From Early Trauma to Self-Harm: A Sequential Mediation Model of Self-Efficacy, Psychological Resilience, and Depression in Adolescents

From Early Trauma to Self-Harm: A Sequential Mediation Model of Self-Efficacy, Psychological Resilience, and Depression in 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 Article From Early Trauma to Self-Harm: A Sequential Mediation Model of Self-Efficacy, Psychological Resilience, and Depression in Adolescents Jingyi Chu, Yihan Wang, Xinya Zhang, Zhiqi Jiang, Yunzhe Li, Kexin Wang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8697764/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Objective Examining the mechanisms through which childhood trauma influences non-suicidal self-injury (NSSI) among adolescents suffering depressive disorders via self-efficacy, psychological resilience, and depression, thereby providing theoretical support for adolescent mental health interventions. Methods The Children's Depression Inventory (CDI), the Childhood Trauma Questionnaire (CTQ), the Connor-Davidson Resilience Scale (CD-RISC), the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire (ANSAQ), and the General Self-Efficacy Scale (GSES) were used to assess 201 adolescents aged 10–19 years with depressive disorders who attended a psychiatric hospital in Zhejiang Province from September 2024 to March 2025. After excluding outliers (calculated using Mahalanobis distance), data analysis was conducted on 200 patients. Results Childhood trauma was positively associated with NSSI and depression, and inversely linked to adolescents' self-efficacy and psychological resilience. NSSI was positively associated with depression. Childhood trauma exerted a chained mediating effect on NSSI via self-efficacy, psychological resilience, and depression. Conclusion Childhood trauma exerted a serial mediating effect on NSSI through self-efficacy, psychological resilience, and depression, implicating these three factors as key conduits in the childhood trauma to NSSI pathway. These findings highlight the key role of psychosocial mechanisms in NSSI etiology and suggest that interventions for adolescents with childhood trauma should prioritize enhancing self-efficacy and resilience while concurrently managing depressive symptoms, thereby disrupting the cascading trajectory from trauma to self-injury. Health sciences/Diseases Health sciences/Health care Biological sciences/Psychology Social science/Psychology Health sciences/Risk factors childhood trauma adolescents self-efficacy psychological resilience depression non-suicidal self-injury (NSSI) Figures Figure 1 Figure 2 Figure 3 1. Introduction A growing psychosocial phenomenon in children and adolescents is non-suicidal self-injury (NSSI). It is described as intentionally harming oneself physically with no intention to die, with no suicidal intent, and with no seeking social sanction (Lloyd-Richardson et al., 2007 ; Nock, 2009 ). Suicidal acts, socially acceptable behaviors like tattooing, piercings, or religious rites, and unintentional or indirect self-harm (such as through food disorders or substance misuse) are not included in this definition. Cutting, scratching, pounding or bashing, pinching, biting, carving, and scraping are the most popular techniques (Nock, 2009 ; Zetterqvist, 2015 ).In 2013, NSSI was classified under Section 3 of the DSM-5 diagnostic categories (Plener et al., 2014 ). This behavior has been separated from its role as a secondary symptom of traditional mental disorders and designated as an independent clinical phenomenon requiring further research. This provides a clear diagnostic framework for academic focus on related studies within the child and adolescent population (De Leo, 2011 ; Plener et al., 2014 ; Wilkinson & Goodyer, 2011 ). NSSI is particularly prevalent during mid-adolescence (Plener et al., 2015 ). Its prevalence ranged from 11.5% to 33.8% in emerging nations, and worldwide rates are trending upward. (Mannekote Thippaiah et al., 2021 ). One meta-analysis reported adolescent NSSI was found to be as much as 17.2% (Swannell et al., 2014 ). Researchers (Liu et al., 2020 ) found that 26.9% of the subjects had reported engaging in NSSI within the last year in a survey of several Chinese adolescents. Research on NSSI in the general population shows that it has a high prevalence in adolescents, accounting for a lifetime prevalence of approximately 18% worldwide (Muehlenkamp et al., 2012 ). This underscores how important it is to address NSSI in order to preserve adolescent mental health. The rising incidence of this behavior in adolescents has drawn widespread attention as a global public health issue. The distinctiveness of this behavior lies in the fact that, although the perpetrators do not intend to end their lives, repeated physical injury has a direct impact on the physical and mental health of adolescents. Numerous empirical studies show that NSSI considerably raises the likelihood of suicide conduct in addition to increasing the likelihood of mental illness since this group is at a vital period of development in mind and body (Aboussouan et al., 2019 ; Wilkinson et al., 2011 ). Self-harming behaviors frequently indicate that their psychological state requires particular attention. As society places a greater emphasis on mental health for adolescents, NSSI has become a priority for psychological services, education, and families. Understanding its characteristics and current prevalence is fundamental to creating meaningful research and therapeutic initiatives. Childhood trauma, as an environmental factor associated with distal stressors, is widely recognized as promoting the progression of depression (Heim et al., 2008 ). Substantial empirical research shows a direct correlation between childhood trauma and NSSI behavior: more severe childhood trauma is linked to higher cognitive impairment and a greater chance of NSSI (Tatnell et al., 2017 ). The broad definition of childhood trauma was established by the World Health Organization's consultation on preventing child maltreatment: child maltreatment includes diverse types of physical abuse, neglect, and exploitative commercial activities that cause real or possible harm to children's health, survivability, and psychological growth (Zheng et al., 2022 ). Childhood trauma is like a buried wound within an individual, yet it exerts enduring and pronounced effects on both present and future adversities (Berber Çelik & Odacı, 2020 ). From a prevalence perspective, childhood trauma exhibits a high incidence rate across populations, with global exposure rates among children and adolescents ranging from 26.3% to 76.2%, reflecting significant regional and cultural variations (Kessler et al., 2010 ). A German study indicates that about 65% of people who harm themselves had gone through not less than one type of childhood trauma, and around 50% had endured diverse forms of childhood trauma (Brown et al., 2018 ). It is noteworthy that childhood trauma exhibits covert characteristics, with most instances of emotional neglect and implicit abuse proving difficult to identify promptly, leading to a persistent underestimation of its harm. Mechanistically, traumatic experiences such as abuse and neglect during childhood disrupt the individual's early psychological developmental environment and interfere with the functioning of emotional regulation systems, raising the possibility that subsequent NSSI (Serafini et al., 2017 ). Studies on adolescent populations have repeatedly validated this positive predictive relationship. Empirical research indicates that childhood trauma is not only significantly linked to internalizing problems like anxiety and depression in adolescence (Wei & Lü, 2023 ), but also increases the risk of externalizing issues like substance abuse and impulsive behavior. Long-term damage to individuals' interpersonal relationships, career development, and physical and emotional well-being can result from this effect, which can persist into adulthood (Felitti et al., 1998 ). Moreover, childhood trauma diminishes an individual's psychological resilience reserves, making it harder for them to handle stress in the future and thereby becoming an important trigger for multiple mental health issues. Depression, as a prevalent affective disorder, plays a pivotal mediating role between NSSI and childhood trauma. NSSI exhibits a significant association with depression in certain respects. On the one hand, adolescents experiencing depressive states often encounter difficulties in emotional regulation and suffer from low self-worth; NSSI can release pressure or negative emotions, inducing positive sensory experiences (Shao et al., 2021 ). Thus, adolescents may employ NSSI to alleviate emotional distress. Conversely, NSSI may exacerbate depressive symptoms. Factors influencing an individual's NSSI include personality traits, sleep disorders, and emotional regulation. Consequently, those who participate in NSSI are highly susceptible to a variety of emotional disorders (Zhang & Zhang, 2023 ), triggering negative self-evaluation of their behavior, social avoidance, and other issues, thereby becoming trapped in a vicious cycle of “self-injury-depression.” Beyond this, an important predictor for the development of childhood depression is trauma (Rogerson et al., 2023 ). Childhood adverse events relate to increased vulnerability to multiple issues of the mind and body (Antoniou et al., 2023 ). Adverse environments can lead to heightened negative emotions, cognitive distortions, and diminished social connections among adolescents. Concurrently, research indicates that adolescents represent a high-risk group for emotional dysregulation (Tang et al., 2024 ). Attachment theory posits (Choate & Tortorelli, 2022 ) that childhood constitutes a critical stage for establishing security and developing psychological functioning. Stable caregiving relationships and secure environments form essential foundations for psychological maturation. Consequently, adolescents must form and maintain interpersonal relationships, deriving feelings of security, acceptance, and