Longitudinal Influences of Childhood Trauma on Depressive Symptoms among Chinese Vocational School Students: Roles of Anhedonia and Expressive Suppression

Longitudinal Influences of Childhood Trauma on Depressive Symptoms among Chinese Vocational School Students: Roles of Anhedonia and Expressive Suppression | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Longitudinal Influences of Childhood Trauma on Depressive Symptoms among Chinese Vocational School Students: Roles of Anhedonia and Expressive Suppression Hongjuan Jiang, Zongjie Tian, Jiajian Pan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7461371/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract While existing research has consistently established the link between childhood trauma (CT) and depressive symptoms, the mechanisms underlying this relationship remain insufficiently explored, particularly in vocational school students. Notably, the mediating role of anhedonia has not been verified through longitudinal studies, and the moderating effect of expressive suppression (ES) is still unclear. This study sought to address these gaps by exploring the longitudinal relationship between CT and depressive symptoms, with a specific focus on the roles of anhedonia and ES in this relationship among vocational school students in China. A two-wave longitudinal study was conducted with an 18-month interval with 1892 students (519 boys and 1373 girls) from 4 vocational schools in Hainan Province, China. The Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI), Revised Anhedonia Scale-Chinese version (RAS-C), and the expressive suppression subscale of the Emotion Regulation Questionnaire (ERQ) were used for measurement. Results revealed that: (1) CT directly and positively predicted subsequent depressive symptoms ( β = 0.06, p < 0.05). (2) Anhedonia played a longitudinal mediating role in the CT-depression relationship ( β = 0.07; p < 0.05). (3) ES did not moderate the relationship between CT and depressive symptoms but moderated the relationship between CT and anhedonia ( β =-0.17, p < 0.05) and the mediating effect of anhedonia on the relationship between CT and depressive symptoms ( β =-0.39, p < 0.001). These findings suggest that CT may contribute to depressive symptoms among vocational school students through anhedonia. Although ES does not directly affect this pathway, it moderates the trauma–anhedonia link, weakening the indirect effect at higher ES levels. These findings highlight the need for interventions focused on reducing anhedonia and improving emotion regulation in trauma-exposed adolescents, particularly in vocational education settings. Childhood trauma Depressive symptoms Anhedonia Expressive suppression Vocational school students Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The prevalence of depression disorders increases markedly from approximately 3% in childhood to 14–20% in adolescence, with estimates for subthreshold depression ranging from 17–43% and for depressive symptoms ranging from 22–60% [ 1 , 2 ]. Depression disorders during adolescence have been linked to a higher incidence and greater severity of mental disorders in adulthood, as well as to an increased risk of suicide. These findings underscore adolescence as a critical window for the prevention, diagnosis, and treatment of depression [ 1 , 2 ]. Among the multiple etiological factors of depression, childhood trauma (CT) has received particular attention because it is, in principle, preventable. Prior studies have consistently shown that adolescents who are exposed to two or more types of trauma are more likely to develop depressive symptoms. Moreover, earlier exposure is associated with an average onset of depression 4.39 years earlier, greater symptom severity, and broader functional impairment [ 3 – 6 ]. The prevalence of CT among patients with major depression disorder has been reported to be as high as 62%, and such trauma is considered a key risk factor for poor treatment adherence [ 7 , 8 ]. According to the diathesis–stress model, stress interacts with individual vulnerability to precipitate depression [ 9 ]. As a form of chronic stress, CT may influence the development of depression via specific psychological mechanisms; however, these mechanisms have yet to be fully elucidated. Anhedonia, as a core endophenotype of depression, is recognized as one of the risk factors that increases vulnerability to depression and hinders recovery [ 10 , 11 ]. Evidence suggests that CT can lead to anhedonia and serves as an independent predictor of this condition [ 12 , 13 ]. In a cross-sectional study of trauma-exposed individuals, Haim-Nachum et al. [ 14 ] reported that anhedonia mediated the association between CT and depressive symptoms. These findings are consistent with the diathesis–stress model, suggesting that deficits in reward system functioning may diminish or eliminate the buffering effect of positive emotions, thereby increasing susceptibility to threat-related cognitions under stress and precipitating depressive symptoms [ 15 ]. However, longitudinal evidence supporting this mechanism remains scarce. Expressive suppression (ES) is a response-focused emotion-regulation strategy in which individuals consciously inhibit the outward display of emotions after an emotional response has been elicited [ 16 ]. This process not only consumes cognitive resources but also amplifies negative affect and thus has been regarded as a vulnerability factor for depression [ 16 , 17 ]. Higher levels of ES are closely associated with greater depressive symptoms; notably, the use of this strategy has been shown to exacerbate the impact of early trauma on depressive symptomatology, functioning as a moderator in this relationship [ 18 , 19 ]. However, other studies have reported no moderating effect of ES on the association between CT and mental health outcomes [ 20 ]. Both ES and anhedonia are recognized as strong predictors of depression, yet their interrelationship has received limited empirical attention. Interestingly, a longitudinal study of Mexican American adolescents revealed that, within a cultural context encouraging the overt expression of positive emotions, greater suppression of negative emotions was paradoxically associated with lower levels of anhedonia [ 21 ]. This finding raises important questions regarding whether, in cultural contexts that value emotional restraint—such as the traditional Chinese norm of concealing one’s feelings (e.g., “one’s joy or anger should not be readily visible”)—ES might be linked to anhedonia in adolescence. Furthermore, given the robust association between anhedonia and depression and prior evidence that ES can moderate the relationship between CT and depression [ 18 , 19 ], whether ES similarly moderates the association between CT and anhedonia remains unclear. According to data from the Ministry of Education of China, vocational school students accounted for 33.8% of all students enrolled in upper secondary education in 2022. Despite the large size of this population, they remain at a relative disadvantage in terms of educational resources, societal perception, and opportunities for further education and employment [ 22 ]. Compared with their counterparts in general high schools, vocational school students tend to have lower levels of mental health, exhibit more emotional and behavioral problems, and are particularly vulnerable to depression as well as associated suicidal ideation and self-injurious behaviors [ 23 – 26 ]. In response to these concerns, the psychological well-being of this group has attracted increasing policy and academic attention, especially following the release of the Special Action Plan for Comprehensively Strengthening and Improving Students’ Mental Health in the New Era (2023–2025) by the Ministry of Education and 16 other departments in 2023. Present Study In summary, empirical research on the mechanisms linking CT to depressive symptoms among vocational school students remains limited. Longitudinal evidence for the mediating role of anhedonia is lacking, the relationship between ES and anhedonia has yet to be clarified, and the potential moderating effect of ES has received little attention. To address these gaps, the present study employed an 18-month longitudinal design with vocational school students as participants. We constructed a moderated mediation model to examine the prospective impact of CT on depressive symptoms, tested the mediating effect of anhedonia, and assessed the moderating role of ES. Methods Participants and Procedure Employing convenience sampling, the longitudinal component enrolled 2,145 students from four vocational schools in Hainan Province, all of whom participated in the baseline survey in October 2022 (T1). Subsequent assessments were conducted in March 2024 (T2). The respondents whose answers were overly uniform or exhibited excessive fluctuations were excluded, resulting in a final sample of 1,892 valid participants. At T1, the participants’ ages ranged from 14–20 years, with a mean age of 15.23 ± 0.80 years; 519 were male (27.4%), and 1,373 were female (72.6%). The participants who dropped out midway and those who completed all three assessments were coded as 0 and 1, respectively. No statistically significant differences were observed in sex ( χ ² = 3.68; p = 0.055) or age ( t = − 0.80, p = 0.211) between groups, indicating that there was no systematic dropout bias. Prior to participation, approval was obtained from the Ethics Committee of Hainan Medical University (HYLL-2022-425), and the study was conducted in accordance with the principles of the Declaration of Helsinki. School administrators, teachers, and mental health educators assisted with recruitment and communication. Institutional engagement was further enhanced through incentive strategies such as the sharing of research findings, expert-led seminars, and targeted group counseling services. Informed consent procedures were strictly observed: for participants under 18 years old, both parental/guardian consent and student assent were obtained; for participants aged 18 years and above, consent was obtained directly from the students. All surveys were completed via online questionnaires during class sessions, ensuring confidentiality and voluntary participation. Measures Depressive Symptoms (T1, T2) The Chinese version of the Beck Depression Inventory (BDI) was used to measure depressive symptoms [ 27 ]. The scale comprises 21 items, each scored on a scale ranging from 0 to 3 (e.g., “Sorrowful: 0 = I don’t feel sorrowful; 1 = I feel sad most of the time; 2 = I am sad all the time; 3 = I feel very sad or unhappy and can’t stand it”). Total scores were calculated by summing item responses, with higher values indicating more severe depression. Clinical thresholds were defined as follows: 0–4, no or minimal depression; 5–13, mild depression; 14–20, moderate depression; and ≥ 21, severe depression. In this study, the BDI exhibited good reliability ( α = 0.94, 0.95). Childhood Trauma (T1) CT was assessed using the Chinese version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF)[ 28 ]. The CTQ-SF assesses five trauma subtypes: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Its 28 items (25 clinical items + 3 validity items; e.g., “During my childhood, no one in my family cared whether I had enough to eat or drink.”) were rated on a 5-point Likert scale (1 = “never,” 5 = “always”). The clinical thresholds were as follows: emotional abuse ≥ 13, physical abuse ≥ 10, sexual abuse ≥ 8, emotional neglect ≥ 15, and physical neglect ≥ 10. Validity items were scored 0–1, and total validity scores > 3 invalidated responses. The scale showed good reliability in this study ( α = 0.88). Anhedonia (T1, T2) Anhedonia was measured using t he Revised Anhedonia Scale-Chinese version (RAS-C)[ 29 ]. It comprises two subscales: the 61-item Physical Anhedonia Scale (PAS), which assesses reduced pleasure from sensory experiences (e.g., “I have always had a number of favorite