Child maltreatment exposure and adolescent nonsuicidal self-injury: the mediating roles of difficulty in emotion regulation and depressive symptoms

Trajectories of Chinese adolescent depression before and after COVID-19: A cross-temporal meta-analysis with segmented regression

BACKGROUND

The COVID-19 pandemic has had a profound impact on adolescent mental health, particularly in China. However, there is a lack of research examining the trends in depressive symptom levels among Chinese adolescents before and after the pandemic. This study aims to investigate the changes in depressive symptom levels among Chinese adolescents pre- and post-pandemic and to identify the factors influencing these changes.

METHODS

English-language databases (Web of Science, PubMed, Scopus, ProQuest, and Wiley) and Chinese-language databases (CNKI, VIP, and Wanfang) were searched for relevant studies. A total of 90 articles (91 studies) were included in the cross-temporal meta-analysis (N = 473,781), all of which used the Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms in Chinese adolescents. The data for these studies were collected over the period from 2010 to 2023.

RESULTS

Findings indicated that: (1) From 2010 to 2020, year was not a significant predictor of adolescent depressive symptom levels, whereas from 2021 to 2023, year became a significant positive predictor. (2) From 2010 to 2020, females exhibited a more pronounced decrease in depressive symptom levels compared to males; however, from 2021 to 2023, gender differences were not significant. (3) From 2010 to 2020, previous social connectedness, including family size three years prior, divorce rate one year prior, and urbanization level three years prior, significantly and negatively predicted the current year's adolescent depressive symptom levels; however, from 2021 to 2023, the predictive effect of all social indicators was not significant.

CONCLUSIONS

This study enhances the understanding of the mechanisms underlying depression among Chinese adolescents and provides a foundation for decision-making in prevention and intervention strategies.

Childhood emotional maltreatment affects depression of adolescents with mood disorders: the mediating role of functions of non-suicidal self-injury

BACKGROUND

Childhood emotional maltreatment, non-suicidal self-injury and depression are prevalent among adolescents with mood disorders. While existing model indicated that childhood emotional maltreatment, functions of non-suicidal self-injury and depression are interrelated, not much is understood about the interplay of functions of non-suicidal self-injury in the relationship between childhood emotional maltreatment and depression. Thus, the goal of this research was to ascertain how functions of non-suicidal self-injury relate to childhood emotional maltreatment and depression.

METHODS

The participants were adolescents with mood disorders from three hospitals in Sichuan Province, data was collected using self-administered questionnaires, including the Childhood Trauma Questionnaire, Ottawa Self-injury Inventory-Functions, and Childhood Depression Inventory. SPSS26.0 software and PROCESS v3.3 model 4 were used for analysis.

RESULTS

In all, 235 adolescents (Mage=14.8, SD = 1.62) participated in the research. The functions of non-suicidal self-injury (r = 0.289, P < 0.01) and depression (r = 0.475, P < 0.01) were considerably positively connected with childhood emotional maltreatment, and the functions of non-suicidal self-injury were strongly positively correlated with depression (r = 0.364, P < 0.01). The direct impact of childhood emotional maltreatment on depression in adolescents was found to be significant (95% CI 0.434, 0.828) in the mediated effects model. Additionally, the indirect effect of childhood emotional maltreatment on depression through functions of non-suicidal self-injury was found to be significant (95% CI 0.055, 0.236), with a mediating effect value of 17.58%.

CONCLUSION

Childhood emotional maltreatment has a direct impact on depression, but it also has an indirect influence through mediation roles of functions of non-suicidal self-injury. Medical staff should take care of the mental health of adolescents hospitalized for mood disorders so that they can clarify the role of functions of NSSI in lowering depressive symptoms and improving quality of life and create more targeted and effective intervention plans.

Association between childhood emotional abuse and non-suicidal self-injury among Guangxi adolescents in China: A moderated mediation model

BACKGROUND

Childhood Emotional Abuse (CEA) is a known risk factor for Non Suicidal Self-injury (NSSI), which could have devastating repercussions. This study aimed to establish whether Parent-Child Attachment (PCA) and depressive symptoms mediated the CEA-NSSI relationship, as well as whether school connectedness moderated both the direct and indirect relationships between CEA and NSSI.