belonging from these connections (Mathes et al., 2020 ). Childhood trauma impedes the formation of a person's self-concept, social support systems, and emotional regulation abilities and disrupts the establishment of secure attachment. It not only heightens sensitivity to stress responses but may also increase susceptibility to depressive disorders by affecting neurophysiological mechanisms. Furthermore, it is closely associated with elevated risks of multiple mental and physical health problems. We therefore hypothesize that childhood trauma influences an individual's depressive mood through certain pathways, thereby affecting their NSSI. The connection of childhood trauma with NSSI is influenced through an individual's intrinsic psychological resources for coping with adversity beyond the mediating pathway of depression, with psychological resilience playing a particularly crucial protective role. As a key psychological resource for coping with adversity, psychological resilience exhibits a distinct “resource depletion” orientation in its relationship with childhood trauma. Building upon the extended perspective of resource conservation theory (Hobfoll, 1989 ), childhood trauma essentially constitutes a process of depletion within an individual's core psychological resources, and psychological resilience is directly harmed by this depletion of resources. A series of research studies (Anyan & Hjemdal, 2016 ; Min et al., 2015 ) had indicated that elevated levels of negative affect are significantly predicted by low psychological resilience. Numerous investigations have examined psychological resilience as a protector against depression and a mediation or moderator between childhood trauma and depression (Wingo et al., 2010 ). Moreover, emotional neglect during childhood indirectly impacts the “perceived social support” dimension of resilience—individuals deprived of stable caregivers in traumatic environments often struggle to establish trust in others. This hinders their ability to effectively activate external support resources when facing stress, further exacerbating psychological vulnerability (Koçtürk et al., 2021 ; Qin et al., 2021 ). According to a longitudinal study, the earlier the age of childhood trauma occurring and the longer its duration, the stronger its negative predictive effect on psychological resilience in adulthood. And this influence is particularly pronounced among those who suffered compound trauma (Wang et al., 2024 ). Concurrently, psychological resilience exerts a clear protective effect against NSSI: high resilience enables individuals to manage stress through more effective emotional regulation strategies and positive cognitive appraisals, thereby decreasing the possibility of using self-injury as an adaptive strategy for unpleasant feelings. Conversely, low psychological resilience significantly elevates the probability of NSSI occurrence (Huang et al., 2024 ; Weedage et al., 2025 ).When negative emotions accumulate beyond an individual's psychological tolerance threshold, and adaptive coping strategies lacking resilience support are absent, NSSI may emerge as an alternative means for individuals to alleviate emotional distress (Mettler et al., 2021 ). While existing research has preliminarily revealed associative clues between childhood trauma, psychological resilience, and NSSI, more detailed empirical exploration is required regarding the matching patterns between various forms of childhood trauma and specific dimensions of psychological resilience, and also how such matching patterns influence the risk of NSSI occurrence. Similarly, self-efficacy as a protective resource and an individualized core perception of their personal capabilities can impact the link between childhood trauma and NSSI. Self-efficacy denotes an individual's estimation and judgement of one's capacity to accomplish a particular activity, serving as a key psychological variable for understanding behavioral motivation and adversity coping (Bandura, 1977 ). Regarding the association of NSSI and self-efficacy, self-efficacy in resisting NSSI is able to mitigate negative expectations associated with NSSI in protective or high-risk situations (Dawkins et al., 2022 ). Grounded in social cognitive theory (Zare et al., 2023 ), self-efficacy interacts with result expectancy, social supports, self-regulation, and behavioral intentions to influence the possibility of taking behaviors like these. Relevant research has indicated that people with low self-efficacy struggle to control behavioral expectations of alleviating negative emotions through self-injury (Dawkins et al., 2022 ). When facing psychological stress, their lack of confidence in emotional regulation makes them more prone to seek temporary emotional release via NSSI; conversely, high self-efficacy effectively counteracts this negative behavioral expectation (Dawkins et al., 2021 ). This series of mechanisms demonstrates that levels of self-efficacy directly influence an individual's behavioral tendencies in coping with psychological distress, constituting a significant internal factor in predicting NSSI (Hon et al., 2025 ). Concurrently, according to social cognitive theory, the formation of self-efficacy relies on success experiences and positive feedback during early life, whereas childhood trauma disrupts this positive developmental trajectory (Haj-Yahia et al., 2021 ). Traumatic experiences like childhood abuse or neglect significantly diminish a person's psychological regulation-related efficacy or directly undermine their early psychological developmental environment (Wang et al., 2025 ), thereby weakening positive cognitions about their capabilities and the formation of beliefs. Such negative cognition indirectly elevates the risk of NSSI by increasing emotional impulsivity. Thus, through the mediating pathway of self-efficacy, childhood trauma may indirectly influence NSSI (Liu et al., 2018 ; Oakes et al., 2025 ). Based on the above, this study focuses on the rising incidence of NSSI among adolescents and its potential harm to physical and mental health. Childhood trauma, as a common distal stressor, may exert enduring effects on psychological development due to its high incidence and covert nature. Building upon existing research, this study proposes the core hypothesis that childhood trauma may influence adolescent NSSI via the mediating pathway of depression. Furthermore, psychological resilience and self-efficacy, as key psychological assets, may play corresponding roles in the relationship between childhood trauma and NSSI. Addressing the high prevalence and potential risks of NSSI, this study clarifies research hypotheses and maps associative pathways among relevant factors. It provides a clear direction for subsequent empirical research while laying a theoretical foundation for exploring the etiology and intervention strategies for adolescent NSSI. This holds significant value for safeguarding adolescent mental health. 2. Methods 2.1 Participants Adolescents suffering depressive disorders, aged 10 to 19, who visited a mental health facility in Zhejiang Province between September 2024 and March 2025 were selected for this study using convenience sampling. 201 questionnaires were distributed. According to the G*power software calculations, the collected sample size is sufficient for detecting a medium effect size ( f 2 = 0.15) with 0.8 statistical power (Kang, 2021 ). Subsequent to the calculation of the Mahalanobis distance, one invalid questionnaire was excluded, leaving 200 valid responses. Among these, 80 were male, and 120 were female. The distribution of education level is as follows: The population is composed of 59 individuals at the primary education level, 92 at the junior secondary level, and 49 at the senior secondary level. The mean age of the study subjects was 13.73 years, with a standard deviation of 2.25. Inclusion criteria: 1. Diagnosed by two psychiatrists at the consultant level or above, fulfilling the International Classification of Diseases, 10th Revision (ICD-10) criteria for depressive disorders; 2. Adolescents ranged from 10 to 19 years according to the World Health Organization. 3. Voluntary consent from both the participant and their guardian to take part in this study, evidenced by signed informed permission papers; 4. Possession of the capacity to independently comprehend and complete questionnaires; 5. Scale assessments were administered on the day of the visit for outpatients and within one week of admission for inpatients. Exclusion criteria: 1. Previous or current diagnoses of schizophrenia, bipolar affective disorder, and other psychiatric disorders according to ICD-10; 2. Presence of intellectual impairment (e.g., Wechsler Adult Intelligence Scale IQ < 70), cognitive impairment, or psychological developmental delay; 3. Recent major traumatic or stressful events; 4. Language comprehension difficulties or cultural background differences rendering non-compliance with study procedures. The Bengbu Medical University Ethics Committee accepted this study (Approval No. bydc2023019), and prior to participation, every participant and their guardians-in-law provided written informed permission. This study confirms that all methods were performed in accordance with the relevant guidelines and regulations. 2.2 Measurements 2.2.1 General Information Questionnaire The study employed a privately generated general information questionnaire. This tool collected adolescents' personal background data. The data covered age, gender, and school year. 2.2.2 Children's Depression Inventory (CDI) The popular self-assessment tool for evaluating depression symptoms in kids and teenagers is the Children's Depression Inventory (CDI). And it is appropriate for kids and teenagers between the ages of 7 and 17. Its language, context, and presentation style of the items align with the cognitive and emotional experiences of this age group, demonstrating greater ecological validity than adult-oriented scales. It was developed by Maria Kovacs in 1981 based on the Beck Depression Inventory (BDI) (Kovacs, 1985 ). The scale comprises 27 items, each with three options corresponding to 0, 1, or 2 points, yielding an overall score range of 0–54 points. This measures symptom severity (from absent to severe). This study's Cronbach's α coefficient was 0.86. 