From emotional maltreatment to adolescent non-suicidal self-injury: A moderated sequential mediation analysis of loneliness, depression and gender among Chinese adolescents.

BACKGROUND

Non-suicidal self-injury (NSSI) represents a significant public health concern among adolescents, with adverse childhood experiences (ACEs) as robust predictors. However, the mechanisms linking ACEs to NSSI remain inadequately understood, particularly regarding ACE subtype-specific pathways.

OBJECTIVE

This study examined loneliness and depression as mediators in the ACE-NSSI association among Chinese adolescents, with attention to ACE subtype specificity and gender moderation.

PARTICIPANTS AND

SETTING

The sample comprised 993 high school students (Meanage = 17.8; 67.6% female, 32.4% male) from an art preparatory academy in China, recruited between March and May 2024.

METHODS

Cross-sectional design using structural equation modeling to examine the sequential mediation from ACEs through loneliness and depression to NSSI, and the moderation effect of gender in the ACE-loneliness pathway, with bias-corrected bootstrap confidence intervals. ACEs were measured using the ACE-Q, loneliness using the UCLA Loneliness Scale, depression using PHQ-9, and NSSI using the DSHI-9r.

RESULTS

Six-month NSSI prevalence was 17.2%. Loneliness and depression sequentially accounted for the ACE-NSSI association, explaining 7.7% of the total effect. This pathway was significant only for emotional maltreatment (indirect effect: β = 0.106, 95% CI [0.056, 0.183]) and not other ACE types. Gender moderated the ACE-loneliness pathway specifically for emotional maltreatment, with significant indirect effects observed only among females (β =0.048, 95% CI [0.024, 0.088]).

CONCLUSIONS

Emotional maltreatment was associated with NSSI through an interpersonal-affective pathways where loneliness was linked to depression, which in turn was associated with elevated NSSI risk. These specific, modifiable pathways suggest targeted interventions addressing loneliness may reduce NSSI risk, particularly among females with emotional maltreatment histories.