METHODS

Between November and December 2022, 7447 Chinese adolescents in high schools were surveyed through multi-stage cluster random sampling. The participants completed self-reported questionnaires that assessed CEA, PCA, depressive symptoms, school connectedness, and NSSI. Relationships between these variables were examined through moderated mediation analysis using SPSS macro-PROCESS.

RESULTS

After controlling for sociodemographic variables, we found that CEA correlated positively with NSSI through two different pathways: the mediating role of depressive symptoms and the chain-mediating role of both PCA and depressive symptoms. Moreover, school connectedness could moderate the direct and indirect relationships between CEA and NSSI.

LIMITATIONS

The study's cross-sectional design does not allow for causal inferences.

CONCLUSIONS

Overall, PCA, depressive symptoms, and school connectedness could affect the CEA-NSSI relationship.

Pathway from childhood trauma to nonsuicidal self-injury in adolescents with major depressive disorder: the chain-mediated role of psychological resilience and depressive severity

This study aimed to explore the pathway from childhood trauma to nonsuicidal self-injury (NSSI) in adolescents with major depressive disorder (MDD) and to examine the chain-mediating role of psychological resilience and depressive symptoms in this pathway. A total of 391 adolescents with MDD were recruited in the present study. The Chinese version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Chinese version of the Symptoms Check List-90 (SCL-90), the Chinese version of the Conner-Davidson Resilience Scale (CD-RISC), and the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC) were used to evaluate childhood trauma, depressive symptoms, psychological resilience and NSSI, respectively. Our results showed that 60.87% of adolescents with MDD had NSSI in the past month. Childhood trauma frequency was negatively correlated with psychological resilience but positively correlated with depressive symptoms and NSSI severity in adolescents with MDD. The stepwise logistic regression analysis identified that age, childhood trauma and depressive symptoms could independently predict the occurrence of NSSI, and the three-step hierarchical regression showed that childhood trauma, psychological resilience and depressive symptoms were all significantly associated with NSSI frequency in adolescents with MDD. Furthermore, the chain-mediation analysis revealed that psychological resilience and depression serially mediated the relationship between childhood trauma and NSSI in adolescents with MDD. Interventions targeted at improving resilience and depression may mitigate the impact of childhood trauma severity on NSSI risk in adolescents with MDD.

A Multi-Mediation Analysis of the Association between Adverse Childhood Experiences and Non-Suicidal Self-Injury among South African Adolescents

The available research findings suggest that non-suicidal self-injury (NSSI) constitutes an important public health issue, with identified risk factors for NSSI having been found to include exposure to adverse childhood experiences (ACEs) and comorbidity with various mental disorders. However, the available findings have, for the most part, been based on the experiences of individuals living in predominantly high-income countries located in the Global North, and it is not clear whether these findings can be confidently generalised to individuals living in low-resourced countries. As such, this cross-sectional study assessed risk factors for NSSI in a non-clinical sample of 636 South African adolescents (12-18 years old), with the data being analysed using a multi-mediation analysis. ACEs were assessed using a revised version of the ACEs Questionnaire, and NSSI was assessed using items adapted from the Self-Harm subscale of the Risk-Taking and Self-Harm Inventory for Adolescents, with emotion dysregulation, depression, and PTSD being considered as possible mediators. High prevalence rates for NSSI and exposure to five or more ACEs were reported by the participants, with the mediation analysis indicating that significant direct effects of adverse childhood experiences on NSSI were partially mediated by emotion dysregulation. These findings are discussed with respect to their implications for primary, secondary, and tertiary prevention.

The effects of childhood trauma on nonsuicidal self-injury and depressive severity among adolescents with major depressive disorder: The different mediating roles of positive and negative coping styles

OBJECTIVE

We aimed to examine whether positive and negative coping styles mediated the influences of childhood trauma on NSSI or depressive severity in adolescents with major depressive disorder (MDD).

METHODS

The Children's Depression Inventory (CDI), the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC), the short-form Childhood Trauma Questionnaire (CTQ-SF), and the Simplified Coping Style Questionnaire (SCSQ) were evaluated in 313 adolescents with MDD.