2.2.3 Childhood Trauma Questionnaire (CTQ) Seven of the 28 items on the Childhood Trauma Questionnaire (CTQ) utilized in this study require reverse scoring. Zhao Xingfu et al. updated the scale and translated it into Chinese (Zhao Xingfu, 2005). It uses a 5-point rating system, with 1 representing "Never" and 5 representing "Always." Higher scores suggest that the person was subjected to more severe maltreatment as a youngster. "Emotional maltreatment," "physical maltreatment," "sexual maltreatment," "emotional neglect," and "physical neglect" are the five dimensions of the scale. This framework enables researchers to distinguish between different types of traumatic experiences and explore their unique or shared pathways of impact, thereby facilitating subsequent mechanism-based studies. The entire scale range is 25 to 125 points, with each dimension scoring between 5 and 25 points. The whole scale's Cronbach's α coefficient from this study was 0.85. 2.2.4 Connor-Davidson Resilience Scale (CD-RISC) It has three aspects of "tenacity," "self-strengthening,” and "optimism," which are among the scale's twenty-five items. The scale was the Chinese version of the Connor-Davidson Resilience Scale, as modified by Yu Xiaonan and Zhang Jianxin (Xiaonan & Jianxin, 2007 ). Scoring utilized a scale of 1 (“very disagree”) to 5 (“very agree”). The greater the overall score, the more psychologically resilient the person. The scale showed excellent reliability, with a Cronbach's alpha coefficient of 0.95. 2.2.5 Adolescent Non-Suicidal Self-Injury Assessment Questionnaire (ANSAQ) Based on the characteristics of Chinese teenagers, Wan Yuhui et al. created the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire (ANSAQ) used in the study (Yuhui et al., 2018 ). It is intended to assess deliberate physical harm that is not driven by suicidal intent over the course of a year. It is made up of two subscales, behavioral and functional, serving not only as a behavioral screening tool but also as a mechanism exploration tool, making it highly suitable for investigating the complex etiology and impact pathways of NSSI. The score range for this scale is 0 to 48. On a 5-point scale that goes from 0 ("never") to 4 ("always"), a higher frequency of self-harm is represented by greater scores. The Functional Questionnaire scores between 0 and 76 points. The degree of congruence between the item content and the respondent's own motivation was evaluated using a five-point rating system, with scores ranging from 0 ("does not meet at all") to 4 ("fully meets"). Stronger motivation is indicated by a higher score. Cronbach's α = 0.94 showed that the entire scale has acceptable internal consistency dependability. 2.2.6 General Self-Efficacy Scale (GSES) To assess individuals' overall confidence in coping with broad situational challenges, this study employed the unidimensional General Self-Efficacy Scale. Previous studies have indicated that this scale exhibits good reliability and validity when applied in the local context (Wang Caikang, 2001). It comprises ten items. Scoring employs a four-point scale ranging from 1 (‘entirely untrue’) to 4 (‘entirely truthful’), yielding an overall score between ten and forty points. Greater scores indicate higher levels of general self-efficacy. In this study, the Cronbach's α coefficient for this scale was 0.89. 2.3 Procedure In the study, an anonymous questionnaire survey was conducted among 200 adolescents suffering depressive disorders who met the inclusion criteria. The questionnaires were completed independently by both outpatient and inpatient adolescent patients with depressive disorders, with strict confidentiality maintained regarding their personal information. Each questionnaire took approximately 10–20 minutes to complete. A total of 201 questionnaires were distributed. Following the survey, researchers promptly collated the responses, achieving a valid recovery rate of 99.5% with 200 usable questionnaires returned, as illustrated in Fig. 1 . Insert Fig. 1 here 2.4 Data Analysis Perform a systematic process of the data using SPSS 29.0, and scale scores and general demographic factors were described using descriptive statistics. Subsequently, to assess the potential influence of demographic variables, one-way ANOVAs and independent samples t-tests were conducted to compare variations in core scale scores between adolescents of various education levels and genders. Through correlation analysis, pairwise preliminary relationship tests were used among childhood trauma, psychological resilience, depression, and NSSI. To further elucidate the intricate interrelationships among variables, a multiple mediation model was constructed, building upon the established foundation. Employing regression analysis techniques, we systematically examined whether psychological resilience, depression, and self-efficacy mediated the connection between childhood trauma and NSSI. To provide further validation of the robustness of the mediating effect and test the mediation model, confidence intervals for each indirect effect were calculated using model 80 in the PROCESS and the bootstrap technique, thereby enabling statistical inference regarding the significance of the mediating pathway. 3. Results 3.1 Common method bias Include all measurement items of variables in exploratory factor analysis and check for the potential impact of common method bias on data quality using Harman's single-factor experiment. Results revealed that 30 factors had eigenvalues exceeding 1, with maximum factor variance explained amounting to 18.80%. The research data has not been severely affected by common method bias because it is below the 40% crucial level. 3.2 Scores for childhood trauma, self-efficacy, psychological resilience, depression, and NSSI in adolescents suffering depressive disorders The results showed that childhood trauma scores ranged from a maximum of 89 to a minimum of 25 ( M = 51.21, SD = 10.52); self-efficacy scores ranged from a maximum of 40 to a minimum of 10 ( M = 20.27, SD = 5.38); and psychological resilience ranged from a maximum of 117 to a minimum of 25 points ( M = 58.69, SD = 16.62). Depression scores varied between a maximum of 1 and a minimum of 48 points ( M = 28.40, SD = 7.65); NSSI behavior scores varied between 0 and 47 points ( M = 9.80, SD = 9.21); and NSSI function scores varied from 0 to 64 points ( M = 23.14, SD = 13.41). Among these, the top five items with the highest mean scores for NSSI functions were “alleviate feelings of stress or anxiety,” “to avoid things one dislikes or finds unpleasant, such as skipping school, doing homework, or undertaking chores,” “expressing one's anger,” “make oneself feel less lonely,” and “a form of self-punishment or atonement.” As shown in Table 1. Significant differences in NSSI across gender and education levels ( P < 0.05) by independent samples t-tests and one-way ANOVAs were revealed statistically. Significant correlations between scores for NSSI behavior and depression scores across different education levels ( P < 0.05). Intergroup comparison results indicate that participants in the junior secondary school group scored higher than those in the primary school and senior secondary school groups ( P < 0.05). (see Table 2). Table 1 Statistics for NSSI Function Scores Entry M ± SD 16.Alleviate feelings of stress or anxiety. 1.70 ± 1.14 14.To avoid things one dislikes or finds unpleasant, such as skipping school, doing homework, or undertaking chores. 1.53 ± 1.33 13.Expressing one's anger. 1.46 ± 1.16 15.Make oneself feel less lonely. 1.42 ± 1.15 17.A form of self-punishment or atonement. 1.32 ± 1.24 The five items with the highest average scores in the NSSI Functional Questionnaire of the ANSAQ (Adolescent Non-Suicidal Self-Injury Assessment Questionnaire). Table 2 Scores for Each Variable and Differences Across Demographic Variables Variable NSSI behavior NSSI function GSES CD-RISC CDI CTQ Score(M ± SD) 9.80 ± 9.21 23.14 ± 13.41 20.27 ± 5.38 58.69 ± 16.62 28.40 ± 7.65 51.21 ± 10.52 Gender Male ( n = 80) 6.78 ± 5.64 20.54 ± 12.50 20.33 ± 5.21 59.65 ± 18.33 28.15 ± 7.30 50.94 ± 10.45 Female( n = 120) 11.82 ± 10.51 24.88 ± 13.77 20.23 ± 5.52 58.05 ± 15.42 28.57 ± 7.90 51.38 ± 10.60 t 4.390 2.264 -0.118 -0.666 0.376 0.293 P < 0.001 0.025 0.906 0.506 0.707 0.770 Level of education primary school① 59(29.5) 7.88 ± 5.89 21.49 ± 11.40 21.37 ± 6.27 60.10 ± 18.57 26.32 ± 8.20 49.58 ± 8.40 junior secondary school② 92(46.0) 11.53 ± 11.27 23.97 ± 14.29 19.51 ± 5.18 56.18 ± 16.20 29.43 ± 7.83 52.04 ± 12.64 senior secondary school③ 49(24.5) 8.86 ± 7.60 23.57 ± 14.03 20.37 ± 4.38 61.69 ± 14.40 28.96 ± 6.12 51.59 ± 8.13 F 3.234 0.644 2.187 2.081 3.218 1.033 P 0.041 0.526 0.115 0.128 0.042 0.358 Multiple comparisons ②>③>① ②>③>① NSSI behavior, ANSAQ Behavior Subscale; NSSI function, ANSAQ Function Subscale; GSES, General Self-Efficacy Scale; CD-RISC, Connor-Davidson Resilience Scale; CDI, Children's Depression Inventory; CTQ, Childhood Trauma Questionnaire. Insert Table 1 and Fig. 2 here 3.3. Correlation Analysis Between Gender, Education Level, NSSI, Psychological Resilience, Depression, Childhood Trauma, and Self-Efficacy As shown in Table 2, childhood trauma exhibited positive correlations with NSSI and depression ( P < 0.01), whilst demonstrating negative correlations with self-efficacy, psychological resilience, and their respective factors ( P < 0.01). NSSI showed a positive correlation with depression ( P < 0.01) and no significant correlation with psychological resilience or self-efficacy. Rather, there was a substantial connection between NSSI and the optimism factor of psychological resilience ( P < 0.05). Depression showed a negative correlation with self-efficacy, psychological resilience, and all sub-factors ( P < 0.01), while self-efficacy exhibited positive correlations with psychological resilience