foods.”), and the 40-item Social Anhedonia Scale (SAS), which evaluates diminished social enjoyment (e.g., “Getting together with old friends has been one of my greatest pleasures.”). Both scales use dichotomous responses (0 = “disagree,” 1 = “agree”), with higher total scores indicating greater anhedonia. Gender-specific cutoffs were used to classify clinically significant anhedonia: PAS > 20 (women) or > 28 (men) and SAS > 16 (women) or > 20 (men; Kwapil et al., 2002). The scale showed good reliability in this longitudinal ( α = 0.92, 0.97) sample. Emotion Regulation (T1) The Chinese version of the Emotion Regulation Questionnaire (ERQ) comprises 10 items reflecting two factors: cognitive reappraisal (six items; e.g., “When I am faced with a stressful situation, I make myself think about it in a way that helps me calm down.”) and ES (four items; e.g., “I keep my emotions to myself.” )[ 30 ]. Each item of the ERQ was scored from 1 (“completely disagree”) to 7 (“completely agree”), with higher total scores indicating more frequent CR or ES use. In this study, only the ES scale was used, and it showed good reliability ( α = 0.80). Statistical Analyses The data were analyzed using SPSS 29 (IBM Corp., Armonk, NY) and Mplus 8.3 (Muthén & Muthén, Los Angeles, CA). The significance threshold was set at 0.05. The categorical variables were reported as frequencies and percentages, whereas the continuous variables were reported as the means and standard deviations. Independent-samples t tests were conducted to compare age and the scores of each scale between male and female participants. Pearson correlation analyses were performed to examine the relationships among age, depressive symptoms, CT, anhedonia, and ES scores. After controlling for sex (1 = male, 2 = female) and age, depressive symptoms were entered as the dependent variable, CT as the independent variable, anhedonia as the mediator, and ES as the moderator. The mediating, moderating effects, and moderated mediating effects were tested sequentially. Model fit was evaluated using the following criteria: χ 2 /df 0.90, TLI > 0.90, RMSEA < 0.08, and SRMR < 0.05. All of the models reported below met these fit criteria. For the statistically significant interaction terms, simple slope analyses were conducted to illustrate the moderating effects. Harman’s single-factor test was conducted to assess the extent of common method bias. The results indicated that five factors had eigenvalues > 1, with the first factor accounting for 22.32% of the variance, which is below the critical threshold of 40%. These findings suggest that common method bias was not a serious concern in the present study. Results Attrition analyses revealed that the attrition group (N = 253) did not vary from the final sample (N = 1,892) in terms of age, sex, depressive symptoms, or ES. However, the students in the attrition group reported higher levels of anhedonia ( t = 5.46, p < 0.001) and experienced more childhood abuse and neglect ( t = 8.13, p < 0.001). The descriptive statistics and Pearson correlation coefficients for all of the variables are presented in Table 1 . Gender was negatively correlated with all of the study variables. Age was positively correlated with T1 CT, T1 ES, T1 and T2 anhedonia, and T2 depressive symptom scores. The scores for CT, depressive symptoms, anhedonia, and ES at T1 and T2 were positively correlated. Independent-samples t tests revealed that compared with the female participants, the male participants scored significantly higher in terms of age and all of the study variables ( t > 2.56, p < 0.01). Table 1 Descriptive statistics and Pearson correlation among variables Variable x̅±s Gender Age T1 Childhood Trauma T1 Expressive Suppression T1 Anhedonia T1 Depressive Symptoms T1 Anhedonia T2 Gender Age T1 15.2 ± 0.8 -0.14*** Childhood Trauma T1 40.6 ± 13.8 -0.25*** 0.10*** Expressive Suppression T1 17.0 ± 5.0 -0.15*** 0.05* 0.17*** Anhedonia T1 31.7 ± 12.8 -0.18*** 0.07** 0.43*** 0.23*** Depressive Symptoms T1 10.4 ± 4.8 -0.06* 0.04 0.33*** 0.19*** 0.35*** Anhedonia T2 33.8 ± 14.2 -0.28*** 0.08*** 0.40*** 0.20*** 0.66*** 0.27*** Depressive Symptoms T2 8.2 ± 5.1 -0.10*** 0.07** 0.27*** 0.13*** 0.29*** 0.48*** 0.31*** Notes: * p < 0.05; ** p < 0.01; *** p < 0.001. To examine the concurrent mediating role of anhedonia in the relationship between CT and depressive symptoms, a mediation model was constructed at the T1 time point, with CT as the predictor, anhedonia as the mediator, and depressive symptoms as the dependent variable, while controlling for sex and age. The results indicated that, at the same time point, anhedonia exerted a significant concurrent mediating effect on the relationship between CT and depressive symptoms (Table 2 ). Building on the results of the concurrent mediation analysis, the longitudinal mediating effects were further tested. The CT at T1 score was entered as the predictor; the anhedonia scores at T1 and T2 were entered separately as mediators; the depressive symptom scores at T2 served as the dependent variable; and sex, age, and the T1 depressive symptoms were controlled. The results were as follows. (1) T1 anhedonia as a mediator: CT at T1 significantly predicted T1 anhedonia ( β = 0.43, p < 0.001) and T2 depressive symptoms ( β = 0.09, p = 0.004). T1 anhedonia significantly predicted T2 depressive symptoms ( β = 0.11, p < 0.001). The indirect effect was 0.05 (95% CI [0.03, 0.07]), accounting for 35.3% of the total effect (Fig. 1 , Table 2 ). (2) T2 anhedonia as a mediator: CT at T1 significantly predicted T2 anhedonia ( β = 0.40, p < 0.001) and T2 depressive symptoms ( β = 0.06, p = 0.026). T2 anhedonia significantly predicted T2 depressive symptoms ( β = 0.17, p < 0.001). The indirect effect was 0.07 (95% CI [0.05, 0.09]), accounting for 51.5% of the total effect (Fig. 1 , Table 2 ). For both models, the indirect effects were statistically significant, supporting the presence of a longitudinal mediating role of anhedonia in the association between CT and depressive symptoms [ 31 ]. Table 2 The mediating role of Anhedonia between Childhood Trauma and Depressive Symptoms Time Pathway Indirect Effect 95%CI The Proportion Of The Total Effect Transverse T1Childhood Trauma →T1Anhedonia → T1Depressive Symptoms 0.11 [0.08, 0.13] 32.3% Longitudinal T1Childhood Trauma →T1Anhedonia → T2Depressive Symptoms 0.05 [0.03, 0.07] 35.3% T1Childhood Trauma →T2Anhedonia → T2Depressive Symptoms 0.07 [0.05, 0.09] 51.5% Note: The effect value is the standardized coefficient. Notes: * p < 0.05; ** p < 0.01; *** p < 0.001. To examine the concurrent moderating effect of ES on the relationship between CT and depressive symptoms, a moderation model was constructed at T1. The results showed that ES exerted a statistically significant interaction effect ( β = -0.05, p = 0.015). However, a subsequent simple slope analysis indicated that the positive association between CT and depressive symptoms was nonsignificant for both the high-ES group ( B = 0.21, t = 1.57, p = 0.115) and the low-ES group ( B = 0.22, t = 1.77, p = 0.077), suggesting no substantive concurrent moderating effect of ES. The longitudinal moderation effects were further examined on the basis of the concurrent model. In this model, CT at T1 served as the predictor, ES at T1 served as the moderator, and depressive symptoms at T2 served as the outcome variable, while the relevant covariates were controlled. As shown in Fig. 2 A, both CT and ES at T1 significantly and positively predicted T2 depressive symptoms ( β = 0.27, p < 0.001; β = 0.09, p < 0.001). Moreover, their interaction term significantly and negatively predicted T2 depressive symptoms ( β = -0.09, p < 0.001), indicating a potential longitudinal moderation effect. Nevertheless, simple slope analyses revealed that the positive association between CT and depressive symptoms remained nonsignificant in the high-ES group ( B = 0.19, t = 1.32, p = 0.188) and the low-ES group ( B = 0.20, t = 1.52, p = 0.129). Overall, these results suggest that ES did not significantly moderate the relationship between CT and depressive symptoms in either the concurrent or longitudinal models. To investigate the concurrent moderating effect of ES on the relationship between CT and anhedonia, a moderation model was constructed at T1, with CT as the predictor, ES as the moderator, and anhedonia as the outcome variable, while controlling for sex and age. The results indicated a statistically significant interaction between CT and ES ( β = -0.30, p = 0.003), suggesting a concurrent moderating effect. Building on this result, longitudinal moderating effects were further examined. In this model, CT at T1 served as the predictor, ES at T1 served as the moderator, and anhedonia at T2 served as the dependent variable when sex, age, and T1 anhedonia were controlled. As shown in Fig. 2 B, both CT and ES at T1 significantly and positively predicted T2 anhedonia ( β = 0.23, p < 0.001; β = 0.12, p = 0.010), whereas their interaction term significantly and negatively predicted T2 anhedonia ( β = -0.17, p = 0.020), indicating a longitudinal moderation effect. Subsequent simple slope analyses (Fig. 3 ) revealed that the positive effect of CT on anhedonia was significant for both the high-ES group ( B = 0.344, t = 2.135, p = 0.033) and the low-ES group ( B = 0.358, t = 2.414, p = 0.016), with a stronger association in the latter group. This pattern suggests that higher ES levels are associated with a stronger positive relationship between CT and anhedonia. After controlling for sex, age, T1 anhedonia, and T1 depressive symptoms, a moderated mediation model was tested with CT at T1 (X) as the independent variable, anhedonia at T2 (M) as the mediator, depressive symptoms at T2 (Y) as the dependent variable, and ES at T1 (W) as the moderator. The model equations were specified as follows: M =a0 + a1 X + a 2 W + a 3 WX + ε1 (1) Y =c0 + c1 X + b 1 M + ε2 (2) The results from the first-stage moderated mediation analysis revealed that the interaction term of T1 CT and T1 ES significantly predicted T2 anhedonia ( β = -0.39, p < 0.001). Additionally, T2 anhedonia significantly predicted T2 depressive symptoms ( β = 0.17, p < 0.001). These findings indicate that the indirect effect of T1 CT on T2 depressive symptoms via T2 anhedonia was moderated by T1 ES. Next, a bias-corrected nonparametric percentile bootstrap method with 5000 resamples was used to estimate the conditional indirect effect. The 95% confidence interval (CI) for the moderated mediation effect was [0.08, 0.15], which did not include zero, indicating a statistically significant moderated mediation effect. The moderated mediating effect was expressed as (a1 + a3W) b1=0.11 − 0.07 W, demonstrating that the magnitude of the mediating effect varied as a function of W (T1 ES). As illustrated in Fig. 4 , when the T1 ES (W) ranged from 0.14–25.11, the 95% CI for the conditional indirect effect (a1 + a3W) b1 did not include zero, suggesting that the mediating effect was statistically significant and decreased with increasing ES. Conversely, when W ranged from 25.12–27.89, the 95% CI included zero, indicating that the mediating effect was no longer significant. Discussion Guided by the diathesis–stress framework of depression, the present study employed an 18-month longitudinal design to investigate the pathways linking CT to depressive symptoms among vocational school students. The findings revealed that anhedonia served as a longitudinal mediator in the relationship between CT and depressive symptoms. Furthermore, ES moderated the association between CT and anhedonia, thereby influencing the strength of the mediating effect of anhedonia within a certain range. These results provide empirical support for the diathesis–stress model, underscoring the critical role of both emotional expression and hedonic capacity in the development of depression following CT. From a practical perspective, the findings highlight the importance of interventions that encourage adolescents to express their emotions openly