RESULTS

MDD adolescents with NSSI had higher CTQ-SF total score, emotional and sexual abuse subscale scores, but lower CDI total and subscale scores compared to the patients without NSSI. The multiple linear regression analysis revealed that emotional abuse (β = 0.075, 95 % CI: 0.042-0.107) and ineffectiveness (β = -0.084, 95 % CI: -0.160 ∼ -0.009) were significantly associated with the frequency of NSSI in adolescents with MDD, but emotional abuse (β = 0.884, 95 % CI: 0.570-1.197), sexual abuse (β = 0.825, 95 % CI: 0.527-1.124) and negative coping style (β = 0.370, 95 % CI: 0.036-0.704) were independently associated with the depressive severity in these adolescents. Furthermore, the mediation analysis demonstrated that positive coping style partially mediates the effect of childhood trauma on NSSI (Indirect effect = 0.002, 95 % bootCI: 0.001-0.004), while the negative coping style partially mediates the relationship between childhood trauma and depressive severity (Indirect effect = 0.024, 95 % bootCI: 0.005-0.051) in adolescents with MDD.

LIMITATIONS

A cross-sectional design, the retrospective self-reported data, the small sample size.

CONCLUSION

Our findings suggest that coping styles may serve as mediators on the path from childhood trauma to NSSI or depressive severity in MDD adolescents.

The association between child maltreatment, cognitive reappraisal, negative coping styles, and non-suicidal self-injury in adolescents with major depressive disorder

BACKGROUND

Non-suicidal self-injury (NSSI) is a significant public health concern among adolescents with major depressive disorders (MDD). Although previous research has linked child maltreatment (CM) to NSSI, the precise mechanisms remain unclear. This study aims to investigate the association between CM, cognitive reappraisal (CR), negative coping styles (NC) and NSSI in adolescents with MDD, from the perspectives of both Latent Variable Theory and the Network Theory of Mental Disorder.

METHODS

A sample of 651 adolescents with MDD was recruited from January to December 2023. Data on CM, CR, NC, and NSSI were collected through paper-based self-reported questionnaires. Data analysis primarily involved structural equation modeling and network analysis.

RESULTS

The reporting rate of NSSI among adolescents with MDD was 48.2%. CM showed a significant positive correlation with NSSI. NSSI was affected by CM through three paths: the mediating role of CR, the mediating role of NC, and the chain mediating role of both CR and NC. Emotional abuse (EA) was the central node, while NSSI, EA, and "The urge to cry quietly when faced with troubles"(NC10) were the key bridge nodes.

CONCLUSIONS

This study is the first to use both structural equation modeling and network analysis to explore the explore the relationship between CM, CR, NC, and NSSI in adolescents with MDD, providing a theoretical basis for future early prevention and targeted interventions for adolescents with MDD.

The relationship between childhood adversity and affective instability across psychiatric disorders: A meta-analysis

INTRODUCTION

Affective instability represents an important, transdiagnostic biobehavioural dimension of mental ill health and clinical outcome. The causes of affective instability remain unclear. This systematic review and meta-analysis evaluated the extent to which exposure to childhood adversity is associated with affective instability across psychiatric disorders, and which forms of adversity are most strongly associated with affective instability.

METHODS

The review followed a published protocol (PROSPERO: CRD42020168676). Searches in Medline, Embase and PsychInfo identified studies using quantitative measures of childhood adversity and affective instability, published between January 1980 and July 2023. Data were analysed using a random effects meta-analysis separately for each outcome, namely affective lability, emotion dysregulation, and rapid cycling. The Mixed-Methods Appraisal Tool was used to appraise the quality of the literature.

RESULTS

The search identified 36 studies involving 8431 participants. All reports focused on cross-sectional associations. We did not identify any prospective longitudinal research. The analysis showed small, but statistically significant effects of childhood adversity on affective lability (r = 0.09, 95% CI 0.02, 0.17), emotion dysregulation (r = 0.25, 95% CI 0.19, 0.32), and rapid cycling (OR = 1.39; 95% CI 1.14, 1.70). When considering adversity subtypes, emotional abuse showed the strongest effect on affective lability (r = 0.16, 95% CI 0.07, 0.24) and emotion dysregulation (r = 0.32, 95% CI 0.19, 0.44). Quality assessment scores were generally low. Most studies failed to control for confounding factors or offer assurances around the representativeness of the samples.

