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Childhood Maltreatment and Self-Harm in Chinese Adolescents

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Childhood Maltreatment and Self-Harm in Chinese Adolescents Tian et al. BMC Public Health (2021) 21:1561 https://doi.org/10.1186/s12889-021-11605-y RESEARCH ARTICLE Open Access Childhood maltreatment and self-harm in Chinese adolescents: moderation and mediation via resilience Xin Tian1,2†, Jin Lu2,3†, Yusan Che1, Die Fang1, Hailiang Ran1, Xingting He4, Yanjiao Wang2, Tianlan Wang4, Xiufeng Xu2, Guangya Yang4 and Yuanyuan Xiao1* Abstract Background: Published studies examining the association between childhood maltreatment (CM) and self-harm (SH) among adolescents have been accumulated. It is possible that resilience serves as a moderator or mediator in CM-SH association, nevertheless, this topic has never been thoroughly investigated. Methods: In this population-based cross-sectional study, we surveyed 3146 students aged 10–17 in southwest China. The Childhood Trauma Questionnaire (CTQ), the Modified version of Adolescents Self-Harm Scale (MASHS), and the Resilience Scale for Chinese Adolescents (RSCA) were used to measure CM, SH, and resilience. Correlational analyses, hierarchical multivariate linear regression, and structural equation modeling (SEM) were performed to test the moderation and mediation of resilience in CM-SH association. Results: Findings revealed that, resilience with its five dimensions, CM, and SH were significantly correlated with each other. Resilience partially moderated and mediated the association between CM and SH. Besides, among all dimensions of resilience, emotion regulation, interpersonal assistance, and family support presented the strongest mediation in CM-SH association. Conclusions: Our results highlight the importance of resilience in CM related SH among Chinese teenagers. Resilience-oriented intervention could be considered in SH intervention measures for adolescents who had experienced CM. Keywords: Childhood maltreatment, Self-harm behaviors, Resilience, Emotion regulation, Family support, Interpersonal assistance * Correspondence: [email protected] †Xin Tian and Jin Lu contributed equally to this work. 1Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming 650500, Yunnan, China Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Tian et al. BMC Public Health (2021) 21:1561 Page 2 of 9 Background Nevertheless, no published studies have investigated this Childhood maltreatment (CM) is physical, sexual, psy- assumption so far. chological abuse or neglect of children, especially by par- In this cross-sectional study, we intended to discuss ent(s) or caregiver(s). CM has been identified as a major this issue in a large representative sample of Chinese ad- public health issue. It is reported that each year, 4–16% olescents. We tested the hypothesized mediation and and 5–10% of children are physically and sexually moderation of resilience in the association between CM abused, and one-tenth of children suffered from emo- and SH. tional abuse or neglect by their parents [1]. CM is also prevalent in China: a single site survey of 7702 partici- Method pants revealed that, for children under 16 years old, a Participants staggering 31.1% reported had been abused [2]. CM can Participants in this cross-sectional study were recruited impose multiple detrimental impacts on the victims, from 14 schools (5 primary schools, 5 junior middle from deficits in educational achievement, mental prob- schools, and 4 high schools) in Lincang, Yunnan, China, lems (such as depression, anxiety, post-traumatic stress from December 1 to 13, 2019. A three-stage random symptoms), to low self-esteem, dissociation, and person- clustering sampling method was applied in the present ality disorders, all of which can persist into the adult- survey: In stage one, we randomly chose Linxiang district hood [1, 3]. out from 8 prefectures and districts within Lincang’sjuris- Self-harm (SH) normally defined as intentional, direct diction; in stage two, 14 schools in Linxiang district were destruction of body tissue, with or without suicidal in- randomly determined; in stage three, all eligible students tent [4]. Although it can occur within any period of life, (aged 10–17) from 3 to 4 randomly selected classes within a higher prevalence has been found in pubertal age [5]. each chosen school were initially included. SH has long been considered a major problem among youths [6], affecting 17% of those aged between 12 and Measurements 18 years in China [7]. Though non-fatal, SH always indi- Each participant was invited to fill a self-administered cative of tragic outcomes: it has been repeatedly verified questionnaire that contains demographics, CM, resili- as the strongest indicator of future suicide [8]. Besides, ence, SH, bullying, negative life events, etc. Only the following the index episode of SH, self-injurers are former four parts were analyzed in the present study. inclined to develop repeated and frequent SH, and Prior to the survey, informed consents from the partici- about 2–7% of them will commit suicide in the fol- pants and their legal guardians were obtained. This lowing years [9, 10]. study was approved by the Ethics Committee of The Among all adverse psychosocial factors, CM has been Third People’s Hospital of Lincang (Lincang Psychiatry linked to elevated risk of SH in adolescents [11]. Given Hospital). the fact that, CM can increase not only the risk of SH but also the probability of suicidal behaviors [12], CM Childhood maltreatment related SH in youths should be effectively intervened. The brief version of Childhood Trauma Questionnaire Except for direct measures on preventing CM in general, (CTQ) is comprised of 28 questions [17], and can be di- interventions which targeting on crucial mediators or vided into five subscales, measuring three types of abuse moderators in CM-SH association can also be consid- (physical, sexual, emotional) and two types of neglect ered. Resilience is gradually attracting attention in the (emotional and physical). A 5-point Likert scale was recent years, especially among children and adolescents. used to gauge the frequency of maltreatment. The It reflects the ability to well adapt the adversities [13]. It Cronbach’s ɑ for CTQ in the present study was 0.81 has been found that resilient individuals tended to report (Bootstrap 95% CI: 0.80–0.83). The authors had received decreased risk in negative consequences (like depression, permission to use the questionnaire. anxiety) after exposed to CM [14]. Similarly, a higher level of resilience was related to lower risk of internaliz- Resilience ing problems [15]. Therefore, it is reasonable to postu- The Resilience Scale for Chinese Adolescents (RSCA) late that resilience may also protect against SH among is a 28-item instrument [18], assessing five dimen- adolescents who had experienced CM [16]. Also, a sions of resilience (goal concentration, interpersonal meta-analysis concluded that, the detrimental effect of assistance, emotion regulation, family support, and CM can be moderated or even averted under the prem- positive perception). Answers to each question are 5- ise of effectively consolidated resilience of the victims point Likert style, from “completely disagree” (with [14]. Therefore, we put forward the assumption that, re- assigned score of 1) to “completely agree” (with silience plays a prominent role in CM-SH association, assigned score of 5). A higher combined score of possibly as a mediator, or a moderator, or both. RSCA as well as its five dimensions indicate a better Tian et al. BMC Public Health (2021) 21:1561 Page 3 of 9 resilience in general or in specific aspect. The Cron- Table 1 Demographic characteristics of all study samples (N = bach’s ɑ of the RSCA in the present study was 0.86 3146) (Bootstrap 95% CI: 0.85–0.87). The authors had re- Factor N (%) Mean ± SD ceived permission to use the questionnaire. Sex Male 1437 (45.68) SH Female 1709 (54.32) The Modified version of Adolescents Self-Harm Scale (MASHS) simultaneously evaluating the frequency and Age 13.32 ± 2.18 severity of the 18 most commonly seen SH behaviors in Ethinicity Chinese adolescents [19]. Response categories for fre- Han 2113 (67.16) quency and severity were from “never” (with assigned Yi 365 (11.60) “ ” score of 1) to higher than five times (with assigned Wa 103 (3.27) score of 4) and from “non-perceptible injury” (with Others 565 (17.96) assigned score of 1) to “extremely critical injury” (with assigned score of 5). The authors had received permis- Grade sion to use the
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