and that target the alleviation of anhedonia as potential strategies for mitigating depression risk among those with a history of CT. The present study revealed that CT was strongly associated with depressive symptoms both at school entry and 18 months later among vocational school students, which is consistent with the findings of previous research [ 3 – 8 ]. CT can undermine an individual’s sense of safety and lead to social withdrawal; repeated traumatic experiences may foster cognitive distortions, such as catastrophic expectations and hostile attribution biases. Trauma may also diminish self-identity, increasing the likelihood of maladaptive coping strategies—such as avoidance—when facing stressors. Moreover, trauma exposure prior to the age of 12 can severely disrupt neurodevelopment, trigger the onset of depression, and impair other functional domains [ 4 , 8 , 32 ]. These findings underscore the importance of screening for both CT and depressive symptoms at the point of school entry in vocational education. Furthermore, they highlight the need to develop and implement targeted follow-up interventions to support at-risk students. Building on the finding that CT was significantly associated with depressive symptoms among vocational school students, the present study further confirmed that anhedonia functioned as a longitudinal mediator between the two. From a developmental perspective, the maturation of distinct brain regions during childhood follows unique trajectories, relying on coordinated interactions among the amygdala, medial prefrontal cortex, striatum, and hippocampus to support the progressive development of cognitive, emotional, and social abilities. Exposure to different types of trauma can alter the structure, function, and connectivity of these regions, leading to heightened fear responses, diminished emotion regulation capacity, and reduced reward sensitivity, all of which increase vulnerability to depression [ 33 ]. Neurobiological models of stress-induced anhedonia and depression further suggest that traumatic stress disrupts reward-related neural circuits, attenuating the hedonic value of stimuli, dampening anticipatory responses, and ultimately triggering anhedonic subtypes of depression [ 34 , 35 ]. These findings underscore that, for vocational school students with a history of CT, interventions aimed at alleviating anhedonia and addressing trauma-related sequelae should be integrated into school-based mental health programs as a means to reduce depression risk. The present study revealed that ES did not directly or longitudinally moderate the relationship between CT and depressive symptoms among vocational school students. These findings contrast with those of several previous studies suggesting that individuals who tend to rely on ES often have fewer psychological resources and reduced social support and that suppressing negative emotions elicited by trauma may foster maladaptive sadness-related cognitive patterns. Such patterns can lead to mistrust of others, a diminished sense of belonging, and a preference for avoidant coping strategies, which collectively exacerbate depressive symptoms [ 16 , 18 , 19 ]. On the other hand, our results align with those of Jones et al. [ 20 ], who reported no moderating role of ES in the association between CT and mental health indicators, suggesting that ES may not directly amplify the negative psychological effects of CT. The results of the current study revealed that ES positively predicted anhedonia among vocational school students, which differs from the negative association observed by Young et al. [ 21 ] in a sample of Mexican American adolescents, for whom the social climate emphasized the encouragement of positive emotional expression. A potential explanation for this discrepancy may lie in the cultural context: within a collectivist-oriented Chinese cultural setting, moderate emotional restraint is often regarded as an important aspect of social adaptation. However, excessive suppression can deplete cognitive resources, reduce sensitivity to positive stimuli, and thereby exacerbate anhedonia [ 16 , 36 ]. Furthermore, this study is the first to show that ES exerted a longitudinal moderating effect on the relationship between CT and anhedonia—namely, higher levels of ES intensified the long-term negative impact of CT on anhedonia. Given that anhedonia is a shared risk factor for multiple psychiatric disorders—including depression, schizophrenia, and substance addiction—school-based interventions that target emotional expression among vocational school students with a history of CT may help alleviate anhedonic symptoms and consequently reduce the risk of comorbidity across a range of mental illnesses [ 37 ]. A moderated mediation model specifies the conditions under which a mediating process becomes stronger or weaker, thereby extending and refining a simple mediation framework. In the present study, among vocational school students with ES levels from 0.14–25.11 (unstandardized scores), the mediating effect of anhedonia on the relationship between CT and depressive symptoms decreased as ES increased. In other words, although ES did not directly moderate the link between CT and depressive symptoms, it indirectly influenced this association by altering the strength of anhedonia’s mediating role. This pattern is consistent with the findings of Li et al. [ 38 ], who suggested that ES indirectly moderated the association between CT and adult mental health via its influence on self-esteem. In contrast, for students with ES levels from 25.12–27.89, the mediating effect of anhedonia was nonsignificant, implying that under conditions of excessive suppression, CT may trigger depressive symptoms through a direct pathway—marking this subgroup as potentially high risk. Several limitations of this study should be acknowledged. First, all of the behavioral data were collected exclusively through self-report measures, which may have introduced common method bias and social desirability effects. Second, a convenience sampling strategy was employed, and the resulting sample had an imbalanced sex distribution, which constrains the generalizability of the findings. Future research could address these limitations by incorporating experimental and intervention designs; increasing both the diversity and size of the sample; and, in particular, by employing stratified sampling to balance sex composition or performing subgroup analyses to explore sex differences. Moreover, integrating neurobiological indices, such as neuroimaging and endocrine measures, could further clarify the mechanisms by which ES and anhedonia contribute to the link between CT and depressive symptoms. Declarations Ethics Approval and Consent to Participate This study was reviewed and approved by the Ethics Committee of Hainan Medical University (reference no. HYLL-2022-425) and adhered to the ethical principles of the 1964 Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from all participants prior to data collection. For participants under the age of 18, consent was additionally obtained from their parents or legal guardians, along with assent from the minors themselves. Consent for Publication Not applicable. Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Competing interests The authors declare that they have no competing interests. Funding The research was funded by Hainan Provincial Philosophy and Social Sciences Planned Project (Project Numbers: HNSK(YB)23-41, HNSK(ZC)23-162), Planning Fund for Humanities and Social Sciences Research in Western and Frontier Regions of the Ministry of Education (Project Title: Exploring the Brain Neural Mechanisms and Immune Characteristics of Depression in School-Bullied Adolescents from the Perspective of Cognitive Reappraisal; Grant Number: 23XJA190001), Hainan Provincial Natural Science Foundation of China (821RC1124), National Undergraduate Innovation and Entrepreneurship Training Program (202411810011) and Hainan Medical University Undergraduate Innovation and Entrepreneurship Training Program (X202411810006). The founders had no role in the study design, data collection, analysis, writing the paper, and the decision to submit the paper for publication. Authors’ Contributions Hongjuan Jiang: Conceptualization, Data curation, Writing-original draft, Writing-review, Funding acquisition Zongjie Tian: Investigation, Data analysis, Writing-original draft, Funding acquisition, Jiajian Pan: Methodology, Overall coordination, Funding acquisition,Writing-review All authors have read and agreed to the published version of the manuscript. Acknowledgments The authors gratefully acknowledge the exceptional participation of the adolescents, parents, and teachers. References Thapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet. 2022;400:617-31. Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF 3rd, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Wolpert M. Time for united action on depression: A Lancet-World Psychiatric Association Commission. Lancet. 2022;399:957-1022. Pham TS, Qi H, Chen D, Chen H, Fan F. Prevalences of and correlations between childhood trauma and depressive symptoms, anxiety symptoms, and suicidal behavior among institutionalized adolescents in Vietnam. Child Abuse Negl. 2021;115:105022. Alameda L, Golay P, Baumann PS, Progin P, Mebdouhi N, Elowe J, Ferrari C, Do KQ, Conus P. Mild depressive symptoms mediate the impact of childhood trauma on long-term functional outcome in early psychosis patients. Schizophr Bull. 2017;43(5):1027-35. Nelson J, Klumparendt A, Doebler P, Ehring T. Childhood maltreatment and characteristics of adult depression: Meta-analysis. Br J Psychiatry. 2017;210:96-104. Kuzminskaite E, Vinkers CH, Milaneschi Y, Giltay EJ, Penninx BWJH. Childhood trauma and its impact on depressive and anxiety symptomatology in adulthood: A 6-year longitudinal study. J Affect Disord. 2022;312:322-30. Childhood Trauma Meta-Analysis Study G. Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis. Lancet Psychiatry. 2022;9:860-73. Wang H, Liao Y, Guo L, Zhang H, Zhang Y, Lai W, Teopiz KM, Song W, Zhu D, Li L, Lu C, Fan B, McIntyre RS. Association between childhood trauma and medication adherence among patients with major depressive disorder: The moderating role of resilience. BMC Psychiatry. 2022;22:644. Monroe SM, Simons AD. Onset of depression and time to treatment entry: Roles of life stress. J Consult Clin Psychol. 1991;59:123-30. Khazanov GK, Xu C, Dunn BD, Cohen ZD, DeRubeis RJ, Hollon SD. Distress and anhedonia as predictors of depression treatment outcome: A secondary analysis of a randomized clinical trial. Behav Res Ther. 2020;125:103507. Wong S, Le GH, Phan L, Rhee TG, Ho R, Meshkat S, Teopiz KM, Kwan ATH, Mansur RB, Rosenblat JD, McIntyre RS. Effects of anhedonia on health-related quality of life and functional outcomes in major depressive disorder: A systematic review and meta-analysis. J Affect Disord. 2024;356:684-98. Han J, Zhang LH, Zhang CY, Li B, Wang LL, Cai YX. Adolescent’s anhedonia and association with childhood trauma among Chinese adolescents: a cross-sectional study. BMJ Open. 2023;13:e071521. O’ Brien KJ, Ered A, Korenic SA, Olino TM, Schiffman J, Mittal VA, Ellman LM. Childhood trauma, perceived stress, and anhedonia in individuals at clinical high risk for psychosis: Multigroup mediation analysis. Br J Psychiatry. 2023;223:273-9. Haim-Nachum S, Amsalem D, Lazarov A, Zabag R, Neria Y, Sopp MR. Anhedonia mediates the relationships between childhood trauma and symptom severity of PTSD and depression, but not of social anxiety. J Affect Disord. 2024;344:577-84. Borsini A, Wallis ASJ, Zunszain P, Pariante CM, Kempton MJ. Characterizing anhedonia: A systematic review of neuroimaging across the subtypes of reward processing deficits in depression. Cogn Affect Behav Neurosci. 2020;20:816-41. Gross JJ. The emerging field of emotion regulation: an integrative review. Rev Gen Psychol. 