and all its sub-factors ( P < 0.01). Insert Table 2 here 3.4. The Effect of Childhood Trauma on NSSI: A Chain Mediation Analysis of Self-Efficacy, Psychological Resilience, and Depression Figure 3 presents a mediation effect analysis that was performed on standardized data using childhood trauma as the independent variable, NSSI as the dependent variable, self-efficacy, psychological resilience, and depression as mediating factors, and gender and education level as covariates. Childhood trauma was found to be a substantial and positive predictor of depression ( β = 0.234, t = 4.442, P < 0.001) and NSSI ( β = 0.495, t = 9.416, P < 0.001). Additionally, it substantially and adversely predicted psychological resilience ( β = 0.346, t = 5.160, P < 0.001) and self-efficacy ( β = -0.372, t = 5.615, P < 0.001). When self-efficacy was the mediating variable, depression was negatively predicted by self-efficacy ( β = -0.443, t = 5.191, P < 0.001); when psychological resilience was the mediating variable, depression was negatively predicted by psychological resilience ( β = -0.185, t = 2.191, P < 0.05); in the path with self-efficacy, psychological resilience, and depression as mediating variables, self-efficacy ( β = 0.173, t = 1.993, P < 0.05), psychological resilience ( β = 0.341, t = 4.195, P < 0.001), and depression ( β = 0.576, t = 8.444, P < 0.001) all positively predicted NSSI. See Table 4 and Fig. 1 for details. Table 4 Chain Mediation Effects Between NSSI and Childhood Trauma Effect SE LLCI ULCI Relative Effect Proportion Direct effect 0.495 0.053 0.391 0.598 85.49% Childhood Trauma → Self-Efficacy → NSSI -0.064 0.046 -0.162 0.019 Childhood Trauma → Psychological Resilience → NSSI -0.118 0.043 -0.211 -0.043 20.38% Childhood Trauma → Depression → NSSI 0.135 0.033 0.071 0.201 23.32% Childhood Trauma → Self-Efficacy → Depression → NSSI 0.095 0.033 0.040 0.167 16.41% Childhood Trauma → Psychological Resilience → Depression → NSSI 0.037 0.021 0.003 0.085 6.39% Total indirect effect 0.085 0.040 0.004 0.159 14.68% Total effect 0.579 0.055 0.471 0.688 The various pathways from childhood trauma to NSSI are presented in Table 4. Childhood trauma itself is a very strong direct predictor of NSSI in adolescents. The direct impact of childhood trauma on NSSI had an impact value of 0.495 ( SE = 0.053, 95% CI [0.391, 0.598]). In the simple mediation path, the independent mediated effect of self-efficacy was not statistically significant with an impact value of -0.064 ( SE = 0.046, 95% CI [-0.162, 0.019]); the independent mediated effect of psychological resilience with an impact value of -0.118 ( SE = 0.043, 95% CI [-0.211, -0.043]); the independent mediated effect of depression with an impact value of 0.135 ( SE = 0.033, 95% CI [0.071, 0.201]). As per Wen and Ye's mediation effect testing protocol (Zhonglin & Baojuan, 2014), when both direct and indirect effects are significant but exhibit opposite signs, a masking effect is interpreted. Consequently, psychological resilience exhibits a masking effect in its independent mediated pathway. With an impact value of 0.095 ( SE = 0.033, 95% CI [0.040, 0.167]), the combined mediated effect of depression and self-efficacy in the chained mediation route connecting childhood trauma to NSSI. The combined mediated impact of psychological resilience and depression in the chained mediation route connecting childhood trauma to NSSI, with an effect value of 0.037 ( SE = 0.021, 95% CI [0.003, 0.085]). Insert Fig. 3, Table 3, and Table 4 here Table 3 Mediating Effects of Self-Efficacy, Psychological Resilience and Depression on the Relationship Between NSSI and Childhood Trauma Regression equation Integration fit index Significance of regression coefficients Result variables Prediction variables R R 2 F β t NSSI Childhood Trauma 0.640 0.409 45.219 0.579 10.517*** NSSI Childhood Trauma 0.767 0.589 46.003 0.495 9.416*** Self-Efficacy 0.173 1.993* Psychological Resilience 0.341 4.195*** Depression 0.576 8.444*** Self-Efficacy Childhood Trauma 0.379 0.144 10.966 -0.372 -5.615*** Psychological Resilience Childhood Trauma 0.349 0.122 9.088 -0.346 -5.160*** Depression Childhood Trauma 0.737 0.543 46.019 0.234 4.442*** Self-Efficacy -0.443 -5.191*** Psychological Resilience -0.185 -2.191* Note. * P < 0.05 *** P < 0.001. 4. Discussion 4.1 Demographic Differences in NSSI among Adolescent Patients with Depressive Disorders Significant gender disparities in adolescent NSSI were found using independent samples t-tests. Female participants in this study exhibited significantly higher NSSI scores (11.82 ± 10.51, P < 0.001) than males (6.78 ± 5.64, P < 0.001). This may stem from heightened negative affect levels and earlier peak emotional reactivity in females during early puberty due to hormonal shifts, coupled with a greater tendency to employ NSSI as a primary emotion-regulation strategy. Males, conversely, less frequently utilize this approach to address emotional distress (Guo et al., 2025 ), indicating adolescent females are more prone to regulating emotions or expressing distress through self-injury. When stratifying by education levels, junior secondary students exhibited the highest scores for both NSSI and depression. This implies that junior secondary might be a crucial time for the emergence of depression and NSSI among adolescents. This pattern likely correlates with the psychological developmental tasks, academic pressures, familial influences, peer relationship changes, and insufficient emotional regulation capabilities encountered during this stage (Qu et al., 2023 ). 4.2 Correlation Analysis on Adolescent NSSI, Depression, and Childhood Trauma Adolescent NSSI and childhood trauma indicated that they were strongly positively correlated. Childhood trauma of any kind was more common among individuals who had NSSI than among those who had not NSSI (Bahali et al., 2024 ). Even when trauma types differed, childhood trauma retained a unique role in adolescent NSSI (Thomassin et al., 2016 ). This suggests childhood trauma may increase adolescent risk of NSSI through mechanisms affecting emotional regulation, self-perception, and coping strategies. Emotional abuse (EA) is more common than other types of childhood trauma among NSSI populations (Brown et al., 2018 ). In order to maintain control, some family members may use verbal abuse, humiliation, belittling, excessive blaming, unreasonable demands, or even showing apathy and ignoring the child's emotional needs (Xie et al., 2024 ). This form of trauma inflicts enduring damage to children's self-esteem and may distort their self-perception. Research indicates that high cognitive fusion and experiential avoidance may play a significant part in NSSI individuals' continued self-harming behavior (Hu et al., 2021 ). Similarly, depression and NSSI are significantly correlated. When confronted with depression-related negative emotions and numbness, individuals typically exhibit NSSI (Marshall et al., 2013 ), while those engaging in NSSI are inclined to develop depression. Adolescents with depression experience greater difficulty in accurately identifying emotions, exhibit impaired expression of affect, and display features like inflexible thinking and poor imaging (Zhang et al., 2023 ), making them more prone to NSSI. Adolescent NSSI and depression are significantly correlated in both directions, according to research by Tilton-Weaver et al. (Tilton-Weaver & Schwartz-Mette, 2025 ). NSSI acts as an initial trigger, subsequently exacerbating depressive symptoms through emotional dysregulation and negative reinforcement mechanisms, ultimately forming a vicious cycle. Self-efficacy and psychological resilience exhibited complex interactions within the model. Correlation analysis revealed that self-efficacy and psychological resilience showed non-significant negative correlations with NSSI. However, after incorporating all variables into the regression model, the predictive effects of self-efficacy and psychological resilience on NSSI became significant. This may be because correlation analysis represents simple bivariate relationships, whereas multiple regression analysis reveals the true connection between self-efficacy and psychological resilience with NSSI after controlling for childhood trauma and depression. Following this control, the predictive roles of self-efficacy and psychological resilience became apparent. Consequently, we employed the bootstrap method to directly test the mediating effects. 4.3 Functional Aspects of Adolescent NSSI The results of this study demonstrate that alleviating distress or anxiety is the main purpose of adolescent NSSI, suggesting that self-harm is widely perceived within this sample as serving a distress-relieving function, consistent with prior research (Klonsky, 2007 ). The function of NSSI is to regulate upsetting or unpleasant thoughts or feelings through escaping, avoiding, substituting, or directly modifying these conditions (Taylor et al., 2018 ). For adolescents, particularly those in junior secondary school groups, self-injury serves as a functional behavior to achieve temporary relief when academic or familial pressures lack viable outlets. Emotional instability, impulsivity, and lack of self-control may influence adolescent NSSI (Norouzi, 2025 ). This study suggests adolescents employ NSSI to express anger and evade undesirable situations, falling within the category of automatic negative reinforcement (Brown & Plener, 2017 )—a concept within the four-factor model (Nock & Prinstein, 2004 ). Research indicates that loneliness diminishes following NSSI episodes (Nock et al., 2009 ), suggesting self-harm functions not only as an internal emotional regulator but also as an outward signal conveying psychological distress requiring attention. 