CONCLUSIONS

The findings suggest that childhood adversity, particularly emotional abuse, is associated emotional instability in adulthood, but further prospective longitudinal research is needed to confirm causality. The findings have implications for the prevention and treatment of affective instability across psychiatric disorders.

A meta-analysis on the lifetime and period prevalence of self-injury among adolescents with depression

Background

Adolescents are vulnerable to mental disorders due to physiological, psychosocial, and cognitive changes during this critical developmental stage. Depression, in particular, can lead to high-risk behaviors such as self-injury (SI) and suicide. This study aims to estimate the pooled prevalence of SI behaviors among adolescents with depression.

Materials and methods

We systematically searched databases including EMBASE, Scopus, PubMed, and Web of Sciences for relevant articles published on adolescents with depression from January 1, 2000, to January 1, 2024. The quality assessment of the studies was conducted using the Joanna Briggs Institute (JBI) criteria. The global prevalence of SI was calculated based on a random effects model using Stata software version 17.

Results

Our analysis included 29 studies involving 12,934 adolescents. The lifetime prevalence of SI was 52% (95% Confidence Interval [CI]: 41-64), while the period prevalence was 57% (95% CI: 49-64). Notably, a significant relationship was observed between the prevalence of SI and the year of publication of articles (p = 0.002). Furthermore, publication bias was not significant for both lifetime prevalence (p = 0.281) and period prevalence (0.358).

Conclusion

The prevalence of self-injurious behaviors in adolescents with depression is alarmingly high, with more than half of adolescents having engaged in these high-risk behaviors during their lifetime or within the last year. Given the associated risk of suicide, it is crucial to identify individuals at risk and provide timely interventions.

Microstructural abnormalities of white matter in the cingulum bundle of adolescents with major depression and non-suicidal self-injury

BACKGROUND

Non-suicidal self-injury (NSSI) is prevalent in major depressive disorder (MDD) during adolescence, but the underlying neural mechanisms are unclear. This study aimed to investigate microstructural abnormalities in the cingulum bundle associated with NSSI and its clinical characteristics.

METHODS

130 individuals completed the study, including 35 healthy controls, 47 MDD patients with NSSI, and 48 MDD patients without NSSI. We used tract-based spatial statistics (TBSS) with a region of interest (ROI) analysis to compare the fractional anisotropy (FA) of the cingulum bundle across the three groups. receiver-operating characteristics (ROC) analysis was employed to evaluate the ability of the difficulties with emotion regulation (DERS) score and mean FA of the cingulum to differentiate between the groups.

RESULTS

MDD patients with NSSI showed reduced cingulum integrity in the left dorsal cingulum compared to MDD patients without NSSI and healthy controls. The severity of NSSI was negatively associated with cingulum integrity (r = -0.344, p = 0.005). Combining cingulum integrity and DERS scores allowed for successful differentiation between MDD patients with and without NSSI, achieving a sensitivity of 70% and specificity of 83%.

CONCLUSIONS

Our study highlights the role of the cingulum bundle in the development of NSSI in adolescents with MDD. The findings support a frontolimbic theory of emotion regulation and suggest that cingulum integrity and DERS scores may serve as potential early diagnostic tools for identifying MDD patients with NSSI.

The influence of the severity of gender dysphoria on anxiety, depression, suicidal ideation, and non-suicidal self-injury in Chinese transgender, nonbinary, and gender-diverse youth