1998;2:271-99. Dryman MT, Heimberg RG. Emotion regulation in social anxiety and depression: a systematic review of expressive suppression and cognitive reappraisal. Clin Psychol Rev. 2018;65:17-42. Yin W, Pan Y, Zhou L, Wei Q, Zhang S, Hu H, Lin Q, Pan S, Dai C, Wu J. The relationship between childhood trauma and depressive symptoms among Zhuang adolescents: Mediating and moderating effects of cognitive emotion regulation strategies. Front Psychiatry. 2022;13:994065. Lee M, Lee ES, Jun JY, Park S. The effect of early trauma on North Korean refugee youths’ mental health: Moderating effect of emotional regulation strategies. Psychiatry Res. 2020;287:112707. Jones EJ, Marsland AL, Gianaros PJ. Do trait-level emotion regulation strategies moderate associations between retrospective reports of childhood trauma and prospective changes in systemic inflammation? Stress Health. 2023;39:525-38. Young GR, Karnilowicz HR, Mauss IB, Hastings PD, Guyer AE, Robins RW. Prospective associations between emotion regulation and depressive symptoms among Mexican-origin adolescents. Emotion. 2022;22:129-41. Li J. Research on influencing factors of further education intention of secondary vocational students in underdeveloped areas: A crisp-set qualitative comparative analysis based on 56 cases. J Educ Dev. 2021;(12):76-84. Jensen CT, Heinze C, Andersen PK, Bauman A, Charlotte DK. Mental health and physical activity in vocational education and training school students: A population-based survey. Eur J Public Health. 2022;32:233-8. Liu J, Teng Z, Chen Z, Wei Z, Zou T, Qin Y, Yuan H, Liu M, Chen J, Tang H, Xiang H, Wu H, Wu R, Huang J. Exploring the associations between behavioral health risk factors, abnormal eating attitudes, and socio-demographic factors among Chinese youth: Survey of 7,984 vocational high school students in Hunan in 2020. Front Psychiatry. 2022;13:1000821. Dalen JD. The association between school class composition and suicidal ideation in late adolescence: Findings from the Young-HUNT 3 study. Child Adolesc Psychiatry Ment Health. 2012;6:37. Horváth LO, Balint M, Ferenczi-Dallos G, Farkas L, Gadoros J, Gyori D, Kereszteny A, Meszaros G, Szentivanyi D, Velo S, Sarchiapone M, Carli V, Wasserman C, Hoven CW, Wasserman D, Balazs J. Direct self-injurious behavior (D-SIB) and life events among vocational school and high school students. Int J Environ Res Public Health. 2018;15(6):1068. Liu P. Beck Depression Inventory (BDI). Chinese Mental Health Journal. 1999;13(Suppl.):191-4. Fu WQ, Yao SQ, Hong ZH, Zhao XF, Li R, Li Y, Zhang ZQ. Initial reliability and validity of Childhood Trauma Questionnaire (CTQ-SF) applied in Chinese college students. Chinese Journal of Clinical Psychology. 2005;13(1):40-3. Chan RCK, Wang Y, Yan C, Zhao Q, McGrath J, Hsi X, Stone WS. A study of trait anhedonia in non-clinical Chinese samples: Evidence from the Chapman scales for physical and social anhedonia. PLoS One. 2012;7:e34275. Wang L, Liu H, Li Z. Reliability and validity of emotion regulation questionnaire Chinese revised version. Chinese Journal of Clinical Psychology. 2007;15:503-5. MacKinnon D. Introduction to statistical mediation analysis. Erlbaum Psych Press. 2008. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. Guilford Press. 1979. Laricchiuta D, Panuccio A, Picerni E, Biondo D, Genovesi B, Petrosini L. The body keeps the score: The neurobiological profile of traumatized adolescents. Neurosci Biobehav Rev. 2023;145:105033. Bogdan R, Pizzagalli DA. Acute stress reduces reward responsiveness: implications for depression. Biol Psychiatry. 2006;60:1147-54. Zeng Q, Liu A, Li S. The relationship between childhood psychological maltreatment and trait depression: A chain mediating effect of rumination and post-traumatic cognitive changes. Chinese Journal of Clinical Psychology. 2015;23(04):665-9. Chervonsky E, Hunt C. Suppression and expression of emotion in social and interpersonal outcomes: A meta-analysis. Emotion. 2017;17:669-83. Der-Avakian A, Markou A. The neurobiology of anhedonia and other reward-related deficits. Trends Neurosci. 2012;35:68-77. Li C, Fu P, Wang M, Xia Y, Hu C, Liu M, Zhang H, Sheng X, Yang Y. The role of self-esteem and emotion regulation in the associations between childhood trauma and mental health in adulthood: A moderated mediation model. BMC Psychiatry. 2023;23:241. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7461371","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":525251842,"identity":"01cb92b2-0a4c-4992-b7a9-601bffbffd56","order_by":0,"name":"Hongjuan Jiang","email":"","orcid":"","institution":"Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hongjuan","middleName":"","lastName":"Jiang","suffix":""},{"id":525251843,"identity":"cd82dbea-935f-437a-b00c-1b6bfe135509","order_by":1,"name":"Zongjie Tian","email":"","orcid":"","institution":"Hainan Medical 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15:21:53","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111724,"visible":true,"origin":"","legend":"","description":"","filename":"b45084cd23ac4e4b85596c57372762e51structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7461371/v1/e123d982e61d70ab9b1f4cc2.xml"},{"id":93059191,"identity":"4ef26d44-87d6-49c7-80a2-015156a60fdf","added_by":"auto","created_at":"2025-10-08 15:29:53","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":121972,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7461371/v1/7b4b36f7d194c4d48cd6f628.html"},{"id":93058039,"identity":"b069b1c7-ab63-40c6-b551-28f729196a89","added_by":"auto","created_at":"2025-10-08 15:21:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43458,"visible":true,"origin":"","legend":"\u003cp\u003ePath coefficients for the mediating effect of anhedonia between childhood trauma and depressive symptoms.\u003c/p\u003e\n\u003cp\u003eNotes：*\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05; **\u003cem\u003e p\u003c/em\u003e\u0026lt;0.01; ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7461371/v1/0d3885e4e4d9673cdf3af1ca.png"},{"id":93059183,"identity":"c80054f9-68d6-408a-9c7a-a8a35d5f3566","added_by":"auto","created_at":"2025-10-08 15:29:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":79032,"visible":true,"origin":"","legend":"\u003cp\u003eCoefficient plots for the moderating role of expressive suppression.\u003c/p\u003e\n\u003cp\u003eNote: Panel A depicts the moderating effect of expressive suppression on the association between childhood trauma and depressive symptoms; Panel B depicts the moderating effect of expressive suppression on the association between childhood trauma and anhedonia. Interaction Term = T1 Childhood Trauma × T1 Expressive Suppression\u003c/p\u003e\n\u003cp\u003eNotes：*\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05; **\u003cem\u003e p\u003c/em\u003e\u0026lt;0.01; ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7461371/v1/b2e22ab2f246b1752576425e.png"},{"id":93058041,"identity":"baae1f10-a1d7-4256-a984-bfc7fd7a58ec","added_by":"auto","created_at":"2025-10-08 15:21:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":80064,"visible":true,"origin":"","legend":"\u003cp\u003eModeration effect of T1 expressive suppression.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7461371/v1/e25dd7d8e09efe591dbe01ff.png"},{"id":93059511,"identity":"9274bd36-a352-47a6-89e7-6c7fb94a9324","added_by":"auto","created_at":"2025-10-08 15:37:53","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":296857,"visible":true,"origin":"","legend":"\u003cp\u003eModeration of the mediating effect of anhedonia by expressive suppression.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7461371/v1/eca15f768aa5fa4524131d2b.png"},{"id":93061123,"identity":"bcc804e8-7b97-46ae-ad62-746691106d8e","added_by":"auto","created_at":"2025-10-08 16:13:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1087067,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7461371/v1/04da46bf-65b6-4b4e-89ce-81b0895ebda8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Longitudinal Influences of Childhood Trauma on Depressive Symptoms among Chinese Vocational School Students: Roles of Anhedonia and Expressive Suppression","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe prevalence of depression disorders increases markedly from approximately 3% in childhood to 14\u0026ndash;20% in adolescence, with estimates for subthreshold depression ranging from 17\u0026ndash;43% and for depressive symptoms ranging from 22\u0026ndash;60% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Depression disorders during adolescence have been linked to a higher incidence and greater severity of mental disorders in adulthood, as well as to an increased risk of suicide. These findings underscore adolescence as a critical window for the prevention, diagnosis, and treatment of depression [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Among the multiple etiological factors of depression, childhood trauma (CT) has received particular attention because it is, in principle, preventable. Prior studies have consistently shown that adolescents who are exposed to two or more types of trauma are more likely to develop depressive symptoms. Moreover, earlier exposure is associated with an average onset of depression 4.39 years earlier, greater symptom severity, and broader functional impairment [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The prevalence of CT among patients with major depression disorder has been reported to be as high as 62%, and such trauma is considered a key risk factor for poor treatment adherence [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. According to the diathesis\u0026ndash;stress model, stress interacts with individual vulnerability to precipitate depression [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As a form of chronic stress, CT may influence the development of depression via specific psychological mechanisms; however, these mechanisms have yet to be fully elucidated.\u003c/p\u003e\u003cp\u003eAnhedonia, as a core endophenotype of depression, is recognized as one of the risk factors that increases vulnerability to depression and hinders recovery [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Evidence suggests that CT can lead to anhedonia and serves as an independent predictor of this condition [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In a cross-sectional study of trauma-exposed individuals, Haim-Nachum et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] reported that anhedonia mediated the association between CT and depressive symptoms. These findings are consistent with the diathesis\u0026ndash;stress model, suggesting that deficits in reward system functioning may diminish or eliminate the buffering effect of positive emotions, thereby increasing susceptibility to threat-related cognitions under stress and precipitating depressive symptoms [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, longitudinal evidence supporting this mechanism remains scarce.\u003c/p\u003e\u003cp\u003eExpressive suppression (ES) is a response-focused emotion-regulation strategy in which individuals consciously inhibit the outward display of emotions after an emotional response has been elicited [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This process not only consumes cognitive resources but also amplifies negative affect and thus has been regarded as a vulnerability factor for depression [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Higher levels of ES are closely associated with greater depressive symptoms; notably, the use of this strategy has been shown to exacerbate the impact of early trauma on depressive symptomatology, functioning as a moderator in this relationship [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, other studies have reported no moderating effect of ES on the association between CT and mental health outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Both ES and anhedonia are recognized as strong predictors of depression, yet their interrelationship has received limited empirical attention. Interestingly, a longitudinal study of Mexican American adolescents revealed that, within a cultural context encouraging the overt expression of positive emotions, greater suppression of negative emotions was paradoxically associated with lower levels of anhedonia [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This finding raises important questions regarding whether, in cultural contexts that value emotional restraint\u0026mdash;such as the traditional Chinese norm of concealing one\u0026rsquo;s feelings (e.g., \u0026ldquo;one\u0026rsquo;s joy or anger should not be readily visible\u0026rdquo;)\u0026mdash;ES might be linked to anhedonia in adolescence. Furthermore, given the robust association between anhedonia and depression and prior evidence that ES can moderate the relationship between CT and depression [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], whether ES similarly moderates the association between CT and anhedonia remains unclear.