4.4 Analysis of the Mediating Effects of Self-Efficacy, Psychological Resilience, and Depression The results reveal that childhood trauma exerts a strong direct effect on NSSI, representing 85.49% of the overall effect, confirming childhood trauma is a predictor for adolescents developing NSSI. Self-efficacy, psychological resilience, and depression have a chain-mediated impact between childhood trauma and NSSI, according to mediational analysis. In addition to being a favorable predictor of NSSI, childhood trauma has an indirect impact on it through self-efficacy, psychological resilience, and depression. This indirect influence operates via five pathways. The first pathway, mediated by self-efficacy, yielded non-significant effects, whereas childhood trauma exhibited significant effects through the chain-mediated pathway formed by “self-efficacy → depression.” This indicates that self-efficacy primarily influences NSSI by affecting depression in this study. Childhood trauma predisposes adolescents to internalize negative self-beliefs like “I'm incapable” or “I'm unworthy” (Konanur & Muller, 2024 ), thereby diminishing their sense of self-efficacy. Self-efficacy directly contributes to depression or indirectly by its influence on academic achievement, prosocial behavior, and problem behavior (Bandura et al., 1999 ), subsequently increasing NSSI. The third pathway, mediated by depression, accounts for the largest proportion of relative effects among the four pathways. Existing research indicates that childhood trauma correlates with alterations in HPA axis function, which highly overlap with the neurobiological features of depression (Heim et al., 2008 ). Childhood trauma shapes negative self-perceptions and emotionally unstable personality traits, directly increasing susceptibility to depression (Birch et al., 2021 ). The risk of NSSI escalates with worsening depressive symptoms (Xingfang et al., 2022 ). Thus, childhood trauma may render individuals more vulnerable to depression and NSSI during adolescence by influencing brain development and fostering maladaptive coping patterns. A masking effect emerged in the pathway using psychological resilience as a mediating variable. On one hand, childhood trauma directly and positively predicted NSSI. On the other hand, childhood trauma negatively impacted psychological resilience, while psychological resilience positively influenced NSSI, thereby forming an indirect pathway opposite to the direct effect. The actual impact of childhood trauma on NSSI is obscured through this reverse indirect path. The contradictory effect of psychological resilience on NSSI may stem from the study's inclusion of participants with diagnosed depressive disorders; the specificity of this sample likely accounts for the unique manifestation of psychological resilience's influence. George A. Bonanno's theory posits that psychological flexibility forms the bedrock of resilience (Bonanno et al., 2024 ), with the essence of resilience lying in selecting the most appropriate coping strategy for a given situation. Under societal pressure, individuals may suppress or conceal genuine distress to meet expectations of resilience. This “putting on a brave face” constitutes neither authentic resilience nor genuine emotional processing and healing, potentially hindering genuine emotional processing and healing and leading to more severe psychological or physiological issues. In this study, the high psychological resilience exhibited by adolescents with depressive disorders may represent a rigid, pseudo-resilience formed under prolonged stress, centered on emotional suppression and avoidance. Due to its lack of flexibility and tendency to deplete psychological resources, it may paradoxically increase NSSI. This suggests that future interventions should address the paradoxical effects of psychological resilience on NSSI by designing differentiated programs. These should focus on cultivating resilience in problem-solving rather than promoting self-control and repair through emotional suppression. Finally, childhood trauma influences NSSI through a chain of mediation involving psychological resilience and depression. Psychological resilience serves as a crucial bridge linking childhood trauma risk and depressive symptoms (Baiyu et al., 2025). Childhood trauma diminishes psychological resilience, exacerbates depressive levels, and consequently increases NSSI. Consequently, adolescent mental health interventions should prioritize screening for childhood trauma to identify high-risk individuals and enable early intervention. Building upon trauma resolution, efforts should focus on alleviating depressive symptoms while cultivating adaptive psychological resilience, thereby establishing a multi-tiered NSSI prevention framework. 4.5 Innovation This study investigated the mediated effects of self-efficacy, psychological resilience, and depression in the association between childhood trauma and NSSI among adolescents suffering depressive disorders through a chain mediation model. It elucidated how childhood trauma, self-efficacy, psychological resilience, and depression collectively influence NSSI, while also identifying the paradoxical impact of childhood trauma on NSSI via psychological resilience. Future research may further investigate the underlying mechanisms, offering novel perspectives for clinical interventions and treatment in adolescent mental health. 4.6 Limitations Firstly, the results may not be as representative of the adolescent community as they may seem because all participants of this study were selected from a single hospital. To improve the conclusions' generalizability, future studies should take samples from wider geographic regions. Secondly, the general information questionnaire's design was incomplete, failing to incorporate additional information such as household registration status, economic level, and parental marital status. These aspects should be supplemented and refined in subsequent studies. Thirdly, conclusive causal correlations cannot be proved because of the cross-sectional nature of this study. Longitudinal surveys may be employed in further studies to clarify causal linkages between variables. Lastly, the exclusive use of self-report measures may introduce assessment bias. 5. Conclusion In conclusion, childhood trauma has an indirect influence on NSSI through self-efficacy, psychological resilience, and depression, along with having a direct influence on NSSI among adolescents suffering depressive disorders. The association between childhood trauma and NSSI is mediated in a chain-like manner by self-efficacy, psychological resilience, and depression. This study aims to enhance adolescents' psychological health and offer guidance for developing intervention strategies targeting NSSI in young people. Declarations C OMPETING I NTERESTS STATEMENT The authors affirm that they have no conflicting interests. DATA AVAILABILITY STATEMENT If an appropriate request is received, the corresponding author will offer the datasets used and analyzed in the work. ETHICS APPROVAL AND CONSENT TO PARTICIPATE The Bengbu Medical University Human Research Ethics Committee thoroughly reviewed the full procedure before approving it (Project No. bydc2023019). Both the individual in question and the minor's legal guardian gave their informed approval for all data to be collected. CONSENT FOR PUBLICATION The participants gave their consent for publishing. AUTHOR CONTRIBUTIONS CJY, WYH, ZXY, JZQ, LYZ, and WKX drafted the manuscript. CJY analyzed the data and prepared the figures. ZRX compiled the references. WWJ and LL made key changes to the manuscript. The manuscript was reviewed and suggested by all authors. Role of funding sources This work was supported by the Provincial Education Department Natural Science Key Project (grant numbers: 2024AH051196), the 2023 Provincial Quality Engineering Project for Education in the New Era (grant number: 2023cxcysj160), the Innovative Training Program for Chinese College Students (grant number: 202510367034), the Anhui Province New Era Graduate Education Quality Engineering Project (grant numbers: 2024zyxwjxalk187, 2024shsjsfkc028), and the Bengbu Medical University Graduate Student Research Innovation Program Project (grant number: Byycxz24015). Acknowledgments We would like to extend our sincere gratitude to all of the participants who assisted us as well as the researchers who worked on the project. References Aboussouan, A., Snow, A., Cerel, J. & Tucker, R. P. Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans. J. Affect. 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Psychiatry . 168 (5), 495–501. https://doi.org/10.1176/appi.ajp.2010.10050718 (2011). Wingo, A. P. et al. Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure. J. Affect. Disord . 126 (3), 411–414. https://doi.org/10.1016/j.jad.2010.04.009 (2010). Xiaonan, Y. & Jianxin, Z. Comparison of the application of the self-resilience scale with the Connor-Davidson Resilience Scale. Psychol. Sci. (05), 1169–1171. https://doi.org/10.16719/j.cnki.1671-6981.2007.05.035 (2007). Xie, X. et al. The relationship between childhood maltreatment and non-suicidal self-injury in adolescents with depressive disorders. Psychiatry Res. 331 , 115638. https://doi.org/10.1016/j.psychres.2023.115638 (2024). Xingfang, C. et al. Research on the current situation of non-suicidal self-injury in adolescent depressive disorder and related influencing factors. Contemp. Nurses (mid-term) . 29 (10), 137–141. https://doi.org/10.19792/j.cnki.1006-6411.2022.29.039 (2022). Yuhui, W., Wan, L., Jiahu, H. & Fangbiao, T. The preparation of the evaluation questionnaire of adolescent non-suicidal self-injury behavior and its reliability and validity. School Health China . 39 (02), 170–173. https://doi.org/10.16835/j.cnki.1000-9817.2018.02.005 (2018). Zare, E., Kaveh, M. H., Karimi, M., Nazari, M. & Seif, M. The effect of a social cognitive theory-based educational intervention on nonsuicidal self-injury prevention in high school students: A randomized educational intervention trial. J. Adolesc. 95 (5), 1005–1016. https://doi.org/10.1002/jad.12171 (2023). Zetterqvist, M. The DSM-5 diagnosis of nonsuicidal self-injury disorder: a review of the empirical literature. Child. Adolesc. Psychiatry Ment Health . 9 , 31. https://doi.org/10.1186/s13034-015-0062-7 (2015). Zhang, B. et al. Relationship between alexithymia, loneliness, resilience and non-suicidal self-injury in adolescents with depression: a multi-center study. BMC Psychiatry . 