Gender-Differentiated Pathways from Childhood Trauma to Self-Injury: Rumination as a Mediator in Depressed Adolescents

Gender-Differentiated Pathways from Childhood Trauma to Self-Injury: Rumination as a Mediator in Depressed Adolescents | 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 Gender-Differentiated Pathways from Childhood Trauma to Self-Injury: Rumination as a Mediator in Depressed Adolescents Mailin Zhou, Shijian Wang, Doudou Zheng, Jingya Li, Ying Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6987106/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Sep, 2025 Read the published version in BMC Psychology → Version 1 posted 13 You are reading this latest preprint version Abstract Background: Amid the global escalation of adolescent depression and non-suicidal self-injury (NSSI), childhood trauma has been identified as a critical risk factor, yet how specific trauma subtypes contribute to NSSI remains unclear. This study aims to explore the relationship between childhood trauma subtypes and NSSI in depressed adolescents, focusing gender differences, and verify the mediating role of rumination. Methods: This cross-sectional study included 2,006 clinically depressed adolescents (aged 10–19), who were recruited through convenience sampling from a psychiatric hospital in China (2024–2025). Validated scales (Childhood Trauma Questionnaire, Ruminative Response Scale, Ottawa Self-Injury Inventory) were administered. Binary logistic regression, subgroup analysis, and mediation analysis were used to examine the relationships between variables. Results: NSSI prevalence reached 69.3% in depressed adolescents (female:77.6% vs male:52.1%). Emotional neglect (OR=1.82), emotional abuse (OR=2.06), and physical abuse (OR=2.55) were associated with NSSI. Gender difference analysis revealed that females were more sensitive to emotional neglect (OR=2.30) and emotional abuse (OR=2.06), while males were more sensitive to emotional abuse (OR=2.07) and physical abuse (OR=2.12). A single trauma subtype significantly increased the risk of NSSI in females, whereas males required at least two trauma subtypes to significantly increase NSSI risk. Rumination played a mediating role between all trauma subtypes and NSSI, with sexual abuse showing the highest mediation effect (78.02%), indicating a full mediation effect. Conclusions: The childhood trauma-NSSI association in depressed adolescents demonstrates gender difference, with rumination functioning as the central mechanistic pathway. Interventions must prioritize trauma subtype- and gender-tailored strategies to disrupt rumination pathways. Depressed adolescents Childhood trauma subtypes Non-suicidal self-injury Gender differences Rumination Figures Figure 1 1. Introduction Adolescent mental health issues have garnered increasing attention, with depression being the leading cause of health-related disabilities and a major contributor to the global disease burden [ 1 ]. A meta-analysis indicated that the overall prevalence of depression among adolescents in mainland China is 24.3% [ 2 ]. Depressed adolescents are at high risk for various psychological and behavioral problems, and non-suicidal self-injury (NSSI) is particularly prominent in this group. NSSI is defined as a series of deliberate, direct, and repeated self-inflicted physical harm without suicidal intent, which is not socially approved [ 3 ]. Studies show that the incidence of NSSI among depressed adolescents is as high as 40%-60% [ 4 ]. NSSI has a strong predictive value for future suicidal behaviors, with a population-based study in Sweden revealing that 62.2% of the deaths among depressed adolescents involved NSSI [ 5 ]. NSSI not only amplifies the risk of suicide but also exacerbates mental disorders, making it a global public health issue that cannot be ignored [ 6 ]. Exploring the triggering factors of NSSI is crucial for prevention and intervention. Nock’s integrated model emphasizes the role of early distal risk factors, particularly childhood trauma, in triggering NSSI behavior [ 7 ]. Childhood trauma mainly includes five dimensions: emotional neglect, emotional abuse, physical neglect, physical abuse, and sexual abuse [ 8 ]. Surveys indicate that approximately 65% of individuals who self-harm have experienced at least one form of childhood trauma, and about 50% have encountered multiple types of childhood trauma [ 9 ], with a dose-response relationship between the two [ 10 ]. Systematic reviews have shown that all types of childhood trauma are significantly associated with NSSI [ 11 ]. However, there is still insufficient understanding of the relationship between childhood trauma subtypes and NSSI in depressed adolescents, as well as the gender differences in this relationship and the dose-response relationship between them. The mechanisms through which childhood trauma subtypes influence NSSI behaviors remain unclear. In recent years, there has been an increasing focus on the role of cognitive factors in the development of psychological issues. Rumination, a common cognitive coping strategy, refers to an individual’s tendency to engage in repetitive and passive thinking about their negative emotions, their causes, and consequences after experiencing negative events, without taking active steps to resolve the issues [ 12 ]. The Emotional Cascade Model (ECM) of NSSI [ 13 ] suggests that rumination plays a key role in the onset and maintenance of NSSI, as individuals engage in self-injury to alleviate the pain intensified by rumination. Furthermore, there is evidence of a close relationship between childhood trauma and rumination [ 14 – 15 ], with adolescents who have experienced childhood trauma being more likely to develop ruminative thinking compared to those who have not experienced such trauma [ 16 ]. Although one study has confirmed that rumination partially mediates the relationship between childhood trauma and NSSI, the mediating effect of rumination between specific childhood trauma subtypes (such as emotional neglect, physical abuse) and NSSI has yet to be fully explored and revealed. In summary, this study aims to explore the associations between childhood trauma subtypes and NSSI, the gender differences, and the mediating role of rumination in these relationships among depressed adolescents. 2. Methods 2.1Participants and Data Collection A convenience sampling method was employed to recruit adolescent patients diagnosed with depression from the outpatient and inpatient units of the child and adolescent psychiatry department at a mental health hospital in China as research participants. Inclusion criteria included:(1) Diagnosis of depression based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by two experienced psychiatrists. (2) Age between 10 and 19 years old. (3) Participants were able to understand the questionnaire content and complete it truthfully. Exclusion criteria included: (1) Currently experiencing acute episodes of severe mental disorders (e.g., schizophrenia, bipolar disorder); (2) Severe substance abuse problems that may interfere with the evaluation of self-injury behaviors; (3) Neurodevelopmental disorders (e.g., intellectual disability, autism spectrum disorder, attention deficit hyperactivity disorder); (4) Recent exposure to major traumatic events (e.g., the death of a loved one, severe accidents) that could confound the study results. Questionnaires were completed online via electronic QR codes, enhancing the convenience and transparency of the research process. Data collection was conducted in a quiet, private, and uniformly arranged room to minimize environmental interference and ensure participants’ privacy and focus. Researchers provided standardized instructions to participants to help them accurately understand the questionnaire content and task requirements. The completion process takes approximately 15-20 minutes. Data collection for this study occurred between June 2024 and February 2025, though the study is ongoing. This study was approved by the relevant institutional ethics committee (2024-R-156) and informed consent was obtained from all participants. 2.2 Measures 2.2.1Childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ) [17], which categorizes childhood trauma into five distinct dimensions: emotional neglect (the inability to meet essential emotional and psychological needs, such as love and support); emotional abuse (verbal attacks that severely impact a child’s well-being or behaviors that may humiliate, embarrass, or severely threaten the child); physical neglect (failure to meet basic physical needs, such as food and shelter); physical abuse (intentional physical harm); and sexual abuse (any form of sexual contact and/or behavior between a child and an adult). The questionnaire contains 25 items, rated on a 5-point Likert scale from 1 (never) to 5 (always). The total score ranges from 25 to 125, with higher scores indicating more severe abuse. Cumulative childhood trauma (CCT) was created by summing the dichotomized scores of different subscales of childhood trauma, with a total score ranging from 0 to 5 (Cronbach’s α = 0.882). 2.2.2Ruminative Response Scale (RRS) was used to evaluate rumination. The RRS consists of 22 items, evaluating three dimensions of rumination: Symptom Rumination (e.g., “I often think about how lonely I feel”), Brooding (e.g., “I often wonder why I am always like this”), and Reflective Pondering (e.g., “I often analyze my personality to understand why I feel depressed”) [18]. Responses are rated on a 1-4 rating scale, with higher scores indicating a higher level of rumination (Cronbach’s α =0.956). 2.2.3Participants were assessed for the presence of NSSI behavior using the Ottawa Self-Injury Inventory (OSI) [19]. They were asked to respond to the question: “In the past year, have you engaged in any of the following behaviors to intentionally harm yourself? These behaviors were not intended for suicide but may have resulted in bleeding, bruising, or pain”. Participants could respond with “Yes” or “No”, and those who answered “Yes” were classified as exhibiting NSSI behavior. 2.2.4Based on existing literature on childhood trauma and NSSI, various covariates were included in the analysis. The covariates in this study included: age, gender (male or female), academic performance (upper, middle, or lower), and personality (introverted, extroverted, or neutral), parental marital status (first marriage, divorced, one parent deceased, or remarried), Parenting styles (authoritarian, neglectful, authoritative, permissive or democratic ) , whether the participant is an only child (yes or no), Socioeconomic Status (SES) (high, upper-middle, lower-middle, or low), residence (urban, town, or rural). 