\u003c/p\u003e\u003cp\u003eAccording to data from the Ministry of Education of China, vocational school students accounted for 33.8% of all students enrolled in upper secondary education in 2022. Despite the large size of this population, they remain at a relative disadvantage in terms of educational resources, societal perception, and opportunities for further education and employment [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Compared with their counterparts in general high schools, vocational school students tend to have lower levels of mental health, exhibit more emotional and behavioral problems, and are particularly vulnerable to depression as well as associated suicidal ideation and self-injurious behaviors [\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In response to these concerns, the psychological well-being of this group has attracted increasing policy and academic attention, especially following the release of the Special Action Plan for Comprehensively Strengthening and Improving Students\u0026rsquo; Mental Health in the New Era (2023\u0026ndash;2025) by the Ministry of Education and 16 other departments in 2023.\u003c/p\u003e\n\u003ch3\u003ePresent Study\u003c/h3\u003e\n\u003cp\u003eIn summary, empirical research on the mechanisms linking CT to depressive symptoms among vocational school students remains limited. Longitudinal evidence for the mediating role of anhedonia is lacking, the relationship between ES and anhedonia has yet to be clarified, and the potential moderating effect of ES has received little attention. To address these gaps, the present study employed an 18-month longitudinal design with vocational school students as participants. We constructed a moderated mediation model to examine the prospective impact of CT on depressive symptoms, tested the mediating effect of anhedonia, and assessed the moderating role of ES.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Methods","content":"\u003ch2\u003eParticipants and Procedure\u003c/h2\u003e\u003cp\u003eEmploying convenience sampling, the longitudinal component enrolled 2,145 students from four vocational schools in Hainan Province, all of whom participated in the baseline survey in October 2022 (T1). Subsequent assessments were conducted in March 2024 (T2). The respondents whose answers were overly uniform or exhibited excessive fluctuations were excluded, resulting in a final sample of 1,892 valid participants. At T1, the participants’ ages ranged from 14–20 years, with a mean age of 15.23 ± 0.80 years; 519 were male (27.4%), and 1,373 were female (72.6%). The participants who dropped out midway and those who completed all three assessments were coded as 0 and 1, respectively. No statistically significant differences were observed in sex (\u003cem\u003eχ\u003c/em\u003e² = 3.68; \u003cem\u003ep\u003c/em\u003e = 0.055) or age (\u003cem\u003et\u003c/em\u003e = − 0.80, \u003cem\u003ep\u003c/em\u003e = 0.211) between groups, indicating that there was no systematic dropout bias. Prior to participation, approval was obtained from the Ethics Committee of Hainan Medical University (HYLL-2022-425), and the study was conducted in accordance with the principles of the Declaration of Helsinki. School administrators, teachers, and mental health educators assisted with recruitment and communication. Institutional engagement was further enhanced through incentive strategies such as the sharing of research findings, expert-led seminars, and targeted group counseling services. Informed consent procedures were strictly observed: for participants under 18 years old, both parental/guardian consent and student assent were obtained; for participants aged 18 years and above, consent was obtained directly from the students. All surveys were completed via online questionnaires during class sessions, ensuring confidentiality and voluntary participation.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eDepressive Symptoms (T1, T2)\u003c/h2\u003e\u003cp\u003eThe Chinese version of the Beck Depression Inventory (BDI) was used to measure depressive symptoms [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The scale comprises 21 items, each scored on a scale ranging from 0 to 3 (e.g., \u0026ldquo;Sorrowful: 0\u0026thinsp;=\u0026thinsp;I don\u0026rsquo;t feel sorrowful; 1\u0026thinsp;=\u0026thinsp;I feel sad most of the time; 2\u0026thinsp;=\u0026thinsp;I am sad all the time; 3\u0026thinsp;=\u0026thinsp;I feel very sad or unhappy and can\u0026rsquo;t stand it\u0026rdquo;). Total scores were calculated by summing item responses, with higher values indicating more severe depression. Clinical thresholds were defined as follows: 0\u0026ndash;4, no or minimal depression; 5\u0026ndash;13, mild depression; 14\u0026ndash;20, moderate depression; and \u0026ge;\u0026thinsp;21, severe depression. In this study, the BDI exhibited good reliability (\u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.94, 0.95).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eChildhood Trauma (T1)\u003c/h3\u003e\n\u003cp\u003eCT was assessed using the Chinese version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The CTQ-SF assesses five trauma subtypes: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Its 28 items (25 clinical items\u0026thinsp;+\u0026thinsp;3 validity items; e.g., \u0026ldquo;During my childhood, no one in my family cared whether I had enough to eat or drink.\u0026rdquo;) were rated on a 5-point Likert scale (1 = \u0026ldquo;never,\u0026rdquo; 5 = \u0026ldquo;always\u0026rdquo;). The clinical thresholds were as follows: emotional abuse\u0026thinsp;\u0026ge;\u0026thinsp;13, physical abuse\u0026thinsp;\u0026ge;\u0026thinsp;10, sexual abuse\u0026thinsp;\u0026ge;\u0026thinsp;8, emotional neglect\u0026thinsp;\u0026ge;\u0026thinsp;15, and physical neglect\u0026thinsp;\u0026ge;\u0026thinsp;10. Validity items were scored 0\u0026ndash;1, and total validity scores\u0026thinsp;\u0026gt;\u0026thinsp;3 invalidated responses. The scale showed good reliability in this study (\u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.88).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eAnhedonia (T1, T2)\u003c/h2\u003e\u003cp\u003eAnhedonia was measured using \u003cb\u003et\u003c/b\u003ehe Revised Anhedonia Scale-Chinese version (RAS-C)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. It comprises two subscales: the 61-item Physical Anhedonia Scale (PAS), which assesses reduced pleasure from sensory experiences (e.g., \u0026ldquo;I have always had a number of favorite foods.\u0026rdquo;), and the 40-item Social Anhedonia Scale (SAS), which evaluates diminished social enjoyment (e.g., \u0026ldquo;Getting together with old friends has been one of my greatest pleasures.\u0026rdquo;). Both scales use dichotomous responses (0 = \u0026ldquo;disagree,\u0026rdquo; 1 = \u0026ldquo;agree\u0026rdquo;), with higher total scores indicating greater anhedonia. Gender-specific cutoffs were used to classify clinically significant anhedonia: PAS\u0026thinsp;\u0026gt;\u0026thinsp;20 (women) or \u0026gt;\u0026thinsp;28 (men) and SAS\u0026thinsp;\u0026gt;\u0026thinsp;16 (women) or \u0026gt;\u0026thinsp;20 (men; Kwapil et al., 2002). The scale showed good reliability in this longitudinal (\u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.92, 0.97) sample.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEmotion Regulation (T1)\u003c/h3\u003e\n\u003cp\u003eThe Chinese version of the Emotion Regulation Questionnaire (ERQ) comprises 10 items reflecting two factors: cognitive reappraisal (six items; e.g., \u0026ldquo;When I am faced with a stressful situation, I make myself think about it in a way that helps me calm down.\u0026rdquo;) and ES (four items; e.g., \u0026ldquo;I keep my emotions to myself.\u0026rdquo; )[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Each item of the ERQ was scored from 1 (\u0026ldquo;completely disagree\u0026rdquo;) to 7 (\u0026ldquo;completely agree\u0026rdquo;), with higher total scores indicating more frequent CR or ES use. In this study, only the ES scale was used, and it showed good reliability (\u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.80).\u003c/p\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eThe data were analyzed using SPSS 29 (IBM Corp., Armonk, NY) and Mplus 8.3 (Muth\u0026eacute;n \u0026amp; Muth\u0026eacute;n, Los Angeles, CA). The significance threshold was set at 0.05. The categorical variables were reported as frequencies and percentages, whereas the continuous variables were reported as the means and standard deviations. Independent-samples t tests were conducted to compare age and the scores of each scale between male and female participants. Pearson correlation analyses were performed to examine the relationships among age, depressive symptoms, CT, anhedonia, and ES scores. After controlling for sex (1\u0026thinsp;=\u0026thinsp;male, 2\u0026thinsp;=\u0026thinsp;female) and age, depressive symptoms were entered as the dependent variable, CT as the independent variable, anhedonia as the mediator, and ES as the moderator. The mediating, moderating effects, and moderated mediating effects were tested sequentially. Model fit was evaluated using the following criteria:\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e/df\u0026thinsp;\u0026lt;\u0026thinsp;5, CFI\u0026thinsp;\u0026gt;\u0026thinsp;0.90, TLI\u0026thinsp;\u0026gt;\u0026thinsp;0.90, RMSEA\u0026thinsp;\u0026lt;\u0026thinsp;0.08, and SRMR\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All of the models reported below met these fit criteria. For the statistically significant interaction terms, simple slope analyses were conducted to illustrate the moderating effects.