23 (1), 445. https://doi.org/10.1186/s12888-023-04938-y (2023). Zhang, Y. & Zhang, L. Relationship among Aggression, Non-Suicidal Self-Injury, and Depression in Youths. Iran. J. Public. Health . 52 (8), 1711–1719. https://doi.org/10.18502/ijph.v52i8.13410 (2023). Zhao Xingfu, Z. Y., Li Longfei, Z., Yunfei, L., Hezhan, Y. & Shichang Reliability and validity of the Chinese version of the Childhood Abuse Questionnaire. Clinical rehabilitation in China (20), 105–107. (2005). https://kns.cnki.net/kcms2/article/abstract?v=lqoStndJ5wHBOgqWILvC05sItQhOS-b0_XVJNPnfILIpEQvV5MZPE0DdL9M4JmzW84ZBOTJmUNjm9U1kFpijsvVMpos5dOZHggN69aKNVxT9mUET0QwLJ2x2BprHY-3l_tk2g7DZ3ivfcu9GLDyFpPXvzNV5QPG1fSPZnfT_wofMkMRKQBOazA==&uniplatform=NZKPT&language=CHS Zheng, K. et al. Psychological resilience and daily stress mediate the effect of childhood trauma on depression. Child. Abuse Negl. 125 , 105485. https://doi.org/10.1016/j.chiabu.2022.105485 (2022). Zhonglin, W. & Baojuan, Y. Mediation Effects Analysis: Methodology and Model Development. Advances in Psychological Science , 22 (05), 731–745. (2014). https://kns.cnki.net/kcms2/article/abstract?v=lqoStndJ5wGGV8yFdpNR1pNWvkdu-HrrUwGzZDE0J3HXsmfPYjl9yn8d_p3VgBU2Iqn0eaNsaY9kH7fLSW1yfX4YLRXv48tde1zPE_O9UJ-qX4FMgZ6BgbyPG8nofN8VlKa0ZP62wLjNsHe5hi8UUp3vn-uA1SuFXC_ym720bZ7YNjmK3J5zEQ==&uniplatform=NZKPT&language=CHS Additional Declarations No competing interests reported. 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College","correspondingAuthor":false,"prefix":"","firstName":"Yihan","middleName":"","lastName":"Wang","suffix":""},{"id":591344006,"identity":"4e6009d1-280d-48cf-8be4-ce2ee39b00e8","order_by":2,"name":"Xinya Zhang","email":"","orcid":"","institution":"Bengbu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xinya","middleName":"","lastName":"Zhang","suffix":""},{"id":591344011,"identity":"ffd46d56-140e-464f-be76-e78b222611bc","order_by":3,"name":"Zhiqi Jiang","email":"","orcid":"","institution":"Bengbu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zhiqi","middleName":"","lastName":"Jiang","suffix":""},{"id":591344013,"identity":"cfbbcdeb-8d19-49ba-bbad-849bfb365ba4","order_by":4,"name":"Yunzhe Li","email":"","orcid":"","institution":"Bengbu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yunzhe","middleName":"","lastName":"Li","suffix":""},{"id":591344014,"identity":"7b45bed0-5aad-4728-8ca8-e488c9eab046","order_by":5,"name":"Kexin Wang","email":"","orcid":"","institution":"Bengbu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Kexin","middleName":"","lastName":"Wang","suffix":""},{"id":591344015,"identity":"21b2a1f7-a5c6-4939-9e57-8f6effc9a0f4","order_by":6,"name":"Ruoxi Zhang","email":"","orcid":"","institution":"Bengbu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Ruoxi","middleName":"","lastName":"Zhang","suffix":""},{"id":591344016,"identity":"0dfc1ca1-db26-4e86-8aba-5d148624f7fa","order_by":7,"name":"Wenjuan Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAqUlEQVRIiWNgGAWjYHCCBBAhx8befoA0LcZ8PGcSSLMqcZ6EgwFxSg1uJDxg5qm4k94mAbTuR8U2orQkMPOceZbbJt14gLHnzG3CWsxuA7Xkth3ObZM5kMDM2Ea0ln+H09kkEgxI0dJwOIF4Lfb3HyQc/nPssGEbMJAPEuUXyZ4ziQ9n1ByWl29vP/jgRwURWhgYeBIOwJgHcKtCAezEKhwFo2AUjIIRCwBoIz8ErrvV9QAAAABJRU5ErkJggg==","orcid":"","institution":"Bengbu Medical College","correspondingAuthor":true,"prefix":"","firstName":"Wenjuan","middleName":"","lastName":"Wang","suffix":""},{"id":591344017,"identity":"225c3095-6ba7-4510-a709-554fe2127529","order_by":8,"name":"Li Li","email":"","orcid":"","institution":"Bengbu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2026-01-26 07:53:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8697764/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8697764/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102894964,"identity":"1f888b83-b68c-49a6-91cc-7c02d6c63cc1","added_by":"auto","created_at":"2026-02-18 06:16:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":264476,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResearch flowchart\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 201 questionnaires were collected, of which 1 were invalid and the remaining 200 were valid.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8697764/v1/176effac70b158911973d5f4.png"},{"id":102894965,"identity":"61f6e5a0-a7c1-43b3-bfaf-ee456986b547","added_by":"auto","created_at":"2026-02-18 06:16:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":310351,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrelation analysis of variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTenacity, Self-strengthening and Optimism constitute the three sub-dimensions of the CD-RISC (Connor-Davidson Resilience Scale), while NSSI represents the score on the ANSAQ (Adolescent Non-Suicidal Self-Injury Assessment Questionnaire) NSSI behavior questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote. *P\u0026lt;\u003c/em\u003e0.05 **\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8697764/v1/882e4bf2c73460f354ea2542.png"},{"id":102894966,"identity":"1d53f3f4-4139-4039-b7f7-cc6997d8e59a","added_by":"auto","created_at":"2026-02-18 06:16:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":150435,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eChain mediation model illustrating the relationship between childhood trauma and NSSI, mediated by self-efficacy, psychological resilience, and depression.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote. \u003c/em\u003e***\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8697764/v1/011490b7298f791f33f60e56.png"},{"id":102964013,"identity":"82818537-0cf4-4449-ac0e-5c16a0523f30","added_by":"auto","created_at":"2026-02-19 04:21:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2238855,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8697764/v1/c17f0705-d780-4e25-9e75-c73ea5bd9300.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"From Early Trauma to Self-Harm: A Sequential Mediation Model of Self-Efficacy, Psychological Resilience, and Depression in Adolescents","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eA growing psychosocial phenomenon in children and adolescents is non-suicidal self-injury (NSSI). It is described as intentionally harming oneself physically with no intention to die, with no suicidal intent, and with no seeking social sanction (Lloyd-Richardson et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Nock, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Suicidal acts, socially acceptable behaviors like tattooing, piercings, or religious rites, and unintentional or indirect self-harm (such as through food disorders or substance misuse) are not included in this definition. Cutting, scratching, pounding or bashing, pinching, biting, carving, and scraping are the most popular techniques (Nock, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Zetterqvist, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).In 2013, NSSI was classified under Section \u003cspan refid=\"Sec13\" class=\"InternalRef\"\u003e3\u003c/span\u003e of the DSM-5 diagnostic categories (Plener et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This behavior has been separated from its role as a secondary symptom of traditional mental disorders and designated as an independent clinical phenomenon requiring further research. This provides a clear diagnostic framework for academic focus on related studies within the child and adolescent population (De Leo, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Plener et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Wilkinson \u0026amp; Goodyer, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). NSSI is particularly prevalent during mid-adolescence (Plener et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Its prevalence ranged from 11.5% to 33.8% in emerging nations, and worldwide rates are trending upward. (Mannekote Thippaiah et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). One meta-analysis reported adolescent NSSI was found to be as much as 17.2% (Swannell et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Researchers (Liu et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) found that 26.9% of the subjects had reported engaging in NSSI within the last year in a survey of several Chinese adolescents. Research on NSSI in the general population shows that it has a high prevalence in adolescents, accounting for a lifetime prevalence of approximately 18% worldwide (Muehlenkamp et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). This underscores how important it is to address NSSI in order to preserve adolescent mental health. The rising incidence of this behavior in adolescents has drawn widespread attention as a global public health issue. The distinctiveness of this behavior lies in the fact that, although the perpetrators do not intend to end their lives, repeated physical injury has a direct impact on the physical and mental health of adolescents. Numerous empirical studies show that NSSI considerably raises the likelihood of suicide conduct in addition to increasing the likelihood of mental illness since this group is at a vital period of development in mind and body (Aboussouan et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Wilkinson et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Self-harming behaviors frequently indicate that their psychological state requires particular attention. As society places a greater emphasis on mental health for adolescents, NSSI has become a priority for psychological services, education, and families. Understanding its characteristics and current prevalence is fundamental to creating meaningful research and therapeutic initiatives.