2.3 Statistical analysis Categorical variables were summarized using frequencies and proportions, while continuous variables were presented as means (standard deviations) to describe the participant characteristics. The logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between childhood trauma subtypes and NSSI. Subgroup analysis was performed to examine whether there were gender differences in this association. In Model 1, demographic characteristics were adjusted for, including gender, age, academic performance and personality. In Model 2, family environment was adjusted for, including parental marital status, Parenting styles and only child. In Model 3, economic status was adjusted for, including family economic status, residence. In Model 4, rumination was adjusted. Finally, logistic regression-based mediation analysis was conducted to clarify the mediating role of rumination in the relationship between childhood trauma and NSSI in the fully adjusted model. Statistical analysis was performed using SPSS 27.0 and R. 3. Results This study included a total of 2,006 depressed adolescents, with 649 males (32.4%) and 1,357 females (67.6%). The results showed that the overall incidence rate of NSSI among depressed adolescents was 69.3%, with a rate of 52.1% in males and 77.6% in females. Other detailed characteristics are shown in Table 1. The results of the binary logistic regression are shown in Table 2. The subtype incidence rates of childhood trauma were as follows: emotional neglect 53.7%, emotional abuse 29.1%, physical neglect 49.1%, physical abuse 14.9%, and sexual abuse 9.8%. In Model 3, after controlling for demographic and economic factors, emotional neglect, emotional abuse, physical neglect, and physical abuse were identified as direct risk factors for adolescent NSSI behaviors. However, in Model 4, after controlling for rumination, physical neglect was no longer directly associated with NSSI. Additionally, the subtypes of childhood trauma exhibited a cumulative effect on NSSI behaviors, meaning that the more trauma subtypes experienced, the higher the risk of NSSI. The gender differences are presented in Table 3. Although statistical analysis revealed no significant gender differences in the relationship between childhood trauma subtypes and NSSI, the data indicate that females experienced more childhood trauma than males. Males were primarily affected by emotional abuse and physical abuse, while females were more impacted by emotional neglect and emotional abuse. Females appear to be more sensitive to childhood trauma, with the experience of a single trauma subtype significantly increasing the risk of NSSI, whereas males needed to experience multiple trauma subtypes to significantly increase their risk. The mediation effect results are shown in Figure 1. Five trauma subtypes—emotional neglect, emotional abuse, physical neglect, physical abuse, and sexual abuse—were found to influence NSSI through rumination as a mediating variable. The mediation proportions for emotional neglect, emotional abuse, physical neglect, physical abuse, and sexual abuse were 27.05%, 33.11%, 58.05%, 39.07%, and 78.02%, respectively. Sexual abuse was found to fully mediate the effect on NSSI through rumination, with a mediation proportion of 78.02%, consistent with the results in Table 2. Overall, rumination played a significant mediating role in the relationship between different types of trauma subtypes and NSSI. Discussion The present study advances current understanding of NSSI etiology by delineating gender-specific patterns and identifying rumination as a pivotal mediator across all childhood trauma subtypes—a dual contribution that addresses critical gaps in prior research. While existing literature broadly links childhood trauma to NSSI, our findings uniquely demonstrate that females exhibit a “low-threshold, high-sensitivity” response, where exposure to a single trauma subtype, whereas males require cumulative trauma exposure (≥2 subtypes) to manifest comparable risk. This threshold divergence challenges homogeneous trauma-NSSI models and underscores the necessity of gender-tailored prevention frameworks. Furthermore, this study validates the core cognitive mediating role of rumination in the relationship between childhood trauma and NSSI, establishing it as a novel transdiagnostic therapeutic target for intervention development. Among all childhood trauma subtypes, all except sexual abuse were directly associated with NSSI. However, some studies suggest that sexual abuse is also an important trigger for NSSI[20]. One possible explanation is that in populations attending mental health centers, parents often detect and pay attention to their children’s psychological issues at an early stage. This suggests that parents in this group are more sensitive to and concerned about their children’s mental health, leading to a lower incidence of sexual abuse, which makes it difficult to detect a potential link between sexual abuse and NSSI. Additionally, conservative attitudes towards sex, the stigma surrounding sexual abuse victims, and gender norms emphasizing female chastity and male masculinity can also affect the disclosure of sexual abuse[21]. Although the statistical significance was not reached, gender-specific risk patterns have important clinical implications. First, emotional abuse is a common risk factor for NSSI behavior in both males and females, which is consistent with previous research [22]. Emotional abuse refers to the long-term negative attitudes of caregivers toward children, involving verbal attacks on a person’s sense of worth or well-being, including criticism, threats, humiliation, blaming, and insults [23]. Unlike other forms of abuse, many people suffer from long-term emotional abuse without being aware of it[24]. Emotional abuse is one of the most damaging forms of abuse [25], causing lasting harm to a child’s self-esteem and hindering the development of effective emotional regulation skills [26]. These adolescents may exhibit reduced HPA axis response levels [27], making them less sensitive to pain and engaging in NSSI as a coping mechanism to regulate distress [28]. Additionally, physical abuse is an independent risk factor for NSSI in boys, which also confirms previous research findings [29]. In traditional family concepts and educational models, some parents adhere to the outdated idea that “a filial child is raised with a stick” and believe that children need to be corrected through severe corporal punishment to shape their character [30]. Social role theory suggests [31] that societal expectations place a greater social responsibility on boys in adulthood, which encourages parents to adopt stricter parenting strategies for boys than for girls. This belief leads to the possibility that boys may experience physical punishment more frequently than girls during their upbringing. Frequent corporal punishment, as a direct form of physical abuse, severely undermines boys’ self-esteem, causing them to doubt their own worth [29]. Self-blame may explain the association between physical abuse and NSSI. Children may learn to blame themselves for the physical abuse they endure from their parents, especially if they had misbehaved before the incident [29]. NSSI, as a form of self-punishment, is used to alleviate the tension and emotional pain arising from constant self-blame and parental criticism. Emotional neglect is a distinct risk factor for NSSI behavior in females. Research shows that emotional neglect can intensify an individual’s feelings of self-shame and negative self-beliefs, as this neglect implies that the individual is unworthy of others’ care and attention [32]. If a person grows up without caregivers who provide emotional support, security, and are sensitive enough to respond to the child’s needs, it may hinder the development of healthy interpersonal relationships or close friendships [33]. This is particularly true for females, who typically have higher emotional needs and more delicate emotional expressions. Emotional neglect may lead them to feel emotionally isolated, prompting them to engage in NSSI behaviors as a way to elicit care, support, and recognition from others. This study found that female adolescents with depression experience a greater variety of trauma types, showing a “low-threshold, high sensitivity” pattern between childhood trauma exposure and the risk of NSSI. This suggests the existence of gender-specific stress response mechanisms. In addition to the higher sensitivity of females to trauma, another possible explanation is that males, after experiencing trauma, may exhibit more outward behaviors (e.g., violence or aggression)[34], which could influence the onset of NSSI. Furthermore, the societal expectation for males to be resilient and strong may act as a psychological buffer when they encounter trauma. However, when the intensity of trauma exceeds the threshold of this buffering mechanism, it may lead to more severe consequences [35]. The mediating role of rumination in NSSI behavior was observed across all five trauma subtypes, but the strength of the effect varied significantly: the mediating proportion for sexual abuse was as high as 78.02%, with a complete mediation effect. This suggests that the core mechanism triggering NSSI in sexual abuse victims lies in the intrusive rumination triggered by traumatic memories (such as repeatedly reliving the victimization scene) [36]. This aligns closely with the unique shame and low self-worth typically associated with sexual trauma [37]. Victims of sexual abuse often become trapped in a “secret-rumination” cycle due to social stigmatization: the unspeakable nature of the traumatic experience leads to repetitive self-reflection [38-39], and the intensified self-blame resulting from rumination further exacerbates the impulse for NSSI. This study found that rumination plays a significant mediating role between both physical and emotional neglect and NSSI. Compared to other forms of abuse, neglect has a unique impact on children’s cognitive development [40]. Neglect hinders the establishment of close and stable emotional connections between individuals and their caregivers, as the lack of psychological guidance from caregivers deprives infants of their understanding of their inner world and pain in ways that are distinct from abuse. This disruption affects emotional regulation and the subsequent development of interpersonal functioning [41]. Neglect is particularly prevalent among left-behind children [42]. Due to prolonged absence of warmth and support from their families, these children often ruminate on these unpleasant experiences. According to the emotional cascade model, NSSI can serve as a way to divert attention from rumination, with individuals attempting to alleviate the