\u003c/p\u003e\u003cp\u003eHarman\u0026rsquo;s single-factor test was conducted to assess the extent of common method bias. The results indicated that five factors had eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1, with the first factor accounting for 22.32% of the variance, which is below the critical threshold of 40%. These findings suggest that common method bias was not a serious concern in the present study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAttrition analyses revealed that the attrition group (N\u0026thinsp;=\u0026thinsp;253) did not vary from the final sample (N\u0026thinsp;=\u0026thinsp;1,892) in terms of age, sex, depressive symptoms, or ES. However, the students in the attrition group reported higher levels of anhedonia (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.46, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and experienced more childhood abuse and neglect (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.13, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The descriptive statistics and Pearson correlation coefficients for all of the variables are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Gender was negatively correlated with all of the study variables. Age was positively correlated with T1 CT, T1 ES, T1 and T2 anhedonia, and T2 depressive symptom scores. The scores for CT, depressive symptoms, anhedonia, and ES at T1 and T2 were positively correlated. Independent-samples t tests revealed that compared with the female participants, the male participants scored significantly higher in terms of age and all of the study variables (\u003cem\u003et\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;2.56, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescriptive statistics and Pearson correlation among variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ex̅\u0026plusmn;s\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge T1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma T1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExpressive Suppression T1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAnhedonia T1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDepressive Symptoms T1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAnhedonia T2\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.14***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.25***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.10***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExpressive Suppression T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.15***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.17***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnhedonia T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.18***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.07**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.43***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.23***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepressive Symptoms T1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.06*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.33***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.19***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnhedonia T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.28***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.08***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.40***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.20***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.66***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.27***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepressive Symptoms T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.10***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.07**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.27***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.29***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.48***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.31***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eNotes: *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eTo examine the concurrent mediating role of anhedonia in the relationship between CT and depressive symptoms, a mediation model was constructed at the T1 time point, with CT as the predictor, anhedonia as the mediator, and depressive symptoms as the dependent variable, while controlling for sex and age. The results indicated that, at the same time point, anhedonia exerted a significant concurrent mediating effect on the relationship between CT and depressive symptoms (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Building on the results of the concurrent mediation analysis, the longitudinal mediating effects were further tested. The CT at T1 score was entered as the predictor; the anhedonia scores at T1 and T2 were entered separately as mediators; the depressive symptom scores at T2 served as the dependent variable; and sex, age, and the T1 depressive symptoms were controlled. The results were as follows. (1) T1 anhedonia as a mediator: CT at T1 significantly predicted T1 anhedonia (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.43, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and T2 depressive symptoms (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.09, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). T1 anhedonia significantly predicted T2 depressive symptoms (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The indirect effect was 0.05 (95% CI [0.03, 0.07]), accounting for 35.3% of the total effect (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). (2) T2 anhedonia as a mediator: CT at T1 significantly predicted T2 anhedonia (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.40, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and T2 depressive symptoms (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026). T2 anhedonia significantly predicted T2 depressive symptoms (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.17, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The indirect effect was 0.07 (95% CI [0.05, 0.09]), accounting for 51.5% of the total effect (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). For both models, the indirect effects were statistically significant, supporting the presence of a longitudinal mediating role of anhedonia in the association between CT and depressive symptoms [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe mediating role of Anhedonia between Childhood Trauma and Depressive Symptoms\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePathway\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndirect Effect\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eThe Proportion Of The Total Effect\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransverse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT1Childhood Trauma \u0026rarr;T1Anhedonia \u0026rarr;\u003c/p\u003e\n \u003cp\u003eT1Depressive Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.08, 0.13]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLongitudinal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT1Childhood Trauma \u0026rarr;T1Anhedonia \u0026rarr;\u003c/p\u003e\n \u003cp\u003eT2Depressive Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.03, 0.07]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT1Childhood Trauma \u0026rarr;T2Anhedonia \u0026rarr;\u003c/p\u003e\n \u003cp\u003eT2Depressive Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e[0.05, 0.09]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eNote: The effect value is the standardized coefficient.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNotes: *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01; ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e\n\u003cp\u003eTo examine the concurrent moderating effect of ES on the relationship between CT and depressive symptoms, a moderation model was constructed at T1. The results showed that ES exerted a statistically significant interaction effect (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.05, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015). However, a subsequent simple slope analysis indicated that the positive association between CT and depressive symptoms was nonsignificant for both the high-ES group (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.21, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.57, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.115) and the low-ES group (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.22, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.77, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.077), suggesting no substantive concurrent moderating effect of ES. The longitudinal moderation effects were further examined on the basis of the concurrent model. In this model, CT at T1 served as the predictor, ES at T1 served as the moderator, and depressive symptoms at T2 served as the outcome variable, while the relevant covariates were controlled. As shown in Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eA, both CT and ES at T1 significantly and positively predicted T2 depressive symptoms (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; \u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.09, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, their interaction term significantly and negatively predicted T2 depressive symptoms (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.09, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating a potential longitudinal moderation effect. Nevertheless, simple slope analyses revealed that the positive association between CT and depressive symptoms remained nonsignificant in the high-ES group (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.19, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.32, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.188) and the low-ES group (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.20, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.52, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.129). Overall, these results suggest that ES did not significantly moderate the relationship between CT and depressive symptoms in either the concurrent or longitudinal models.\u003c/p\u003e\n\u003cp\u003eTo investigate the concurrent moderating effect of ES on the relationship between CT and anhedonia, a moderation model was constructed at T1, with CT as the predictor, ES as the moderator, and anhedonia as the outcome variable, while controlling for sex and age. The results indicated a statistically significant interaction between CT and ES (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.30, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), suggesting a concurrent moderating effect. Building on this result, longitudinal moderating effects were further examined. In this model, CT at T1 served as the predictor, ES at T1 served as the moderator, and anhedonia at T2 served as the dependent variable when sex, age, and T1 anhedonia were controlled. As shown in Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eB, both CT and ES at T1 significantly and positively predicted T2 anhedonia (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.23, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; \u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.12, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010), whereas their interaction term significantly and negatively predicted T2 anhedonia (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.17, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020), indicating a longitudinal moderation effect. Subsequent simple slope analyses (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) revealed that the positive effect of CT on anhedonia was significant for both the high-ES group (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.344, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.135, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033) and the low-ES group (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.358, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.414, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016), with a stronger association in the latter group. This pattern suggests that higher ES levels are associated with a stronger positive relationship between CT and anhedonia.