Background: Gender dysphoria (GD) is frequently reported among transgender, nonbinary, and gender-diverse (TNG) populations, and is closely related to anxiety, depression, suicidal ideation, and non-suicidal self-injury (NSSI). This study aimed to understand how GD influences the four mental health disparities among TNG youth, and to compare these outcomes depending on the severity of GD. Methods: 96,218 College students participated in the survey, of which the analysis was run on an extracted sub-set data of 2,315 (2.40%) TNG youth, with a mean age of 19.46 (SD = 1.52). Self-reported inventories measured sociodemographic factors, the severity of GD (Utrecht Gender Dysphoria Scale-Gender Spectrum), anxiety (seven-item Generalized Anxiety Disorder Questionnaire), depression (nine-item Patient Health Questionnaire), suicidal ideation (Suicidal Behaviors Questionnaire-Revised), and NSSI (Clinician-Rated Severity of Non-Suicidal Self-Injury Scale). Binary logistic regression assessed the association between significant GD and the four psychiatric disorders. Adjusted multiple logistic regression, and directed acyclic graph (DAG) analyses were conducted to explore the activating relationship among GD, sociodemographic factors, and psychiatric disorders. Results: 1,582 (68.30%) TNG youth who experienced significant levels of GD (total scores cutoff >= 46) were entered into the analyses. Binary logistic regression displayed significantly positive associations between significant GD and anxiety, depression, suicidal ideation, and NSSI. Multiple regression models showed risk factors included poor relationship with one's father/mother, tobacco smoking, alcohol consumption, and having a lower subjective social status. While family harmony, a higher father's educational level, and partaking in exercise were protective factors that exerted distinct impacts on these four psychiatric disorders. DAG findings showed a poor relationship with one's father with significant GD via other socio-demographic characteristics, activated psychiatric disorders. Conclusions: TNG youth with higher levels of GD also exhibited more severe anxiety, depression, suicidal ideation, and NSSI. Tailored interventions should be provided to prioritize relieving those with severe GD to protect TNG youth from psychiatric outcomes further.

The Impact of Recent Life Events, Internalizing Symptoms, and Emotion Regulation on the Severity of Non-Suicidal Self-Injury in Adolescents: A Mediation Analysis

Background

Previous studies have demonstrated a strong association between recent stressful life events and non-suicidal self-injury (NSSI) among adolescents. Internalizing symptoms and difficulty in emotion regulation (DER) may mediate this relationship. This study aimed to investigate the relationship between recent stressful life events and NSSI severity in adolescents and the potential moderating role of internalizing symptoms and DER.

Methods

A total of 224 adolescent inpatients (78.6% female) participated in the study, with an age range of 12-18 years old. Data on recent stressful life events, internalizing symptoms, DER, and NSSI behaviors were collected using a clinician-rated questionnaire. A structural equation model was used to test the hypothesized model.

Results

The rate of NSSI reporting among adolescents in the past 12 months was 65.18%. Recent stressful life events were found to be directly associated with NSSI severity (β = 0.128, P = 0.023). A chain-mediating effect between recent stressful life events and NSSI was also confirmed (β = 0.034, P = 0.023), with DER and internalizing symptoms playing a chain-mediating role and DER having a significantly indirect association with NSSI through internalizing symptoms.

Conclusion

Recent stressful life events appear to play a role in the etiology of NSSI, particularly punishment and interpersonal relationship events that warrant special attention. DER and internalizing symptoms play a chain-mediating role in the relationship between life events and NSSI. Reducing recent stressful life events, screening for internalizing symptoms, and improving emotion regulation may decrease NSSI behavior among adolescents.

The Effect of Bullying Victimization on Adolescent Non-Suicidal Self-Injury: The Mediating Roles of Alexithymia and Self-Esteem

Background & Aim

Non-suicidal self-injury (NSSI) in adolescents is a serious public health issue influenced by the interaction of multiple factors. The purpose of this study was to investigate the multiple mediating roles of alexithymia and self-esteem in the association between bullying victimization and NSSI in a sample of Chinese adolescents.

Methods

A survey of 1299 adolescents from two public middle schools in Henan Province, China, was undertaken. Data were collected using the Chinese version of the Delaware bullying victimization scale-student (DBVS-S), the Toronto Alexithymia-20 Scale (TAS-20-C), the Rosenberg self-esteem scale (RSES), and the adolescent self-injury questionnaire. Besides, we performed a structural equation modeling (SEM) with latent variables using AMOS 26.0 to examine the relationship between variables and the mediating effects.

Results

The SEM analysis found that not only can bullying victimization directly impact NSSI, but that alexithymia and self-esteem have a chain mediating effect in the association between bullying victimization and NSSI. This mediating effect contributed 22.47% to the total effect.

Conclusion

These findings validate bullying victimization, alexithymia, and low self-esteem are important variables that affect NSSI among Chinese adolescents. Educators need to implement some prevention and intervention strategies to ameliorate the campus atmosphere and adolescents' mental health aimed at avoiding NSSI behavior in adolescence.

