童年创伤与青少年非自杀性自伤： 自尊与抑郁的链式中介作用

Childhood Trauma and Adolescent Non-Suicidal Self-Injury: The Chain Mediating Roles of Self-Esteem and Depression

摘要: 目的：探讨青少年童年创伤经历、自尊水平、抑郁症状与非自杀性自伤行为(NSSI)的相关性及其内部心理机制，为NSSI预防干预提供依据。方法：采用分层随机抽样，随机选取重庆市5所中学，使用自编人口统计量表、青少年自我伤害问卷、童年期创伤问卷(CTQ)、自尊量表(SES)、抑郁自评量表(SDS)评估NSSI行为、童年创伤、自尊水平及抑郁症状。运用Spearman相关分析探讨变量间关系，并通过链式中介模型(童年创伤为自变量，自尊和抑郁为中介变量，NSSI为因变量)检验中介效应。结果：童年创伤与自尊呈显著负相关(r = −0.310, P < 0.001)，与抑郁(r = 0.318, P < 0.001)、NSSI (r = 0.267, P < 0.001)呈显著正相关；自尊与NSSI呈负相关(r = −0.310, P < 0.001)，抑郁与NSSI呈正相关(r = 0.318, P < 0.001)。中介分析显示：童年创伤对NSSI存在直接效应。自尊和抑郁在二者间起链式中介作用，总中介效应占总效应的54.9%。其中三条路径显著：1) 童年创伤→自尊→非自杀性自伤行为(效应值 = −0.0139，占比22.82%)；2) 童年创伤→抑郁→非自杀性自伤行为(效应值 = −0.0074，占比12.15%)；3) 童年创伤→自尊→抑郁→非自杀性自伤行为(效应值 = −0.0122，占比20.03%)。结论：童年创伤可通过降低自尊水平和加剧抑郁症状的链式机制，增加青少年NSSI风险。自尊和抑郁在童年创伤与NSSI间存在显著的链式中介效应。临床干预中应重视对青少年童年创伤史的早期筛查，针对低自尊与抑郁症状开展整合式心理干预，以阻断“创伤–自尊降低–抑郁加重–自伤行为”的恶性链条，提升NSSI的临床治疗效果。

Abstract: Objective: To explore the relationship between childhood trauma experiences, self-esteem, depressive symptoms, and non-suicidal self-injury (NSSI) among adolescents, and to examine the underlying psychological mechanism, thereby providing empirical evidence for the prevention and intervention of NSSI. Methods: A stratified random sampling method was employed to select five secondary schools in Chongqing. Participants were assessed using a self-designed demographic questionnaire, the Adolescent Self-Harm Scale, the Childhood Trauma Questionnaire (CTQ), the Self-Esteem Scale (SES), and the Self-Rating Depression Scale (SDS) to measure NSSI behaviors, childhood trauma, self-esteem, and depressive symptoms, respectively. Spearman correlation analysis was used to examine the relationships among the variables. A chain mediation model (with childhood trauma as the independent variable, self-esteem and depression as mediators, and NSSI as the dependent variable) was conducted to test the mediation effects. Results: Childhood trauma was significantly negatively correlated with self-esteem (r = −0.310, P < 0.001), and significantly positively correlated with depression (r = 0.318, P < 0.001) and NSSI (r = 0.267, P < 0.001). Self-esteem was negatively correlated with NSSI (r = −0.310, P < 0.001), while depression was positively correlated with NSSI (r = 0.318, P < 0.001). Mediation analysis revealed a direct effect of childhood trauma on NSSI. Self-esteem and depression served as chain mediators between childhood trauma and NSSI, with the total indirect effect accounting for 54.9% of the total effect. Three specific indirect pathways were significant: 1) childhood trauma → self-esteem → NSSI (effect size = −0.0139, accounting for 22.82% of the total effect); 2) childhood trauma → depression → NSSI (effect size = −0.0074, accounting for 12.15%); and 3) childhood trauma → self-esteem → depression → NSSI (effect size = −0.0122, accounting for 20.03%). Conclusion: Childhood trauma may increase the risk of NSSI among adolescents through a chain mechanism involving decreased self-esteem and exacerbated depressive symptoms. Self-esteem and depression play a significant chain mediating role in the relationship between childhood trauma and NSSI. In clinical practice, attention should be paid to the early screening of childhood trauma history in adolescents, and integrated psychological interventions targeting low self-esteem and depressive symptoms should be implemented to interrupt the vicious chain of “trauma-decreased self-esteem-worsened depression-self-injurious behavior”, thereby improving the clinical efficacy of NSSI treatment.