\u003c/p\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003cp\u003eAfter controlling for sex, age, T1 anhedonia, and T1 depressive symptoms, a moderated mediation model was tested with CT at T1 (X) as the independent variable, anhedonia at T2 (M) as the mediator, depressive symptoms at T2 (Y) as the dependent variable, and ES at T1 (W) as the moderator. The model equations were specified as follows:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e=a0\u0026thinsp;+\u0026thinsp;a1\u003cem\u003eX\u003c/em\u003e\u0026thinsp;+\u0026thinsp;a\u003csub\u003e2\u003c/sub\u003e\u003cem\u003eW\u003c/em\u003e\u0026thinsp;+\u0026thinsp;a\u003csub\u003e3\u003c/sub\u003e\u003cem\u003eWX\u003c/em\u003e\u0026thinsp;+\u0026thinsp;\u0026epsilon;1 (1)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eY\u003c/em\u003e=c0\u0026thinsp;+\u0026thinsp;c1\u003cem\u003eX\u003c/em\u003e\u0026thinsp;+\u0026thinsp;b\u003csub\u003e1\u003c/sub\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;+\u0026thinsp;\u0026epsilon;2 (2)\u003c/p\u003e\n \u003cp\u003eThe results from the first-stage moderated mediation analysis revealed that the interaction term of T1 CT and T1 ES significantly predicted T2 anhedonia (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.39, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, T2 anhedonia significantly predicted T2 depressive symptoms (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.17, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings indicate that the indirect effect of T1 CT on T2 depressive symptoms via T2 anhedonia was moderated by T1 ES. Next, a bias-corrected nonparametric percentile bootstrap method with 5000 resamples was used to estimate the conditional indirect effect. The 95% confidence interval (CI) for the moderated mediation effect was [0.08, 0.15], which did not include zero, indicating a statistically significant moderated mediation effect. The moderated mediating effect was expressed as (a1\u0026thinsp;+\u0026thinsp;a3W) b1=0.11\u0026thinsp;\u0026minus;\u0026thinsp;0.07 W, demonstrating that the magnitude of the mediating effect varied as a function of W (T1 ES). As illustrated in Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, when the T1 ES (W) ranged from 0.14\u0026ndash;25.11, the 95% CI for the conditional indirect effect (a1\u0026thinsp;+\u0026thinsp;a3W) b1 did not include zero, suggesting that the mediating effect was statistically significant and decreased with increasing ES. Conversely, when W ranged from 25.12\u0026ndash;27.89, the 95% CI included zero, indicating that the mediating effect was no longer significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eGuided by the diathesis\u0026ndash;stress framework of depression, the present study employed an 18-month longitudinal design to investigate the pathways linking CT to depressive symptoms among vocational school students. The findings revealed that anhedonia served as a longitudinal mediator in the relationship between CT and depressive symptoms. Furthermore, ES moderated the association between CT and anhedonia, thereby influencing the strength of the mediating effect of anhedonia within a certain range. These results provide empirical support for the diathesis\u0026ndash;stress model, underscoring the critical role of both emotional expression and hedonic capacity in the development of depression following CT. From a practical perspective, the findings highlight the importance of interventions that encourage adolescents to express their emotions openly and that target the alleviation of anhedonia as potential strategies for mitigating depression risk among those with a history of CT.\u003c/p\u003e\u003cp\u003eThe present study revealed that CT was strongly associated with depressive symptoms both at school entry and 18 months later among vocational school students, which is consistent with the findings of previous research [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. CT can undermine an individual\u0026rsquo;s sense of safety and lead to social withdrawal; repeated traumatic experiences may foster cognitive distortions, such as catastrophic expectations and hostile attribution biases. Trauma may also diminish self-identity, increasing the likelihood of maladaptive coping strategies\u0026mdash;such as avoidance\u0026mdash;when facing stressors. Moreover, trauma exposure prior to the age of 12 can severely disrupt neurodevelopment, trigger the onset of depression, and impair other functional domains [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These findings underscore the importance of screening for both CT and depressive symptoms at the point of school entry in vocational education. Furthermore, they highlight the need to develop and implement targeted follow-up interventions to support at-risk students.\u003c/p\u003e\u003cp\u003eBuilding on the finding that CT was significantly associated with depressive symptoms among vocational school students, the present study further confirmed that anhedonia functioned as a longitudinal mediator between the two. From a developmental perspective, the maturation of distinct brain regions during childhood follows unique trajectories, relying on coordinated interactions among the amygdala, medial prefrontal cortex, striatum, and hippocampus to support the progressive development of cognitive, emotional, and social abilities. Exposure to different types of trauma can alter the structure, function, and connectivity of these regions, leading to heightened fear responses, diminished emotion regulation capacity, and reduced reward sensitivity, all of which increase vulnerability to depression [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Neurobiological models of stress-induced anhedonia and depression further suggest that traumatic stress disrupts reward-related neural circuits, attenuating the hedonic value of stimuli, dampening anticipatory responses, and ultimately triggering anhedonic subtypes of depression [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These findings underscore that, for vocational school students with a history of CT, interventions aimed at alleviating anhedonia and addressing trauma-related sequelae should be integrated into school-based mental health programs as a means to reduce depression risk.\u003c/p\u003e\u003cp\u003eThe present study revealed that ES did not directly or longitudinally moderate the relationship between CT and depressive symptoms among vocational school students. These findings contrast with those of several previous studies suggesting that individuals who tend to rely on ES often have fewer psychological resources and reduced social support and that suppressing negative emotions elicited by trauma may foster maladaptive sadness-related cognitive patterns. Such patterns can lead to mistrust of others, a diminished sense of belonging, and a preference for avoidant coping strategies, which collectively exacerbate depressive symptoms [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. On the other hand, our results align with those of Jones et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], who reported no moderating role of ES in the association between CT and mental health indicators, suggesting that ES may not directly amplify the negative psychological effects of CT.\u003c/p\u003e\u003cp\u003eThe results of the current study revealed that ES positively predicted anhedonia among vocational school students, which differs from the negative association observed by Young et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] in a sample of Mexican American adolescents, for whom the social climate emphasized the encouragement of positive emotional expression. A potential explanation for this discrepancy may lie in the cultural context: within a collectivist-oriented Chinese cultural setting, moderate emotional restraint is often regarded as an important aspect of social adaptation. However, excessive suppression can deplete cognitive resources, reduce sensitivity to positive stimuli, and thereby exacerbate anhedonia [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Furthermore, this study is the first to show that ES exerted a longitudinal moderating effect on the relationship between CT and anhedonia\u0026mdash;namely, higher levels of ES intensified the long-term negative impact of CT on anhedonia. Given that anhedonia is a shared risk factor for multiple psychiatric disorders\u0026mdash;including depression, schizophrenia, and substance addiction\u0026mdash;school-based interventions that target emotional expression among vocational school students with a history of CT may help alleviate anhedonic symptoms and consequently reduce the risk of comorbidity across a range of mental illnesses [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA moderated mediation model specifies the conditions under which a mediating process becomes stronger or weaker, thereby extending and refining a simple mediation framework. In the present study, among vocational school students with ES levels from 0.14\u0026ndash;25.11 (unstandardized scores), the mediating effect of anhedonia on the relationship between CT and depressive symptoms decreased as ES increased. In other words, although ES did not directly moderate the link between CT and depressive symptoms, it indirectly influenced this association by altering the strength of anhedonia\u0026rsquo;s mediating role. This pattern is consistent with the findings of Li et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], who suggested that ES indirectly moderated the association between CT and adult mental health via its influence on self-esteem. In contrast, for students with ES levels from 25.12\u0026ndash;27.89, the mediating effect of anhedonia was nonsignificant, implying that under conditions of excessive suppression, CT may trigger depressive symptoms through a direct pathway\u0026mdash;marking this subgroup as potentially high risk.\u003c/p\u003e\u003cp\u003eSeveral limitations of this study should be acknowledged. First, all of the behavioral data were collected exclusively through self-report measures, which may have introduced common method bias and social desirability effects. Second, a convenience sampling strategy was employed, and the resulting sample had an imbalanced sex distribution, which constrains the generalizability of the findings. Future research could address these limitations by incorporating experimental and intervention designs; increasing both the diversity and size of the sample; and, in particular, by employing stratified sampling to balance sex composition or performing subgroup analyses to explore sex differences. Moreover, integrating neurobiological indices, such as neuroimaging and endocrine measures, could further clarify the mechanisms by which ES and anhedonia contribute to the link between CT and depressive symptoms.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Ethics Committee of Hainan Medical University (reference no. HYLL-2022-425) and adhered to the ethical principles of the 1964 Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from all participants prior to data collection. For participants under the age of 18, consent was additionally obtained from their parents or legal guardians, along with assent from the minors themselves.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was funded by Hainan Provincial Philosophy and Social Sciences Planned Project (Project Numbers: HNSK(YB)23-41, HNSK(ZC)23-162), Planning Fund for Humanities and Social Sciences Research in Western and Frontier Regions of the Ministry of Education (Project Title: Exploring the Brain Neural Mechanisms and Immune Characteristics of Depression in School-Bullied Adolescents from the Perspective of Cognitive Reappraisal; Grant Number: 23XJA190001), Hainan Provincial Natural Science Foundation of China (821RC1124), National Undergraduate Innovation and Entrepreneurship Training Program (202411810011) and Hainan Medical University Undergraduate Innovation and Entrepreneurship Training Program \u0026nbsp;(X202411810006). The founders had no role in the study design, data collection, analysis, writing the paper, and the decision to submit the paper for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHongjuan Jiang: Conceptualization, Data curation, Writing-original draft, Writing-review, Funding acquisition\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eZongjie Tian: Investigation, Data analysis, Writing-original draft, Funding acquisition,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJiajian Pan: Methodology, Overall coordination, Funding acquisition,Writing-review\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the exceptional participation of the adolescents, parents, and teachers.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet. 2022;400:617-31.\u003c/li\u003e\n\u003cli\u003eHerrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF 3rd, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Wolpert M. Time for united action on depression: A Lancet-World Psychiatric Association Commission. Lancet. 