pain and distress caused by rumination through this extreme behavior [13]. Rumination also plays a partial mediating role between both physical and emotional abuse and NSSI. In abusive situations, the instillation of contradictory emotions, such as the justification “hitting you is for your own good”, leads adolescents into a state of cognitive confusion between love and hate. This polarity reversal causes complex and conflicting psychological pain in adolescents. In such a cultural environment, they are unable to express their inner emotions in a healthy way and can only resort to NSSI behaviors to communicate their inner pain and struggles [43]. Strengths and Limitations This study has several notable strengths. It targets adolescents with depression, a high-risk group, and uses a large sample size, ensuring the findings are both significant and relevant for improving mental health in this population. The study carefully categorizes childhood trauma subtypes and examines their unique effects, controlling for important covariates such as age, gender, and family environment. This approach enhances the internal validity of the findings, providing more accurate insights into the relationships between these variables. Additionally, the research highlights gender differences in the link between childhood trauma and NSSI, offering valuable evidence for gender-specific interventions. Despite these strengths, the study has some limitations. The use of convenience sampling introduces selection bias, which restricts the generalizability of the findings. Additionally, the reliance on self-reported data from questionnaires may lead to recall bias and social desirability bias, potentially affecting the accuracy of the data. Furthermore, the cross-sectional design of the study prevents the establishment of causal relationships, limiting the ability to explore the complex causal pathways between childhood trauma, rumination, and NSSI behavior. Conclusions This study examines the association between childhood trauma subtypes and NSSI in depressed adolescents. Gender analyses reveal that females are more affected by emotional neglect and abuse, while males are more sensitive to emotional and physical abuse. The number of trauma subtypes shows a dose-response relationship with NSSI: females exposed to a single trauma subtype significantly increase their risk of NSSI, whereas males need to accumulate at least two subtypes to manifest a risk. Rumination mediates this relationship, particularly in sexual abuse, where it fully mediates the effect. Future research should focus on gender-specific interventions targeting trauma exposure and rumination to reduce NSSI risk. Abbreviations NSSI Non-suicidal self-injury CI Confidence interval ORs the odds ratios ECM The Emotional Cascade Model CCT Cumulative childhood trauma CTQ Childhood Trauma Questionnaire RRS Ruminative Response Scale Declarations Acknowledgements The authors would like to thank all participants for their voluntary participation and the staff for their help with data collection in this study. Author Contributions ZML conceived the study, developed the analytical strategy, analyzed the data, discussed the solutions and wrote the manuscript. WSJ, ZDD and LJY recruited and prepared the participants. All authors coordinated the overall project administration and contributed to the interpretation of findings. YY critically reviewed the manuscript. All authors have read and approved the final manuscript. Funding This study was funded by Shandong Province Traditional Chinese Medicine Science and Technology Project (NO.M20243303) and Medical Health Science and Technology Project of Shandong Provincial Health Commission (NO.202303090513). Data availability Due to participant privacy protection, the data cannot be publicly shared. To access the data, please contact the corresponding author. Ethics approval and consent to participate All procedures were conducted in accordance with relevant laws and institutional guidelines, and approval was obtained from the Ethics Committee of Shandong University School of Nursing and Rehabilitation (2024-R-156). The participants and their guardians provided their informed consent to participate in this study. Clinical trial number Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Lu B, Lin L, Su X. 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Wen YJ, Li XB, Zhao XX, Wang XQ, Hou WP, Bo QJ, Zheng W, Pao C, Tan T, Wang CY. The effect of left-behind phenomenon and physical neglect on behavioral problems of children. Child Abuse Negl. 2019 Feb;88:144-151. Sun F, Li H, Song W, Bao J, Zhen Z. Patterns of psychological pain and self-harm behaviors in adolescents. Suicide and Life-Threatening Behavior. 2022 Oct;52(5):1012-1023. Tables Table 1. Characteristics of Participants ( n , %). Subgroup Total Male ( n =649) Female ( n= 1357) c 2 /t P Non-NSSI ( n =311) NSSI ( n =338) Non-NSSI ( n =304) NSSI ( n =1053) Performance 2.051 0.359 Upper Tier 348(17.3) 70(22.5) 68(20.1) 45(14.8) 165(15.7) Middle Tier 972(48.5) 142(45.7) 150(44.4) 160(52.6) 520(49.4) Lower Tier 686(34.2) 99(31.8) 120(35.5) 99(32.6) 368(34.9) Personality 8.036 0.018 Introverted 899(44.8) 139(44.7) 176(52.1) 134(44.1) 450(42.7) Extroverted 243(12.1) 47(15.1) 30(8.9) 46(15.1) 120(11.4) Neutral 864(43.1) 125(40.2) 132(39.1) 124(40.8) 483(45.9) Parents’ Marital Status 2.323 0.508 First Marriage 1710(85.2) 268(86.2) 297(87.9) 266(87.5) 879(83.5) Divorced 147(7.3) 27(8.7) 16(4.7) 16(5.3) 88(8.4) One Deceased 33(1.6) 4(1.3) 6(1.8) 5(1.6) 18(1.7) Remarried 116(5.8) 12(3.9) 19(5.6) 17(5.6) 68(6.5) Only Child 0.005 0.943 Yes 573(28.6) 93(29.9) 121(35.8) 82(27.0) 277(26.3) No 1433(71.4) 218(70.1) 217(64.2) 222(73.0) 776(73.7) Parenting styles 46.548 <0.001 Authoritarian 321(16.0) 52(16.7) 66(19.5) 44(14.5) 159(15.1) Neglectful 287(14.3) 27(8.7) 47(13.9) 28(9.2) 185(17.6) Authoritative 461(23.0) 46(14.8) 80(23.7) 67(22.0) 268(25.5) Permissive 144(7.2) 31(10.0) 26(7.7) 24(7.9) 63(6.0) Democratic 793(39.5) 155(49.8) 119(35.2) 141(46.4) 378(35.9) Residence 6.338 0.042 Urban 1050(52.3) 163(52.4) 167(49.4) 161(53.0) 559(53.1) Town 690(34.4) 91(29.3) 121(35.8) 103(33.9) 375(35.6) Rural 266(13.3) 57(18.3) 50(14.8) 40(13.1) 119(11.3) SES 27.107 <0.001 High 56(2.8) 16(5.1) 10(3.0) 14(4.6) 16(1.5) Upper-Middle 740(36.9) 127(40.8) 112(33.1) 129(42.4) 372(35.3) Lower-Middle 1089(54.3) 151(48.6) 182(53.8) 150(49.3) 606(57.5) Low 121(6.0) 17(5.5) 34(10.1) 11(3.6) 59(5.6) Age, M(SD) 15.2(2.1) 15.2(2.2) 15.6(1.8) 15.3(2.4) 15.0(2.0) 3.14 0.002 Rumination, M(SD) 57.1(16.6) 45.8(16.1) 59.0(14.1) 48.9(16.2) 62.1(15.2) -8.312 <0.001 Abbreviations: M, mean; NSSI, Non - Suicidal Self - Injury; SES, socioeconomic status; SD, Standard Deviation. Table 2. Relationships between childhood trauma subtypes and NSSI. Group n (%) OR (95%CI) Unadjusted Model1 a Model2 b Model3 c Model4 d Emotional Neglect No 929(46.3) 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] Yes 1077(53.7) 2.63(2.16-3.20) 2.37(1.93-2.90) 2.12(1.71-2.63) 2.05(1.65-2.55) 1.82 (1.45-2.30) Emotional Abuse No 1422(70.9) 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] Yes 584(29.1) 4.39(3.36-5.75) 3.96(3.01-5.21) 3.55(2.67-4.72) 3.48(2.61-4.64) 2.06(1.52-2.79) Physical Neglect No 1021(50.9) 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] Yes 985(49.1) 1.79(1.47-2.17) 1.75(1.43-2.14) 1.57(1.28-1.94) 1.55(1.25-1.91) 1.25(0.99-1.57) Physical Abuse No 1707(85.1) 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] Yes 299(14.9) 2.46(1.79-3.39) 2.92(2.09-4.08) 2.55(1.81-3.58) 2.50(1.78-3.53) 2.55(1.81-3.58) Sexual Abuse No 1810(90.2) 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] Yes 196(9.8) 1.06(1.02-1.11) 1.48(1.03-2.11) 1.37(0.95-1.97) 1.34(0.93-1.94) 1.01(0.69-1.49) CCT 0 565(28.2) 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1[Reference] 1 475(23.7) 1.98(1.54-2.56) 1.92(1.47-2.49) 1.86(1.42-2.43) 1.82(1.39-2.39) 1.67(1.26-2.22) 2 502(25.0) 2.49(1.92-3.22) 2.33(1.78-3.04) 2.17(1.64-2.87) 2.11(1.59-2.80) 1.72(1.28-2.33) ≥3 464(23.1) 6.16(4.49-8.47) 5.74(4.13-7.97) 5.13(3.63-7.26) 4.95(3.49-7.02) 2.89(2.00-4.18) Abbreviations: CI, Confidence Interval; NSSI, Non - Suicidal Self - Injury; OR, odds ratio. a Model 1: Adjusted for gender, age, performance and personality. b Model 2: Adjusted for gender, age, performance, personality, parental marriage, parenting styles and only child. c Model 3: Adjusted for gender, age, performance, personality, parental marriage, parenting styles, only child, residence and SES. d Model 4: Adjusted for gender, age, performance, personality, parental marriage, parenting styles, only child, residence SES and rumination. Table 3. Relationships between childhood trauma subtypes and NSSI by gender. Group Male Female ROR c P n (%) OR (95% CI) a aOR (95% CI) b n (%) OR (95% CI) a aOR (95% CI) b Emotional Neglect No 364(56.1) 1 [Reference] 1 [Reference] 565(41.6) 1 [Reference] 1 [Reference] Yes 285(43.9) 1.73(1.26-2.36) 1.38(0.96-1.99) 792(58.4) 3.01(2.31-3.93) 2.30(1.69-3.13) 0.60 0.087 Emotional Abuse No 518(79.8) 1 [Reference] 1 [Reference] 904(66.6) 1 [Reference] 1 [Reference] Yes 131(20.2) 4.43(2.82-6.96) 2.07(1.24-3.45) 453(33.4) 3.75(2.66-5.29) 2.06(1.40-3.02) 1.00 0.577 Physical Neglect No 348(53.6) 1 [Reference] 1 [Reference] 673(49.6) 1 [Reference] 1 [Reference] Yes 301(46.4) 1.70(1.25-2.32) 1.22(0.84-1.76) 684(50.4) 1.83(1.41-2.38) 1.28(0.95-1.72) 0.95 0.838 Physical Abuse No 535(82.4) 1 [Reference] 1 [Reference] 1172(86.4) 1 [Reference] 1 [Reference] Yes 114(17.6) 3.10(1.98-4.86) 2.12(1.27-3.56) 185(13.6) 2.64(1.63-4.28) 1.57(0.94-2.64) 1.35 0.305 Sexual Abuse No 591(91.1) 1 [Reference] 1 [Reference] 1219(89.8) 1 [Reference] 1 [Reference] Yes 58(8.9) 1.70 (0.97-2.97) 1.02(0.54-1.94) 138(10.2) 1.34(0.85-2.11) 0.98(0.60-1.62) 1.04 0.710 CCT 0 227(35.0) 1 [Reference] 1 [Reference] 338(24.9) 1 [Reference] 1 [Reference] 1 156(24.0) 1.74(1.15-2.63) 1.57(0.99-2.50) 319(23.5) 2.03(1.45-2.85) 1.75(1.21-2.53) 0.90 0.955 2 148(22.8) 2.00(1.31-3.04) 1.70(1.05-2.75) 354(26.1) 2.58(1.83-3.64) 1.80(1.22-2.67) 0.94 0.973 ≥3 118(18.2) 4.72(2.88-7.73) 2.25(1.27-3.99) 346(25.5) 6.58(4.27-10.16) 3.53(2.15-5.81) 0.64 0.545 Abbreviations: OR, odds ratio; ROR, relative odds ratio; CCT, cumulative childhood trauma; CI, Confidence Interval. a: Unadjusted model. b: Adjusted for gender, age, performance, personality, parental marriage, parenting styles, only child, residence SES and rumination. c: Calculated by adjusted OR. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Sep, 2025 Read the published version in BMC Psychology → Version 1 posted Editorial decision: Revision requested 31 Jul, 2025 Reviews received at journal 28 Jul, 2025 Reviewers agreed at journal 28 Jul, 2025 Reviewers agreed at journal 28 Jul, 2025 Reviewers agreed at journal 25 Jul, 2025 Reviewers agreed at journal 25 Jul, 2025 Reviews received at journal 23 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviewers invited by journal 22 Jul, 2025 Editor invited by journal 02 Jul, 2025 Editor assigned by journal 28 Jun, 2025 Submission checks completed at journal 28 Jun, 2025 First submitted to journal 26 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-6987106","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":489783957,"identity":"0446043e-f69a-4da6-a9f9-2b8d929c7f80","order_by":0,"name":"Mailin Zhou","email":"","orcid":"","institution":"Shandong University","correspondingAuthor":false,"prefix":"","firstName":"Mailin","middleName":"","lastName":"Zhou","suffix":""},{"id":489783958,"identity":"553594d4-1ec9-49d1-a66d-9c5d07fb4c9d","order_by":1,"name":"Shijian Wang","email":"","orcid":"","institution":"Shandong Mental Health Center","correspondingAuthor":false,"prefix":"","firstName":"Shijian","middleName":"","lastName":"Wang","suffix":""},{"id":489783959,"identity":"4dbeab21-2d1d-4085-8d9c-248202cb9af8","order_by":2,"name":"Doudou Zheng","email":"","orcid":"","institution":"Shandong Mental Health Center","correspondingAuthor":false,"prefix":"","firstName":"Doudou","middleName":"","lastName":"Zheng","suffix":""},{"id":489783960,"identity":"74dfac11-af82-461a-bb22-05b5fbae2dd2","order_by":3,"name":"Jingya Li","email":"","orcid":"","institution":"Shandong Mental Health Center","correspondingAuthor":false,"prefix":"","firstName":"Jingya","middleName":"","lastName":"Li","suffix":""},{"id":489783961,"identity":"f7de6d9d-c1c5-4e8b-a144-bc5941ba6c9e","order_by":4,"name":"Ying Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYDCCA1Can5n54IMPBjZ2xGhhbADRku1tyYYzCtKSiddicOaMmTTPh0MQHj7Ad7z5+YOPew4nNtxIMJC2MTjAzMB++OgGfFokzxwzbJzx7HBi44yEBOMcgzt8DDxpaTfwaTG4kcPYzHPgcGKzRMKB5ByDZ8wMEjxmxGlpk0hsOGxhcJixgWgtPTyHGZsZiNEC8svMGQfSjWewtzEz9hikJbMR8gswxB58+HDAWnb/Yf7vP378sbHjZz98DK8WKGh2bIAx2YhQDgJ19kQqHAWjYBSMgpEIAASgVrFXCMCfAAAAAElFTkSuQmCC","orcid":"","institution":"Shandong Mental Health Center","correspondingAuthor":true,"prefix":"","firstName":"Ying","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2025-06-27 02:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6987106/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6987106/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40359-025-03440-2","type":"published","date":"2025-09-26T15:57:31+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87519956,"identity":"6d2acb65-b545-4cc3-99eb-caf3215f7ce9","added_by":"auto","created_at":"2025-07-24 17:32:06","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":87029,"visible":true,"origin":"","legend":"\u003cp\u003eMediating effect of Rumination between childhood trauma subtypes(a-e) and NSSI; The 95% \u003cem\u003eCI\u003c/em\u003eof these estimates was computed using the bootstrap method (1,000 samples); The model was adjusted for gender, age, performance, personality, parental marriage, parenting styles, only child, residence and SES.\u003c/p\u003e\n\u003cp\u003eAbbreviations: NSSI, non-suicidal self-injury.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6987106/v1/c4dd948ba997f3c8b4c0f79a.jpg"},{"id":92430706,"identity":"8aebdb4b-5592-4d5a-8567-74f1f3e3d5db","added_by":"auto","created_at":"2025-09-29 16:07:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1194375,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6987106/v1/303bad32-c45a-4f42-91d6-665017852d55.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gender-Differentiated Pathways from Childhood Trauma to Self-Injury: Rumination as a Mediator in Depressed Adolescents","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAdolescent mental health issues have garnered increasing attention, with depression being the leading cause of health-related disabilities and a major contributor to the global disease burden [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A meta-analysis indicated that the overall prevalence of depression among adolescents in mainland China is 24.3% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Depressed adolescents are at high risk for various psychological and behavioral problems, and non-suicidal self-injury (NSSI) is particularly prominent in this group. NSSI is defined as a series of deliberate, direct, and repeated self-inflicted physical harm without suicidal intent, which is not socially approved [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Studies show that the incidence of NSSI among depressed adolescents is as high as 40%-60% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. NSSI has a strong predictive value for future suicidal behaviors, with a population-based study in Sweden revealing that 62.2% of the deaths among depressed adolescents involved NSSI [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. NSSI not only amplifies the risk of suicide but also exacerbates mental disorders, making it a global public health issue that cannot be ignored [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eExploring the triggering factors of NSSI is crucial for prevention and intervention. Nock\u0026rsquo;s integrated model emphasizes the role of early distal risk factors, particularly childhood trauma, in triggering NSSI behavior [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Childhood trauma mainly includes five dimensions: emotional neglect, emotional abuse, physical neglect, physical abuse, and sexual abuse [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Surveys indicate that approximately 65% of individuals who self-harm have experienced at least one form of childhood trauma, and about 50% have encountered multiple types of childhood trauma [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], with a dose-response relationship between the two [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Systematic reviews have shown that all types of childhood trauma are significantly associated with NSSI [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, there is still insufficient understanding of the relationship between childhood trauma subtypes and NSSI in depressed adolescents, as well as the gender differences in this relationship and the dose-response relationship between them.\u003c/p\u003e\u003cp\u003eThe mechanisms through which childhood trauma subtypes influence NSSI behaviors remain unclear. In recent years, there has been an increasing focus on the role of cognitive factors in the development of psychological issues. Rumination, a common cognitive coping strategy, refers to an individual\u0026rsquo;s tendency to engage in repetitive and passive thinking about their negative emotions, their causes, and consequences after experiencing negative events, without taking active steps to resolve the issues [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The Emotional Cascade Model (ECM) of NSSI [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] suggests that rumination plays a key role in the onset and maintenance of NSSI, as individuals engage in self-injury to alleviate the pain intensified by rumination. Furthermore, there is evidence of a close relationship between childhood trauma and rumination [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], with adolescents who have experienced childhood trauma being more likely to develop ruminative thinking compared to those who have not experienced such trauma [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Although one study has confirmed that rumination partially mediates the relationship between childhood trauma and NSSI, the mediating effect of rumination between specific childhood trauma subtypes (such as emotional neglect, physical abuse) and NSSI has yet to be fully explored and revealed.\u003c/p\u003e\u003cp\u003eIn summary, this study aims to explore the associations between childhood trauma subtypes and NSSI, the gender differences, and the mediating role of rumination in these relationships among depressed adolescents.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1Participants and Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA convenience sampling method was employed to recruit adolescent patients diagnosed with depression from the outpatient and inpatient units of the child and adolescent psychiatry department at a mental health hospital in China as research participants. Inclusion criteria included:(1) Diagnosis of depression based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by two experienced psychiatrists. (2) Age between 10 and 19 years old. (3) Participants were able to understand the questionnaire content and complete it truthfully. Exclusion criteria included: (1) Currently experiencing acute episodes of severe mental disorders (e.g., schizophrenia, bipolar disorder); (2) Severe substance abuse problems that may interfere with the evaluation of self-injury behaviors; (3) Neurodevelopmental disorders (e.g., intellectual disability, autism spectrum disorder, attention deficit hyperactivity disorder); (4) Recent exposure to major traumatic events (e.g., the death of a loved one, severe accidents) that could confound the study results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQuestionnaires were completed online via electronic QR codes, enhancing the convenience and transparency of the research process. Data collection was conducted in a quiet, private, and uniformly arranged room to minimize environmental interference and ensure participants’ privacy and focus. Researchers provided standardized instructions to participants to help them accurately understand the questionnaire content and task requirements. The completion process takes approximately 15-20 minutes. Data collection for this study occurred between June 2024 and February 2025, though the study is ongoing. This study was approved by the relevant institutional ethics committee (2024-R-156) and informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2.2.1Childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ) [17], which categorizes childhood trauma into five distinct dimensions: emotional neglect (the inability to meet essential emotional and psychological needs, such as love and support); emotional abuse (verbal attacks that severely impact a child’s well-being or behaviors that may humiliate, embarrass, or severely threaten the child); physical neglect (failure to meet basic physical needs, such as food and shelter); physical abuse (intentional physical harm); and sexual abuse (any form of sexual contact and/or behavior between a child and an adult). The questionnaire contains 25 items, rated on a 5-point Likert scale from 1 (never) to 5 (always). The total score ranges from 25 to 125, with higher scores indicating more severe abuse. Cumulative childhood trauma (CCT) was created by summing the dichotomized scores of different subscales of childhood trauma, with a total score ranging from 0 to 5 (Cronbach’s α = 0.882).