\u003c/p\u003e \u003cp\u003eChildhood trauma, as an environmental factor associated with distal stressors, is widely recognized as promoting the progression of depression (Heim et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Substantial empirical research shows a direct correlation between childhood trauma and NSSI behavior: more severe childhood trauma is linked to higher cognitive impairment and a greater chance of NSSI (Tatnell et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The broad definition of childhood trauma was established by the World Health Organization's consultation on preventing child maltreatment: child maltreatment includes diverse types of physical abuse, neglect, and exploitative commercial activities that cause real or possible harm to children's health, survivability, and psychological growth (Zheng et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Childhood trauma is like a buried wound within an individual, yet it exerts enduring and pronounced effects on both present and future adversities (Berber \u0026Ccedil;elik \u0026amp; Odacı, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). From a prevalence perspective, childhood trauma exhibits a high incidence rate across populations, with global exposure rates among children and adolescents ranging from 26.3% to 76.2%, reflecting significant regional and cultural variations (Kessler et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). A German study indicates that about 65% of people who harm themselves had gone through not less than one type of childhood trauma, and around 50% had endured diverse forms of childhood trauma (Brown et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). It is noteworthy that childhood trauma exhibits covert characteristics, with most instances of emotional neglect and implicit abuse proving difficult to identify promptly, leading to a persistent underestimation of its harm. Mechanistically, traumatic experiences such as abuse and neglect during childhood disrupt the individual's early psychological developmental environment and interfere with the functioning of emotional regulation systems, raising the possibility that subsequent NSSI (Serafini et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Studies on adolescent populations have repeatedly validated this positive predictive relationship. Empirical research indicates that childhood trauma is not only significantly linked to internalizing problems like anxiety and depression in adolescence (Wei \u0026amp; L\u0026uuml;, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), but also increases the risk of externalizing issues like substance abuse and impulsive behavior. Long-term damage to individuals' interpersonal relationships, career development, and physical and emotional well-being can result from this effect, which can persist into adulthood (Felitti et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Moreover, childhood trauma diminishes an individual's psychological resilience reserves, making it harder for them to handle stress in the future and thereby becoming an important trigger for multiple mental health issues.\u003c/p\u003e \u003cp\u003eDepression, as a prevalent affective disorder, plays a pivotal mediating role between NSSI and childhood trauma. NSSI exhibits a significant association with depression in certain respects. On the one hand, adolescents experiencing depressive states often encounter difficulties in emotional regulation and suffer from low self-worth; NSSI can release pressure or negative emotions, inducing positive sensory experiences (Shao et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Thus, adolescents may employ NSSI to alleviate emotional distress. Conversely, NSSI may exacerbate depressive symptoms. Factors influencing an individual's NSSI include personality traits, sleep disorders, and emotional regulation. Consequently, those who participate in NSSI are highly susceptible to a variety of emotional disorders (Zhang \u0026amp; Zhang, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), triggering negative self-evaluation of their behavior, social avoidance, and other issues, thereby becoming trapped in a vicious cycle of \u0026ldquo;self-injury-depression.\u0026rdquo; Beyond this, an important predictor for the development of childhood depression is trauma (Rogerson et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Childhood adverse events relate to increased vulnerability to multiple issues of the mind and body (Antoniou et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Adverse environments can lead to heightened negative emotions, cognitive distortions, and diminished social connections among adolescents. Concurrently, research indicates that adolescents represent a high-risk group for emotional dysregulation (Tang et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Attachment theory posits (Choate \u0026amp; Tortorelli, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) that childhood constitutes a critical stage for establishing security and developing psychological functioning. Stable caregiving relationships and secure environments form essential foundations for psychological maturation. Consequently, adolescents must form and maintain interpersonal relationships, deriving feelings of security, acceptance, and belonging from these connections (Mathes et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Childhood trauma impedes the formation of a person's self-concept, social support systems, and emotional regulation abilities and disrupts the establishment of secure attachment. It not only heightens sensitivity to stress responses but may also increase susceptibility to depressive disorders by affecting neurophysiological mechanisms. Furthermore, it is closely associated with elevated risks of multiple mental and physical health problems. We therefore hypothesize that childhood trauma influences an individual's depressive mood through certain pathways, thereby affecting their NSSI.\u003c/p\u003e \u003cp\u003eThe connection of childhood trauma with NSSI is influenced through an individual's intrinsic psychological resources for coping with adversity beyond the mediating pathway of depression, with psychological resilience playing a particularly crucial protective role. As a key psychological resource for coping with adversity, psychological resilience exhibits a distinct \u0026ldquo;resource depletion\u0026rdquo; orientation in its relationship with childhood trauma. Building upon the extended perspective of resource conservation theory (Hobfoll, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1989\u003c/span\u003e), childhood trauma essentially constitutes a process of depletion within an individual's core psychological resources, and psychological resilience is directly harmed by this depletion of resources. A series of research studies (Anyan \u0026amp; Hjemdal, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Min et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) had indicated that elevated levels of negative affect are significantly predicted by low psychological resilience. Numerous investigations have examined psychological resilience as a protector against depression and a mediation or moderator between childhood trauma and depression (Wingo et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Moreover, emotional neglect during childhood indirectly impacts the \u0026ldquo;perceived social support\u0026rdquo; dimension of resilience\u0026mdash;individuals deprived of stable caregivers in traumatic environments often struggle to establish trust in others. This hinders their ability to effectively activate external support resources when facing stress, further exacerbating psychological vulnerability (Ko\u0026ccedil;t\u0026uuml;rk et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Qin et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). According to a longitudinal study, the earlier the age of childhood trauma occurring and the longer its duration, the stronger its negative predictive effect on psychological resilience in adulthood. And this influence is particularly pronounced among those who suffered compound trauma (Wang et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Concurrently, psychological resilience exerts a clear protective effect against NSSI: high resilience enables individuals to manage stress through more effective emotional regulation strategies and positive cognitive appraisals, thereby decreasing the possibility of using self-injury as an adaptive strategy for unpleasant feelings. Conversely, low psychological resilience significantly elevates the probability of NSSI occurrence (Huang et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Weedage et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).When negative emotions accumulate beyond an individual's psychological tolerance threshold, and adaptive coping strategies lacking resilience support are absent, NSSI may emerge as an alternative means for individuals to alleviate emotional distress (Mettler et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). While existing research has preliminarily revealed associative clues between childhood trauma, psychological resilience, and NSSI, more detailed empirical exploration is required regarding the matching patterns between various forms of childhood trauma and specific dimensions of psychological resilience, and also how such matching patterns influence the risk of NSSI occurrence.