic substance use as well as family history of schizophrenia and mood disorders; (b) proximal factors: depressive symptoms, psychotic-like experiences (PLEs), and insomnia; and (c) sociodemographic characteristics.

RESULTS

Suicidal ideation was directly associated with unemployment, being single, higher level of RD, lifetime history of NSSI as well as higher severity of PLEs, depression, and insomnia. The association of distal factors with suicidal ideation was fully (a history of CT and symptoms of ADHD) or partially (a history of NSSI and RD) mediated by proximal factors (PLEs, depression, and insomnia).

CONCLUSIONS

Main findings from this study posit the role of distal factors related to neurodevelopmental disorders, CT and NSSI in shaping suicide risk. Their effects might be partially or fully mediated by depression, PLEs, and insomnia.

Prevalence of Adverse Childhood Experiences and Their Associations with Non-Suicidal Self-Injury Among Chinese Adolescents with Depression

The presence of adverse childhood experiences (ACEs) in adolescents diagnosed with depression has been associated with an extensive range of mental health issues, including non-suicidal self-injury (NSSI). However, there has been a dearth of research into the prevalence of ACEs and their associations with NSSI among depressed adolescent populations in China. This study aimed to investigate the prevalence of different types of ACEs and their associations with NSSI in depressed Chinese adolescents. Utilizing Chi-squared tests, latent class analysis (LCA), and multinomial logistic regression, the prevalence of different types of ACEs and their associations with NSSI were determined in a sample of 562 adolescents with depression. Among depressed adolescents. 92.9% of depressed adolescents reported ACEs, and the prevalence of emotional neglect, physical abuse, caregiver treated violently, and bullying was relatively high. ACEs, including sexual abuse (OR = 5.645), physical abuse (OR = 3.603), emotional neglect (OR = 3.096), emotional abuse (OR = 2.701), caregiver divorce/family separation (OR = 2.5), caregiver treated violently (OR = 2.221), and caregiver substance abuser (OR = 2.117), were associated with increased odds of exposure among depressed adolescents with NSSI. The high ACEs class (19%), the moderate ACEs class (40%), and the low ACEs class (41%) were identified as latent classes. NSSI was more prevalent in the high/moderate ACEs class compared to the low ACEs class, particularly in the high ACEs class. The situation of the prevalence of ACEs among adolescents with depression was unsatisfactory, and certain types of ACEs were associated with NSSI. Eliminating potential risk factors for NSSI requires the early prevention and targeted intervention of ACEs. Moreover, additional large-scale longitudinal studies are necessary to assess the different development trajectories associated with ACEs, such as the relationships between the different development periods of ACEs and NSSI, and to ensure the adoption of evidence-based prevention and intervention strategies.

Cyber Dating Abuse Victimization and Experiential Avoidance Among Chinese Female Adolescents: The Roles of Self-Compassion and Interpersonal Flexibility

Cyber dating abuse victimization (CDAV) among female adolescents is common and harmful; however, little is known regarding how CDAV relates to victims' experiential avoidance in the Chinese context. Drawing from general strain theory, this cross-sectional study investigated possible differences in the relationships among CDAV, experiential avoidance, and self-compassion according to female adolescents' levels of interpersonal flexibility (low vs. high). A sample of 420 female adolescents aged 13 to 17 years (mean age = 15.78 years) who had been in intimate relationships during the past year participated in a voluntary and anonymous paper-and-pencil survey. Participants completed four self-reported measures on CDAV experience, self-compassion, experiential avoidance, and interpersonal flexibility. The findings indicated that nearly 49% of participants had experienced CDAV in the last year; CDAV exposure was directly linked with experiential avoidance and indirectly related to experiential avoidance through self-compassion. Moderation analyses showed that the negative associations between CDAV and experiential avoidance and self-compassion were only significant among participants with low interpersonal flexibility. These findings deepen the understanding of CDAV as a risk factor for reduced self-compassion and increased experiential avoidance in female adolescents. However, high interpersonal flexibility is a potential protector. This study has implications for the prevention of experiential avoidance among female adolescents exposed to CDAV and supports incorporating self-compassion and interpersonal flexibility skills to combat the negative outcomes of CDAV.

Effects of childhood trauma on nonsuicidal self-injury in adolescent patients with bipolar II depression

OBJECTIVE

This study was performed to explore the effect of childhood trauma on nonsuicidal self-injury (NSSI) in adolescents with bipolar II (BD II) depression.

METHODS

Based on the diagnostic criteria of the DSM-5 and structured interviews to assess the presence or absence of NSSI, 184 adolescent patients with BD II depression were divided into the NSSI (n = 112) and non-NSSI (n = 72) groups. The Adolescent Nonsuicidal Self-Injury Assessment Questionnaire (ANSAQ), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Toronto Alexithymia Scale (TAS-20), Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA) were used to assess the subjects.