\u003c/p\u003e\n\u003cp\u003e2.2.2Ruminative Response Scale (RRS) was used to evaluate rumination. The RRS consists of 22 items, evaluating three dimensions of rumination: Symptom Rumination (e.g., “I often think about how lonely I feel”), Brooding (e.g., “I often wonder why I am always like this”), and Reflective Pondering (e.g., “I often analyze my personality to understand why I feel depressed”) [18]. Responses are rated on a 1-4 rating scale, with higher scores indicating a higher level of rumination (Cronbach’s \u003cem\u003eα\u003c/em\u003e=0.956).\u003c/p\u003e\n\u003cp\u003e2.2.3Participants were assessed for the presence of NSSI behavior using the Ottawa Self-Injury Inventory (OSI) [19]. They were asked to respond to the question: “In the past year, have you engaged in any of the following behaviors to intentionally harm yourself? These behaviors were not intended for suicide but may have resulted in bleeding, bruising, or pain”. Participants could respond with “Yes” or “No”, and those who answered “Yes” were classified as exhibiting NSSI behavior.\u003c/p\u003e\n\u003cp\u003e2.2.4Based on existing literature on childhood trauma and NSSI, various covariates were included in the analysis. The covariates in this study included: age, gender (male or female), academic performance (upper, middle, or lower), and personality (introverted, extroverted, or neutral), parental marital status (first marriage, divorced, one parent deceased, or remarried), Parenting styles (authoritarian, neglectful, authoritative, permissive or democratic\u003cstrong\u003e)\u003c/strong\u003e, whether the participant is an only child (yes or no), Socioeconomic Status (SES) (high, upper-middle, lower-middle, or low), residence (urban, town, or rural).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCategorical variables were summarized using frequencies and proportions, while continuous variables were presented as means (standard deviations) to describe the participant characteristics. The logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between childhood trauma subtypes and NSSI. Subgroup analysis was performed to examine whether there were gender differences in this association. In Model 1, demographic characteristics were adjusted for, including gender, age, academic performance and personality. In Model 2, family environment was adjusted for, including parental marital status, Parenting styles and only child. In Model 3, economic status was adjusted for, including family economic status, residence. In Model 4, rumination was adjusted. Finally, logistic regression-based mediation analysis was conducted to clarify the mediating role of rumination in the relationship between childhood trauma and NSSI in the fully adjusted model. Statistical analysis was performed using SPSS 27.0 and R.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eThis study included a total of 2,006 depressed adolescents, with 649 males (32.4%) and 1,357 females (67.6%). The results showed that the overall incidence rate of NSSI among depressed adolescents was 69.3%, with a rate of 52.1% in males and 77.6% in females. Other detailed characteristics are shown in Table 1.\u003c/p\u003e\n\u003cp\u003eThe results of the binary logistic regression are shown in Table 2. The subtype incidence rates of childhood trauma were as follows: emotional neglect 53.7%, emotional abuse 29.1%, physical neglect 49.1%, physical abuse 14.9%, and sexual abuse 9.8%. In Model 3, after controlling for demographic and economic factors, emotional neglect, emotional abuse, physical neglect, and physical abuse were identified as direct risk factors for adolescent NSSI behaviors. However, in Model 4, after controlling for rumination, physical neglect was no longer directly associated with NSSI. Additionally, the subtypes of childhood trauma exhibited a cumulative effect on NSSI behaviors, meaning that the more trauma subtypes experienced, the higher the risk of NSSI.\u003c/p\u003e\n\u003cp\u003eThe gender differences are presented in Table 3. Although statistical analysis revealed no significant gender differences in the relationship between childhood trauma subtypes and NSSI, the data indicate that females experienced more childhood trauma than males. Males were primarily affected by emotional abuse and physical abuse, while females were more impacted by emotional neglect and emotional abuse. Females appear to be more sensitive to childhood trauma, with the experience of a single trauma subtype significantly increasing the risk of NSSI, whereas males needed to experience multiple trauma subtypes to significantly increase their risk.\u003c/p\u003e\n\u003cp\u003eThe mediation effect results are shown in Figure 1. Five trauma subtypes\u0026mdash;emotional neglect, emotional abuse, physical neglect, physical abuse, and sexual abuse\u0026mdash;were found to influence NSSI through rumination as a mediating variable. The mediation proportions for emotional neglect, emotional abuse, physical neglect, physical abuse, and sexual abuse were 27.05%, 33.11%, 58.05%, 39.07%, and 78.02%, respectively. Sexual abuse was found to fully mediate the effect on NSSI through rumination, with a mediation proportion of 78.02%, consistent with the results in Table 2. Overall, rumination played a significant mediating role in the relationship between different types of trauma subtypes and NSSI.\u003c/p\u003e\n\n"},{"header":"Discussion","content":"\u003cp\u003eThe present study advances current understanding of NSSI etiology by delineating gender-specific patterns and identifying rumination as a pivotal mediator across all childhood trauma subtypes—a dual contribution that addresses critical gaps in prior research. While existing literature broadly links childhood trauma to NSSI, our findings uniquely demonstrate that females exhibit a “low-threshold, high-sensitivity” response, where exposure to a single trauma subtype, whereas males require cumulative trauma exposure (≥2 subtypes) to manifest comparable risk. This threshold divergence challenges homogeneous trauma-NSSI models and underscores the necessity of gender-tailored prevention frameworks. Furthermore, this study validates the core cognitive mediating role of rumination in the relationship between childhood trauma and NSSI, establishing it as a novel transdiagnostic therapeutic target for intervention development.\u003c/p\u003e\n\u003cp\u003eAmong all childhood trauma subtypes, all except sexual abuse were directly associated with NSSI. However, some studies suggest that sexual abuse is also an important trigger for NSSI[20]. One possible explanation is that in populations attending mental health centers, parents often detect and pay attention to their children’s psychological issues at an early stage. This suggests that parents in this group are more sensitive to and concerned about their children’s mental health, leading to a lower incidence of sexual abuse, which makes it difficult to detect a potential link between sexual abuse and NSSI. Additionally, conservative attitudes towards sex, the stigma surrounding sexual abuse victims, and gender norms emphasizing female chastity and male masculinity can also affect the disclosure of sexual abuse[21].\u003c/p\u003e\n\u003cp\u003eAlthough the statistical significance was not reached, gender-specific risk patterns have important clinical implications. First, emotional abuse is a common risk factor for NSSI behavior in both males and females, which is consistent with previous research [22]. Emotional abuse refers to the long-term negative attitudes of caregivers toward children, involving verbal attacks on a person’s sense of worth or well-being, including criticism, threats, humiliation, blaming, and insults [23]. Unlike other forms of abuse, many people suffer from long-term emotional abuse without being aware of it[24]. Emotional abuse is one of the most damaging forms of abuse [25], causing lasting harm to a child’s self-esteem and hindering the development of effective emotional regulation skills [26]. These adolescents may exhibit reduced HPA axis response levels [27], making them less sensitive to pain and engaging in NSSI as a coping mechanism to regulate distress [28].\u003c/p\u003e\n\u003cp\u003eAdditionally, physical abuse is an independent risk factor for NSSI in boys, which also confirms previous research findings [29]. In traditional family concepts and educational models, some parents adhere to the outdated idea that “a filial child is raised with a stick” and believe that children need to be corrected through severe corporal punishment to shape their character [30]. Social role theory suggests [31] that societal expectations place a greater social responsibility on boys in adulthood, which encourages parents to adopt stricter parenting strategies for boys than for girls. This belief leads to the possibility that boys may experience physical punishment more frequently than girls during their upbringing. Frequent corporal punishment, as a direct form of physical abuse, severely undermines boys’ self-esteem, causing them to doubt their own worth [29]. Self-blame may explain the association between physical abuse and NSSI. Children may learn to blame themselves for the physical abuse they endure from their parents, especially if they had misbehaved before the incident [29]. NSSI, as a form of self-punishment, is used to alleviate the tension and emotional pain arising from constant self-blame and parental criticism.\u003c/p\u003e\n\u003cp\u003eEmotional neglect is a distinct risk factor for NSSI behavior in females. Research shows that emotional neglect can intensify an individual’s feelings of self-shame and negative self-beliefs, as this neglect implies that the individual is unworthy of others’ care and attention [32]. If a person grows up without caregivers who provide emotional support, security, and are sensitive enough to respond to the child’s needs, it may hinder the development of healthy interpersonal relationships or close friendships [33]. This is particularly true for females, who typically have higher emotional needs and more delicate emotional expressions. Emotional neglect may lead them to feel emotionally isolated, prompting them to engage in NSSI behaviors as a way to elicit care, support, and recognition from others.