Mediating role of anxiety and impulsivity in the association between child maltreatment and lifetime non-suicidal self-injury with and without suicidal self-injury

BACKGROUND

Child maltreatment can increase the risk of lifetime non-suicidal self-injury (NSSI) and suicidal self-injury (SSI), but there is limited knowledge regarding the differences of potentially psychological mechanisms between NSSI with and without SSI.

METHODS

Participants, 3918 community-based Chinese young men aged 18-34 years in Chengdu, were included in this study. We investigated the association between depression, anxiety, psychosis, child maltreatment, adulthood traumatic events, impulsivity, alcohol dependence, drug abuse, and lifetime of NSSI among participants with and without SSI. Parallel mediation analysis was utilized to explore the mediators for the relation between child maltreatment and NSSI.

RESULTS

The prevalence of lifetime NSSI was 6.1 % (95 % CI: 5.4 %-6.9 %) among young men. Anxiety and impulsivity partially mediated the effect of child maltreatment on NSSI either with (indirect effect: 51.2 %) or without SSI (indirect effect: 34.3 %). Depression was independently and significantly associated with only NSSI but not with NSSI+SSI. Alcohol dependence and psychosis were independently and significantly associated with NSSI+SSI and mediated the effect of child maltreatment on NSSI+SSI.

LIMITATIONS

The cross-sectional survey data limits the robustness of the proof to the causal relationships.

CONCLUSIONS

Anxiety and impulsivity are associated with NSSI either with or without SSI and partially mediate the effect of child maltreatment on NSSI. Depression is associated with only NSSI, while alcohol dependence and psychosis are only associated with NSSI+SSI. It could be crucial to improve treatment and recovery of alcohol dependence and psychosis for preventing young men engaged in NSSI from attempting SSI.

The amplitude of low-frequency fluctuation characteristics in depressed adolescents with suicide attempts: a resting-state fMRI study

Background

The amplitude of low-frequency fluctuation (ALFF) is a measure of spontaneous brain activity derived from resting-state functional magnetic resonance imaging (rs-fMRI). Previous research has suggested that abnormal ALFF values may be associated with major depressive disorder (MDD) and suicide attempts in adolescents. In this study, our aim was to investigate the differences in ALFF values between adolescent MDD patients with and without a history of suicide attempts, and to explore the potential utility of ALFF as a neuroimaging biomarker for aiding in the diagnosis and prediction of suicide attempts in this population.

Methods

The study included 34 adolescent depression patients with suicide attempts (SU group), 43 depression patients without suicide attempts (NSU group), and 36 healthy controls (HC group). Depression was diagnosed using a threshold score greater than 17 on the Hamilton Depression Rating Scale (HDRS). The rs-fMRI was employed to calculate zALFF values and compare differences among the groups. Associations between zALFF values in specific brain regions and clinical variables such as emotion regulation difficulties were explored using Pearson partial correlation analysis. Receiver-Operating Characteristics (ROC) analysis assessed the ability of mean zALFF values to differentiate between SU and NSU groups.

Results

Significant differences in zALFF values were observed in the left and right inferior temporal gyrus (l-ITG, r-ITG) and right fusiform gyrus (r-FG) among the three groups (GRF corrected). Both SU and NSU groups exhibited increased zALFF values in the inferior temporal gyrus compared to the HC group. Furthermore, the SU group showed significantly higher zALFF values in the l-ITG and r-FG compared to both the NSU group and the HC group. Partial correlation analysis revealed a negative correlation between zALFF values in the left superior and middle frontal gyrus (l-SFG, l-MFG) and the degree of emotional dysregulation in the SU group (R = -0.496, p = 0.003; R = -0.484, p = 0.005). Combining zALFF values from the l-ITG and r-FG achieved successful discrimination between depressed adolescents with and without suicide attempts (AUC = 0.855) with high sensitivity (86%) and specificity (71%).

Conclusion

Depressed adolescents with suicidal behavior exhibit unique neural activity patterns in the inferior temporal gyrus and fusiform gyrus. These findings highlight the potential utility of these specific brain regions as biomarkers for identifying suicide risk in depressed adolescents. Furthermore, associations between emotion dysregulation and activity in their frontal gyrus regions were observed. These findings provide preliminary yet pertinent insights into the pathophysiology of suicide in depressed adolescents.