2022;399:957-1022.\u003c/li\u003e\n\u003cli\u003ePham TS, Qi H, Chen D, Chen H, Fan F. Prevalences of and correlations between childhood trauma and depressive symptoms, anxiety symptoms, and suicidal behavior among institutionalized adolescents in Vietnam. Child Abuse Negl. 2021;115:105022.\u003c/li\u003e\n\u003cli\u003eAlameda L, Golay P, Baumann PS, Progin P, Mebdouhi N, Elowe J, Ferrari C, Do KQ, Conus P. Mild depressive symptoms mediate the impact of childhood trauma on long-term functional outcome in early psychosis patients. Schizophr Bull. 2017;43(5):1027-35.\u003c/li\u003e\n\u003cli\u003eNelson J, Klumparendt A, Doebler P, Ehring T. Childhood maltreatment and characteristics of adult depression: Meta-analysis. Br J Psychiatry. 2017;210:96-104.\u003c/li\u003e\n\u003cli\u003eKuzminskaite E, Vinkers CH, Milaneschi Y, Giltay EJ, Penninx BWJH. Childhood trauma and its impact on depressive and anxiety symptomatology in adulthood: A 6-year longitudinal study. J Affect Disord. 2022;312:322-30.\u003c/li\u003e\n\u003cli\u003eChildhood Trauma Meta-Analysis Study G. Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis. Lancet Psychiatry. 2022;9:860-73.\u003c/li\u003e\n\u003cli\u003eWang H, Liao Y, Guo L, Zhang H, Zhang Y, Lai W, Teopiz KM, Song W, Zhu D, Li L, Lu C, Fan B, McIntyre RS. Association between childhood trauma and medication adherence among patients with major depressive disorder: The moderating role of resilience. BMC Psychiatry. 2022;22:644.\u003c/li\u003e\n\u003cli\u003eMonroe SM, Simons AD. Onset of depression and time to treatment entry: Roles of life stress. J Consult Clin Psychol. 1991;59:123-30.\u003c/li\u003e\n\u003cli\u003eKhazanov GK, Xu C, Dunn BD, Cohen ZD, DeRubeis RJ, Hollon SD. Distress and anhedonia as predictors of depression treatment outcome: A secondary analysis of a randomized clinical trial. Behav Res Ther. 2020;125:103507.\u003c/li\u003e\n\u003cli\u003eWong S, Le GH, Phan L, Rhee TG, Ho R, Meshkat S, Teopiz KM, Kwan ATH, Mansur RB, Rosenblat JD, McIntyre RS. Effects of anhedonia on health-related quality of life and functional outcomes in major depressive disorder: A systematic review and meta-analysis. J Affect Disord. 2024;356:684-98. \u003c/li\u003e\n\u003cli\u003eHan J, Zhang LH, Zhang CY, Li B, Wang LL, Cai YX. Adolescent\u0026rsquo;s anhedonia and association with childhood trauma among Chinese adolescents: a cross-sectional study. BMJ Open. 2023;13:e071521.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo; Brien KJ, Ered A, Korenic SA, Olino TM, Schiffman J, Mittal VA, Ellman LM. Childhood trauma, perceived stress, and anhedonia in individuals at clinical high risk for psychosis: Multigroup mediation analysis. Br J Psychiatry. 2023;223:273-9.\u003c/li\u003e\n\u003cli\u003eHaim-Nachum S, Amsalem D, Lazarov A, Zabag R, Neria Y, Sopp MR. Anhedonia mediates the relationships between childhood trauma and symptom severity of PTSD and depression, but not of social anxiety. J Affect Disord. 2024;344:577-84.\u003c/li\u003e\n\u003cli\u003eBorsini A, Wallis ASJ, Zunszain P, Pariante CM, Kempton MJ. Characterizing anhedonia: A systematic review of neuroimaging across the subtypes of reward processing deficits in depression. Cogn Affect Behav Neurosci. 2020;20:816-41.\u003c/li\u003e\n\u003cli\u003eGross JJ. The emerging field of emotion regulation: an integrative review. Rev Gen Psychol. 1998;2:271-99.\u003c/li\u003e\n\u003cli\u003eDryman MT, Heimberg RG. Emotion regulation in social anxiety and depression: a systematic review of expressive suppression and cognitive reappraisal. Clin Psychol Rev. 2018;65:17-42.\u003c/li\u003e\n\u003cli\u003eYin W, Pan Y, Zhou L, Wei Q, Zhang S, Hu H, Lin Q, Pan S, Dai C, Wu J. The relationship between childhood trauma and depressive symptoms among Zhuang adolescents: Mediating and moderating effects of cognitive emotion regulation strategies. Front Psychiatry. 2022;13:994065.\u003c/li\u003e\n\u003cli\u003eLee M, Lee ES, Jun JY, Park S. The effect of early trauma on North Korean refugee youths\u0026rsquo; mental health: Moderating effect of emotional regulation strategies. Psychiatry Res. 2020;287:112707.\u003c/li\u003e\n\u003cli\u003eJones EJ, Marsland AL, Gianaros PJ. Do trait-level emotion regulation strategies moderate associations between retrospective reports of childhood trauma and prospective changes in systemic inflammation? Stress Health. 2023;39:525-38.\u003c/li\u003e\n\u003cli\u003eYoung GR, Karnilowicz HR, Mauss IB, Hastings PD, Guyer AE, Robins RW. Prospective associations between emotion regulation and depressive symptoms among Mexican-origin adolescents. Emotion. 2022;22:129-41.\u003c/li\u003e\n\u003cli\u003eLi J. Research on influencing factors of further education intention of secondary vocational students in underdeveloped areas: A crisp-set qualitative comparative analysis based on 56 cases. J Educ Dev. 2021;(12):76-84.\u003c/li\u003e\n\u003cli\u003eJensen CT, Heinze C, Andersen PK, Bauman A, Charlotte DK. Mental health and physical activity in vocational education and training school students: A population-based survey. Eur J Public Health. 2022;32:233-8.\u003c/li\u003e\n\u003cli\u003eLiu J, Teng Z, Chen Z, Wei Z, Zou T, Qin Y, Yuan H, Liu M, Chen J, Tang H, Xiang H, Wu H, Wu R, Huang J. Exploring the associations between behavioral health risk factors, abnormal eating attitudes, and socio-demographic factors among Chinese youth: Survey of 7,984 vocational high school students in Hunan in 2020. Front Psychiatry. 2022;13:1000821.\u003c/li\u003e\n\u003cli\u003eDalen JD. The association between school class composition and suicidal ideation in late adolescence: Findings from the Young-HUNT 3 study. Child Adolesc Psychiatry Ment Health. 2012;6:37.\u003c/li\u003e\n\u003cli\u003eHorv\u0026aacute;th LO, Balint M, Ferenczi-Dallos G, Farkas L, Gadoros J, Gyori D, Kereszteny A, Meszaros G, Szentivanyi D, Velo S, Sarchiapone M, Carli V, Wasserman C, Hoven CW, Wasserman D, Balazs J. Direct self-injurious behavior (D-SIB) and life events among vocational school and high school students. Int J Environ Res Public Health. 2018;15(6):1068.\u003c/li\u003e\n\u003cli\u003eLiu P. Beck Depression Inventory (BDI). Chinese Mental Health Journal. 1999;13(Suppl.):191-4.\u003c/li\u003e\n\u003cli\u003eFu WQ, Yao SQ, Hong ZH, Zhao XF, Li R, Li Y, Zhang ZQ. Initial reliability and validity of Childhood Trauma Questionnaire (CTQ-SF) applied in Chinese college students. Chinese Journal of Clinical Psychology. 2005;13(1):40-3.\u003c/li\u003e\n\u003cli\u003eChan RCK, Wang Y, Yan C, Zhao Q, McGrath J, Hsi X, Stone WS. A study of trait anhedonia in non-clinical Chinese samples: Evidence from the Chapman scales for physical and social anhedonia. PLoS One. 2012;7:e34275.\u003c/li\u003e\n\u003cli\u003eWang L, Liu H, Li Z. Reliability and validity of emotion regulation questionnaire Chinese revised version. Chinese Journal of Clinical Psychology. 2007;15:503-5.\u003c/li\u003e\n\u003cli\u003eMacKinnon D. Introduction to statistical mediation analysis. Erlbaum Psych Press. 2008.\u003c/li\u003e\n\u003cli\u003eBeck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. Guilford Press. 1979.\u003c/li\u003e\n\u003cli\u003eLaricchiuta D, Panuccio A, Picerni E, Biondo D, Genovesi B, Petrosini L. The body keeps the score: The neurobiological profile of traumatized adolescents. Neurosci Biobehav Rev. 2023;145:105033.\u003c/li\u003e\n\u003cli\u003eBogdan R, Pizzagalli DA. Acute stress reduces reward responsiveness: implications for depression. Biol Psychiatry. 2006;60:1147-54.\u003c/li\u003e\n\u003cli\u003eZeng Q, Liu A, Li S. The relationship between childhood psychological maltreatment and trait depression: A chain mediating effect of rumination and post-traumatic cognitive changes. Chinese Journal of Clinical Psychology. 2015;23(04):665-9.\u003c/li\u003e\n\u003cli\u003eChervonsky E, Hunt C. Suppression and expression of emotion in social and interpersonal outcomes: A meta-analysis. Emotion. 2017;17:669-83.\u003c/li\u003e\n\u003cli\u003eDer-Avakian A, Markou A. The neurobiology of anhedonia and other reward-related deficits. Trends Neurosci. 2012;35:68-77.\u003c/li\u003e\n\u003cli\u003eLi C, Fu P, Wang M, Xia Y, Hu C, Liu M, Zhang H, Sheng X, Yang Y. The role of self-esteem and emotion regulation in the associations between childhood trauma and mental health in adulthood: A moderated mediation model. BMC Psychiatry. 2023;23:241.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Childhood trauma, Depressive symptoms, Anhedonia, Expressive suppression, Vocational school students","lastPublishedDoi":"10.21203/rs.3.rs-7461371/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7461371/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWhile existing research has consistently established the link between childhood trauma (CT) and depressive symptoms, the mechanisms underlying this relationship remain insufficiently explored, particularly in vocational school students. Notably, the mediating role of anhedonia has not been verified through longitudinal studies, and the moderating effect of expressive suppression (ES) is still unclear. This study sought to address these gaps by exploring the longitudinal relationship between CT and depressive symptoms, with a specific focus on the roles of anhedonia and ES in this relationship among vocational school students in China. A two-wave longitudinal study was conducted with an 18-month interval with 1892 students (519 boys and 1373 girls) from 4 vocational schools in Hainan Province, China. The Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI), Revised Anhedonia Scale-Chinese version (RAS-C), and the expressive suppression subscale of the Emotion Regulation Questionnaire (ERQ) were used for measurement. Results revealed that: (1) CT directly and positively predicted subsequent depressive symptoms (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (2) Anhedonia played a longitudinal mediating role in the CT-depression relationship (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.07; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (3) ES did not moderate the relationship between CT and depressive symptoms but moderated the relationship between CT and anhedonia (\u003cem\u003eβ\u003c/em\u003e=-0.17, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and the mediating effect of anhedonia on the relationship between CT and depressive symptoms (\u003cem\u003eβ\u003c/em\u003e=-0.39, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings suggest that CT may contribute to depressive symptoms among vocational school students through anhedonia. Although ES does not directly affect this pathway, it moderates the trauma\u0026ndash;anhedonia link, weakening the indirect effect at higher ES levels. These findings highlight the need for interventions focused on reducing anhedonia and improving emotion regulation in trauma-exposed adolescents, particularly in vocational education settings.\u003c/p\u003e","manuscriptTitle":"Longitudinal Influences of Childhood Trauma on Depressive Symptoms among Chinese Vocational School Students: Roles of Anhedonia and Expressive Suppression","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 15:21:48","doi":"10.21203/rs.3.rs-7461371/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-09-26T05:45:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-17T05:28:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-01T08:49:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-29T15:56:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-08-29T15:53:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"022bc414-a001-4af6-9442-78714d87271c","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-08T15:21:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 15:21:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7461371","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7461371","identity":"rs-7461371","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}