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study found that female adolescents with depression experience a greater variety of trauma types, showing a “low-threshold, high sensitivity” pattern between childhood trauma exposure and the risk of NSSI. This suggests the existence of gender-specific stress response mechanisms. In addition to the higher sensitivity of females to trauma, another possible explanation is that males, after experiencing trauma, may exhibit more outward behaviors (e.g., violence or aggression)[34], which could influence the onset of NSSI. Furthermore, the societal expectation for males to be resilient and strong may act as a psychological buffer when they encounter trauma. However, when the intensity of trauma exceeds the threshold of this buffering mechanism, it may lead to more severe consequences [35].\u003c/p\u003e\n\u003cp\u003eThe mediating role of rumination in NSSI behavior was observed across all five trauma subtypes, but the strength of the effect varied significantly: the mediating proportion for sexual abuse was as high as 78.02%, with a complete mediation effect. This suggests that the core mechanism triggering NSSI in sexual abuse victims lies in the intrusive rumination triggered by traumatic memories (such as repeatedly reliving the victimization scene) [36]. This aligns closely with the unique shame and low self-worth typically associated with sexual trauma [37]. Victims of sexual abuse often become trapped in a “secret-rumination” cycle due to social stigmatization: the unspeakable nature of the traumatic experience leads to repetitive self-reflection [38-39], and the intensified self-blame resulting from rumination further exacerbates the impulse for NSSI.\u003c/p\u003e\n\u003cp\u003eThis study found that rumination plays a significant mediating role between both physical and emotional neglect and NSSI. Compared to other forms of abuse, neglect has a unique impact on children’s cognitive development [40]. Neglect hinders the establishment of close and stable emotional connections between individuals and their caregivers, as the lack of psychological guidance from caregivers deprives infants of their understanding of their inner world and pain in ways that are distinct from abuse. This disruption affects emotional regulation and the subsequent development of interpersonal functioning [41]. Neglect is particularly prevalent among left-behind children [42]. Due to prolonged absence of warmth and support from their families, these children often ruminate on these unpleasant experiences. According to the emotional cascade model, NSSI can serve as a way to divert attention from rumination, with individuals attempting to alleviate the pain and distress caused by rumination through this extreme behavior [13].\u003c/p\u003e\n\u003cp\u003eRumination also plays a partial mediating role between both physical and emotional abuse and NSSI. In abusive situations, the instillation of contradictory emotions, such as the justification “hitting you is for your own good”, leads adolescents into a state of cognitive confusion between love and hate. This polarity reversal causes complex and conflicting psychological pain in adolescents. In such a cultural environment, they are unable to express their inner emotions in a healthy way and can only resort to NSSI behaviors to communicate their inner pain and struggles [43].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several notable strengths. It targets adolescents with depression, a high-risk group, and uses a large sample size, ensuring the findings are both significant and relevant for improving mental health in this population. The study carefully categorizes childhood trauma subtypes and examines their unique effects, controlling for important covariates such as age, gender, and family environment. This approach enhances the internal validity of the findings, providing more accurate insights into the relationships between these variables. Additionally, the research highlights gender differences in the link between childhood trauma and NSSI, offering valuable evidence for gender-specific interventions. Despite these strengths, the study has some limitations. The use of convenience sampling introduces selection bias, which restricts the generalizability of the findings. Additionally, the reliance on self-reported data from questionnaires may lead to recall bias and social desirability bias, potentially affecting the accuracy of the data. Furthermore, the cross-sectional design of the study prevents the establishment of causal relationships, limiting the ability to explore the complex causal pathways between childhood trauma, rumination, and NSSI behavior.\u003c/p\u003e\n\n"},{"header":"Conclusions","content":"\u003cp\u003eThis study examines the association between childhood trauma subtypes and NSSI in depressed adolescents. Gender analyses reveal that females are more affected by emotional neglect and abuse, while males are more sensitive to emotional and physical abuse. The number of trauma subtypes shows a dose-response relationship with NSSI: females exposed to a single trauma subtype significantly increase their risk of NSSI, whereas males need to accumulate at least two subtypes to manifest a risk. Rumination mediates this relationship, particularly in sexual abuse, where it fully mediates the effect. Future research should focus on gender-specific interventions targeting trauma exposure and rumination to reduce NSSI risk.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNSSI Non-suicidal self-injury\u003c/p\u003e\n\u003cp\u003eCI Confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eORs the odds ratios\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eECM The Emotional Cascade Model\u003c/p\u003e\n\u003cp\u003eCCT Cumulative childhood trauma\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCTQ Childhood Trauma Questionnaire\u003c/p\u003e\n\u003cp\u003eRRS Ruminative Response Scale\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participants for their voluntary participation and the staff for their help with data collection in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZML conceived the study, developed the analytical strategy, analyzed the data, discussed the solutions and wrote the manuscript. WSJ, ZDD and LJY recruited and prepared the participants. All authors coordinated the overall project administration and contributed to the interpretation of findings. YY critically reviewed the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Shandong Province Traditional Chinese Medicine Science and Technology Project (NO.M20243303) and Medical Health Science and Technology Project of Shandong Provincial Health Commission (NO.202303090513).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to participant privacy protection, the data cannot be publicly shared. To access the data, please contact the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were conducted in accordance with relevant laws and institutional guidelines, and approval was obtained from the Ethics Committee of Shandong University School of Nursing and Rehabilitation (2024-R-156). The participants and their guardians provided their informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLu B, Lin L, Su X. Global burden of depression or depressive symptoms in children and adolescents: A systematic review and meta-analysis. J Affect Disord. 2024;354:553-562. \u003c/li\u003e\n\u003cli\u003eTang, X., Tang, S., Ren, Z., \u0026amp; Wong, D. F. K. 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Patterns of psychological pain and self-harm behaviors in adolescents. Suicide and Life-Threatening Behavior. 2022 Oct;52(5):1012-1023. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Characteristics of Participants (\u003cem\u003en\u003c/em\u003e, %).\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubgroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e=649)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003cem\u003en=\u003c/em\u003e1357)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ec\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e/t\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-NSSI\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e=311)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSSI\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e=338)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-NSSI\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e=304)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSSI\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003cem\u003en\u003c/em\u003e=1053)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerformance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eUpper Tier\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e348(17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e70(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e68(20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e45(14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e165(15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMiddle Tier\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e972(48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e142(45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e150(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e160(52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e520(49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eLower Tier\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e686(34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e99(31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e120(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e99(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e368(34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e8.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eIntroverted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e899(44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e139(44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e176(52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e134(44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e450(42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eExtroverted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e243(12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e47(15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e30(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e46(15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e120(11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e864(43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e125(40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e132(39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e124(40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e483(45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParents\u0026rsquo; Marital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eFirst Marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1710(85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e268(86.