RESULT

The CTQ-SF, HAMD, HAMA, and TAS-20 scores were significantly higher in the NSSI group than in the non-NSSI group (p &lt; .01). Logistic regression analysis showed emotional abuse (p = .028, OR = 1.14, 95% CI = 1.01-1.28) and age of onset (p = .009) as risk factors for NSSI. Adolescents with onset age 12-13 years (OR = 6.30, 95% CI = 1.72-23.10) and 14-15 years (OR = 2.24, 95% CI = 1.04-4.84) had a higher risk of self-injury relative to adolescents aged 16-18 years.

CONCLUSION

Childhood trauma and alexithymia were important influencing factors in adolescent patients with BD II depression. Emotional abuse and age of onset as risk factors for NSSI, and difficulties in emotion recognition were positively associated with the patients' NSSI.

Influence of family function on social anxiety among Chinese nursing students: The mediating role of alexithymia

AIMS

This study aims to explore the relationship between family function, alexithymia and social anxiety among Chinese nursing students, especially to determine whether alexithymia acts as a mediator between family function and social anxiety among this social group.

DESIGN

A cross-sectional study.

METHODS

From January to March 2021, a cross-sectional study was conducted among 204 Chinese nursing students at a nursing school of a medical university in the Northeastern Region of China. The interaction anxiousness scale, APGAR family function scale and Tronto alexithymia scale were used for measurement of social anxiety, perceived family function and alexithymia respectively. The data were subjected to correlation analysis, multiple linear regression and structural equation modelling (SEM).

RESULTS

Results indicated that social anxiety score was negatively correlated with perceived family function (r = -.232), but positively with alexithymia (r = .307). After controlling for demographic variables, family function and alexithymia could explain 14.5% of the total variance in social anxiety. The SEM results suggested that the effect of family function on social anxiety was partially mediated by alexithymia with a 36.9% mediating effect.

CONCLUSIONS

This study reveals that alexithymia might partially mediate the impact of family function and social anxiety in Chinese nursing students. In this sense, improvement of alexithymia is expected to be an effective strategy to ameliorate the severity social anxiety in Chinese nursing students, especially for those with a dysfunctional family context.

The Relationship between Cyber-Ostracism and Adolescents' Non-Suicidal Self-Injury: Mediating Roles of Depression and Experiential Avoidance

Based on the experiential avoidance model, the current study aims to test the relationship between cyber-ostracism and adolescents' non-suicidal self-injury and to explore the mediating roles of depression and experiential avoidance. A sample of 1062 middle school students completed questionnaires on cyber-ostracism, depression, experiential avoidance, and self-injurious behavior. The results showed that cyber-ostracism, depression, experiential avoidance, and non-suicidal self-injury were positively correlated with each other. After controlling for gender and age, the mediation model test shows that cyber-ostracism was significantly and positively associated with non-suicidal self-injury. Depression and experiential avoidance mediated the relationship between cyber-ostracism and non-suicidal self-injury parallelly and sequentially. This study highlights the potential mechanisms of action between cyber-ostracism and adolescent non-suicidal self-injury and finds that cyber-ostracism is a risk factor for non-suicidal self-injury. This founding suggests that extra attention should be paid to the role of the online environment in addition to the offline environment experiences for the intervention of non-suicidal self-injury.

Body dissatisfaction and non-suicidal self-injury among Chinese young adults: a moderated mediation analysis

OBJECTIVE

Extensive evidence from Western societies supports the role for body dissatisfaction in the etiological models of non-suicidal self-injury (NSSI). However, research of the underlying mechanisms of this relationship has been limited, especially in China. Therefore, the aim of this study was to examine the association between body dissatisfaction and NSSI among college students in China. Possible mediating roles for psychological distress and disordered eating, as well as a moderating role for self-compassion, were also examined.

METHODS

College students (n = 655, M_age = 20.32 years, SD = 1.02) were recruited from Henan province, China. Each participant completed questionnaires regarding body dissatisfaction, psychological distress, disordered eating, and self-compassion.

RESULTS

A close to medium positive relationship between body dissatisfaction and NSSI was revealed with r = 0.24 (p < .001). The relationship was found to be fully mediated by psychological distress and disordered eating. The mediation role for disordered eating was found to be further moderated by self-compassion, suggesting that self-compassion acted as a buffer against the relationship between disordered eating and NSSI.

CONCLUSION

These findings indicate that body dissatisfaction, psychological distress, disordered eating, and self-compassion may play important roles in Chinese young adults' NSSI. Researchers and practitioners need to pay closer attention to the underlying mechanisms of how body dissatisfaction links to NSSI to deepen the understanding of their linkage as well as to provide appropriate interventions.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.