Frontiers in psychology · 2026
Statistical indirect associations of sleep disturbance and GAD symptoms in the relationship between childhood trauma and non-suicidal self-injury in adolescents with depression.
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Shao Heng, Xie Ziqiu, Wu Yalu, Yang Tingting, Zhang Mengzhu, He Kongliang
Аннотация
BACKGROUND: Childhood trauma is an early stressor for adolescent depression. Previous studies have reported a link between childhood trauma and non-suicidal self-injury (NSSI) behaviors; however, the underlying associations among these variables remain unclear.
METHOD: Using the Chinese Version of the Functional Assessment of Self-Mutilation, Childhood Trauma Questionnaire Short Form, Pittsburgh Sleep Quality Index, and Generalized Anxiety Disorder-7 scale (GAD-7) as research instruments, we evaluated adolescents with depression who met the ICD-10 criteria for depressive episodes (n = 2,308) from the outpatient clinic of 12 psychiatric hospitals in China.
RESULTS: The scores of sleep disturbance, GAD symptoms, childhood trauma, and their subtypes for the adolescents with depression in the NSSI group were higher than those in the non-NSSI group. Pearson correlation analysis revealed that childhood trauma and its subtypes showed significant positive correlations with NSSI severity, sleep disturbance, and GAD symptoms. PROCESS-based mediation analysis and SEM-based sensitivity analyses showed significant statistical indirect associations between childhood trauma and NSSI behavior through sleep disturbance, GAD symptoms, and the sequential pathway involving sleep disturbance and GAD symptoms. After excluding general confounding factors, emotional abuse, physical abuse, sexual abuse, and physical neglect were significantly associated with NSSI severity in the cross-sectional regression model.
CONCLUSION: It is essential to remain alert to the increased risk of NSSI behavior among adolescents with depression, particularly those who have experienced different types of childhood trauma. Special consideration should be given to the impact of clinical symptoms such as sleep disturbance and GAD symptoms, and early intervention should be implemented to mitigate or reduce the possibility of NSSI behavior.
METHOD: Using the Chinese Version of the Functional Assessment of Self-Mutilation, Childhood Trauma Questionnaire Short Form, Pittsburgh Sleep Quality Index, and Generalized Anxiety Disorder-7 scale (GAD-7) as research instruments, we evaluated adolescents with depression who met the ICD-10 criteria for depressive episodes (n = 2,308) from the outpatient clinic of 12 psychiatric hospitals in China.
RESULTS: The scores of sleep disturbance, GAD symptoms, childhood trauma, and their subtypes for the adolescents with depression in the NSSI group were higher than those in the non-NSSI group. Pearson correlation analysis revealed that childhood trauma and its subtypes showed significant positive correlations with NSSI severity, sleep disturbance, and GAD symptoms. PROCESS-based mediation analysis and SEM-based sensitivity analyses showed significant statistical indirect associations between childhood trauma and NSSI behavior through sleep disturbance, GAD symptoms, and the sequential pathway involving sleep disturbance and GAD symptoms. After excluding general confounding factors, emotional abuse, physical abuse, sexual abuse, and physical neglect were significantly associated with NSSI severity in the cross-sectional regression model.
CONCLUSION: It is essential to remain alert to the increased risk of NSSI behavior among adolescents with depression, particularly those who have experienced different types of childhood trauma. Special consideration should be given to the impact of clinical symptoms such as sleep disturbance and GAD symptoms, and early intervention should be implemented to mitigate or reduce the possibility of NSSI behavior.