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e297(87.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e266(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e879(83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e147(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e27(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e16(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e16(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e88(8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eOne Deceased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e33(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e4(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e6(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e5(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e18(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eRemarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e116(5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e12(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e19(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e17(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e68(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnly Child\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.943\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e573(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e93(29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e121(35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e82(27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e277(26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1433(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e218(70.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e217(64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e222(73.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e776(73.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParenting styles\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e46.548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eAuthoritarian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e321(16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e52(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e66(19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e44(14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e159(15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eNeglectful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e287(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e27(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e47(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e28(9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e185(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eAuthoritative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e461(23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e46(14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e80(23.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e67(22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e268(25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003ePermissive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e144(7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e31(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e26(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e24(7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e63(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eDemocratic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e793(39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e155(49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e119(35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e141(46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e378(35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e6.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1050(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e163(52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e167(49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e161(53.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e559(53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eTown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e690(34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e91(29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e121(35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e103(33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e375(35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e266(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e57(18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e50(14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e40(13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e119(11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e27.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e56(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e16(5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e10(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e14(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e16(1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eUpper-Middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e740(36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e127(40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e112(33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e129(42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e372(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eLower-Middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1089(54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e151(48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e182(53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e150(49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e606(57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e121(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e17(5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e34(10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e59(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, M(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e15.2(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e15.2(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e15.6(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e15.3(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e15.0(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRumination, M(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e57.1(16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e45.8(16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e59.0(14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e48.9(16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e62.1(15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-8.312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: M, mean; NSSI, Non - Suicidal Self - Injury; SES, socioeconomic status; SD, Standard Deviation.\u003c/p\u003e\n\u003cp\u003eTable 2. Relationships between childhood trauma subtypes and NSSI.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnadjusted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel1\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel2\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel3\u003csup\u003ec\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel4\u003csup\u003ed\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional Neglect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e929(46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1077(53.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.63(2.16-3.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.37(1.93-2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.12(1.71-2.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.05(1.65-2.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.82 (1.45-2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional Abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1422(70.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e584(29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.39(3.36-5.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3.96(3.01-5.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3.55(2.67-4.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3.48(2.61-4.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.06(1.52-2.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical Neglect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1021(50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e985(49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.79(1.47-2.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.75(1.43-2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.57(1.28-1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.55(1.25-1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.25(0.99-1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical Abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1707(85.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e299(14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.46(1.79-3.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.92(2.09-4.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.55(1.81-3.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.50(1.78-3.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.55(1.81-3.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual Abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1810(90.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e196(9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.06(1.02-1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.48(1.03-2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.37(0.95-1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.34(0.93-1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.01(0.69-1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e565(28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1[Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e475(23.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.98(1.54-2.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.92(1.47-2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.86(1.42-2.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.82(1.39-2.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.67(1.26-2.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e502(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.49(1.92-3.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.33(1.78-3.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.17(1.64-2.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.11(1.59-2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.72(1.28-2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e464(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.16(4.49-8.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.74(4.13-7.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.13(3.63-7.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.95(3.49-7.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.89(2.00-4.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: CI, Confidence Interval; NSSI, Non - Suicidal Self - Injury; OR, odds ratio.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eModel 1: Adjusted for gender, age, performance and personality.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003eModel 2: Adjusted for gender, age, performance, personality, parental marriage, parenting styles and only child.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003eModel 3: Adjusted for gender, age, performance, personality, parental marriage, parenting styles, only child, residence and SES.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ed\u003c/sup\u003eModel 4: Adjusted for gender, age, performance, personality, parental marriage, parenting styles, only child, residence SES and rumination.\u003c/p\u003e\n\u003cp\u003eTable 3. Relationships between childhood trauma subtypes and NSSI by gender.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROR\u003csup\u003ec\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR (95% CI)\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR (95% CI)\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional Neglect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e364(56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e565(41.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e285(43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.73(1.26-2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.38(0.96-1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e792(58.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.01(2.31-3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.30(1.69-3.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional Abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e518(79.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e904(66.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e131(20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4.43(2.82-6.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.07(1.24-3.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e453(33.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.75(2.66-5.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.06(1.40-3.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical Neglect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e348(53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e673(49.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e301(46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.70(1.25-2.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.22(0.84-1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e684(50.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.83(1.41-2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.28(0.95-1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical Abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e535(82.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1172(86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e114(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.10(1.98-4.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.12(1.27-3.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e185(13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.64(1.63-4.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.57(0.94-2.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual Abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e591(91.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1219(89.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e58(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.70 (0.97-2.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.02(0.54-1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e138(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.34(0.85-2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.98(0.60-1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.710\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e227(35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e338(24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1 [Reference]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e156(24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.74(1.15-2.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.57(0.99-2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e319(23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.03(1.45-2.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.75(1.21-2.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.955\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e148(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.00(1.31-3.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.70(1.05-2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e354(26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.58(1.83-3.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.80(1.22-2.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.973\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e118(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4.72(2.88-7.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.25(1.27-3.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e346(25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e6.58(4.27-10.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3.53(2.15-5.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.545\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: OR, odds ratio; ROR, relative odds ratio; CCT, cumulative childhood trauma; CI, Confidence Interval.\u003c/p\u003e\n\u003cp\u003ea: Unadjusted model.\u003c/p\u003e\n\u003cp\u003eb: Adjusted for gender, age, performance, personality, parental marriage, parenting styles, only child, residence SES and rumination.\u003c/p\u003e\n\u003cp\u003ec: Calculated by adjusted OR.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"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":"Depressed adolescents, Childhood trauma subtypes, Non-suicidal self-injury, Gender differences, Rumination","lastPublishedDoi":"10.21203/rs.3.rs-6987106/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6987106/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAmid the global escalation of adolescent depression and non-suicidal self-injury (NSSI), childhood trauma has been identified as a critical risk factor, yet how specific trauma subtypes contribute to NSSI remains unclear. This study aims to explore the relationship between childhood trauma subtypes and NSSI in depressed adolescents, focusing gender differences, and verify the mediating role of rumination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This cross-sectional study included 2,006 clinically depressed adolescents (aged 10–19), who were recruited through convenience sampling from a psychiatric hospital in China (2024–2025). Validated scales (Childhood Trauma Questionnaire, Ruminative Response Scale, Ottawa Self-Injury Inventory) were administered. Binary logistic regression, subgroup analysis, and mediation analysis were used to examine the relationships between variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e NSSI prevalence reached 69.3% in depressed adolescents (female:77.6% vs male:52.1%). Emotional neglect (OR=1.82), emotional abuse (OR=2.06), and physical abuse (OR=2.55) were associated with NSSI. Gender difference analysis revealed that females were more sensitive to emotional neglect (OR=2.30) and emotional abuse (OR=2.06), while males were more sensitive to emotional abuse (OR=2.07) and physical abuse (OR=2.12). A single trauma subtype significantly increased the risk of NSSI in females, whereas males required at least two trauma subtypes to significantly increase NSSI risk. Rumination played a mediating role between all trauma subtypes and NSSI, with sexual abuse showing the highest mediation effect (78.02%), indicating a full mediation effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe childhood trauma-NSSI association in depressed adolescents demonstrates gender difference, with rumination functioning as the central mechanistic pathway. Interventions must prioritize trauma subtype- and gender-tailored strategies to disrupt rumination pathways.\u003c/p\u003e","manuscriptTitle":"Gender-Differentiated Pathways from Childhood Trauma to Self-Injury: Rumination as a Mediator in Depressed Adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-24 17:32:02","doi":"10.21203/rs.3.rs-6987106/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-31T07:55:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-28T12:23:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130049793025673486252128622435854392148","date":"2025-07-28T07:41:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129704145893216518132524935949532430418","date":"2025-07-28T07:30:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"186516943621647378430790372927498982066","date":"2025-07-25T14:54:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64208819748385931031266799524557938923","date":"2025-07-25T10:14:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-23T08:52:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256377717540002790715837758145930049786","date":"2025-07-22T19:56:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-22T18:52:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-02T11:32:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-28T04:28:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-28T04:27:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-06-27T02:04:13+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":"e0c8d50c-6758-47bb-8484-9385d46cd79c","owner":[],"postedDate":"July 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-29T16:05:03+00:00","versionOfRecord":{"articleIdentity":"rs-6987106","link":"https://doi.org/10.1186/s40359-025-03440-2","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2025-09-26 15:57:31","publishedOnDateReadable":"September 26th, 2025"},"versionCreatedAt":"2025-07-24 17:32:02","video":"","vorDoi":"10.1186/s40359-025-03440-2","vorDoiUrl":"https://doi.org/10.1186/s40359-025-03440-2","workflowStages":[]},"version":"v1","identity":"rs-6987106","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6987106","identity":"rs-6987106","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}