\u003c/p\u003e \u003cp\u003eSimilarly, self-efficacy as a protective resource and an individualized core perception of their personal capabilities can impact the link between childhood trauma and NSSI. Self-efficacy denotes an individual's estimation and judgement of one's capacity to accomplish a particular activity, serving as a key psychological variable for understanding behavioral motivation and adversity coping (Bandura, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1977\u003c/span\u003e). Regarding the association of NSSI and self-efficacy, self-efficacy in resisting NSSI is able to mitigate negative expectations associated with NSSI in protective or high-risk situations (Dawkins et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Grounded in social cognitive theory (Zare et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), self-efficacy interacts with result expectancy, social supports, self-regulation, and behavioral intentions to influence the possibility of taking behaviors like these. Relevant research has indicated that people with low self-efficacy struggle to control behavioral expectations of alleviating negative emotions through self-injury (Dawkins et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). When facing psychological stress, their lack of confidence in emotional regulation makes them more prone to seek temporary emotional release via NSSI; conversely, high self-efficacy effectively counteracts this negative behavioral expectation (Dawkins et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This series of mechanisms demonstrates that levels of self-efficacy directly influence an individual's behavioral tendencies in coping with psychological distress, constituting a significant internal factor in predicting NSSI (Hon et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Concurrently, according to social cognitive theory, the formation of self-efficacy relies on success experiences and positive feedback during early life, whereas childhood trauma disrupts this positive developmental trajectory (Haj-Yahia et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Traumatic experiences like childhood abuse or neglect significantly diminish a person's psychological regulation-related efficacy or directly undermine their early psychological developmental environment (Wang et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), thereby weakening positive cognitions about their capabilities and the formation of beliefs. Such negative cognition indirectly elevates the risk of NSSI by increasing emotional impulsivity. Thus, through the mediating pathway of self-efficacy, childhood trauma may indirectly influence NSSI (Liu et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Oakes et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBased on the above, this study focuses on the rising incidence of NSSI among adolescents and its potential harm to physical and mental health. Childhood trauma, as a common distal stressor, may exert enduring effects on psychological development due to its high incidence and covert nature. Building upon existing research, this study proposes the core hypothesis that childhood trauma may influence adolescent NSSI via the mediating pathway of depression. Furthermore, psychological resilience and self-efficacy, as key psychological assets, may play corresponding roles in the relationship between childhood trauma and NSSI. Addressing the high prevalence and potential risks of NSSI, this study clarifies research hypotheses and maps associative pathways among relevant factors. It provides a clear direction for subsequent empirical research while laying a theoretical foundation for exploring the etiology and intervention strategies for adolescent NSSI. This holds significant value for safeguarding adolescent mental health.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003eAdolescents suffering depressive disorders, aged 10 to 19, who visited a mental health facility in Zhejiang Province between September 2024 and March 2025 were selected for this study using convenience sampling. 201 questionnaires were distributed. According to the G*power software calculations, the collected sample size is sufficient for detecting a medium effect size (\u003cem\u003ef\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.15) with 0.8 statistical power (Kang, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Subsequent to the calculation of the Mahalanobis distance, one invalid questionnaire was excluded, leaving 200 valid responses. Among these, 80 were male, and 120 were female. The distribution of education level is as follows: The population is composed of 59 individuals at the primary education level, 92 at the junior secondary level, and 49 at the senior secondary level. The mean age of the study subjects was 13.73 years, with a standard deviation of 2.25.\u003c/p\u003e \u003cp\u003eInclusion criteria:\u003c/p\u003e \u003cp\u003e1. Diagnosed by two psychiatrists at the consultant level or above, fulfilling the International Classification of Diseases, 10th Revision (ICD-10) criteria for depressive disorders; 2. Adolescents ranged from 10 to 19 years according to the World Health Organization. 3. Voluntary consent from both the participant and their guardian to take part in this study, evidenced by signed informed permission papers; 4. Possession of the capacity to independently comprehend and complete questionnaires; 5. Scale assessments were administered on the day of the visit for outpatients and within one week of admission for inpatients.\u003c/p\u003e \u003cp\u003eExclusion criteria:\u003c/p\u003e \u003cp\u003e1. Previous or current diagnoses of schizophrenia, bipolar affective disorder, and other psychiatric disorders according to ICD-10; 2. Presence of intellectual impairment (e.g., Wechsler Adult Intelligence Scale IQ\u0026thinsp;\u0026lt;\u0026thinsp;70), cognitive impairment, or psychological developmental delay; 3. Recent major traumatic or stressful events; 4. Language comprehension difficulties or cultural background differences rendering non-compliance with study procedures.\u003c/p\u003e \u003cp\u003e The Bengbu Medical University Ethics Committee accepted this study (Approval No. bydc2023019), and prior to participation, every participant and their guardians-in-law provided written informed permission. This study confirms that all methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Measurements\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 General Information Questionnaire\u003c/h2\u003e \u003cp\u003eThe study employed a privately generated general information questionnaire. This tool collected adolescents' personal background data. The data covered age, gender, and school year.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Children's Depression Inventory (CDI)\u003c/h2\u003e \u003cp\u003eThe popular self-assessment tool for evaluating depression symptoms in kids and teenagers is the Children's Depression Inventory (CDI). And it is appropriate for kids and teenagers between the ages of 7 and 17. Its language, context, and presentation style of the items align with the cognitive and emotional experiences of this age group, demonstrating greater ecological validity than adult-oriented scales. It was developed by Maria Kovacs in 1981 based on the Beck Depression Inventory (BDI) (Kovacs, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1985\u003c/span\u003e). The scale comprises 27 items, each with three options corresponding to 0, 1, or 2 points, yielding an overall score range of 0\u0026ndash;54 points. This measures symptom severity (from absent to severe). This study's Cronbach's α coefficient was 0.86.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Childhood Trauma Questionnaire (CTQ)\u003c/h2\u003e \u003cp\u003eSeven of the 28 items on the Childhood Trauma Questionnaire (CTQ) utilized in this study require reverse scoring. Zhao Xingfu et al. updated the scale and translated it into Chinese (Zhao Xingfu, 2005). It uses a 5-point rating system, with 1 representing \"Never\" and 5 representing \"Always.\" Higher scores suggest that the person was subjected to more severe maltreatment as a youngster. \"Emotional maltreatment,\" \"physical maltreatment,\" \"sexual maltreatment,\" \"emotional neglect,\" and \"physical neglect\" are the five dimensions of the scale. This framework enables researchers to distinguish between different types of traumatic experiences and explore their unique or shared pathways of impact, thereby facilitating subsequent mechanism-based studies. The entire scale range is 25 to 125 points, with each dimension scoring between 5 and 25 points. The whole scale's Cronbach's α coefficient from this study was 0.85.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4 Connor-Davidson Resilience Scale (CD-RISC)\u003c/h2\u003e \u003cp\u003eIt has three aspects of \"tenacity,\" \"self-strengthening,\u0026rdquo; and \"optimism,\" which are among the scale's twenty-five items. The scale was the Chinese version of the Connor-Davidson Resilience Scale, as modified by Yu Xiaonan and Zhang Jianxin (Xiaonan \u0026amp; Jianxin, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Scoring utilized a scale of 1 (\u0026ldquo;very disagree\u0026rdquo;) to 5 (\u0026ldquo;very agree\u0026rdquo;). The greater the overall score, the more psychologically resilient the person. The scale showed excellent reliability, with a Cronbach's alpha coefficient of 0.95.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.5 Adolescent Non-Suicidal Self-Injury Assessment Questionnaire (ANSAQ)\u003c/h2\u003e \u003cp\u003eBased on the characteristics of Chinese teenagers, Wan Yuhui et al. created the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire (ANSAQ) used in the study (Yuhui et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). It is intended to assess deliberate physical harm that is not driven by suicidal intent over the course of a year. It is made up of two subscales, behavioral and functional, serving not only as a behavioral screening tool but also as a mechanism exploration tool, making it highly suitable for investigating the complex etiology and impact pathways of NSSI. The score range for this scale is 0 to 48. On a 5-point scale that goes from 0 (\"never\") to 4 (\"always\"), a higher frequency of self-harm is represented by greater scores. The Functional Questionnaire scores between 0 and 76 points. The degree of congruence between the item content and the respondent's own motivation was evaluated using a five-point rating system, with scores ranging from 0 (\"does not meet at all\") to 4 (\"fully meets\"). Stronger motivation is indicated by a higher score. Cronbach's α\u0026thinsp;=\u0026thinsp;0.94 showed that the entire scale has acceptable internal consistency dependability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.2.6 General Self-Efficacy Scale (GSES)\u003c/h2\u003e \u003cp\u003eTo assess individuals' overall confidence in coping with broad situational challenges, this study employed the unidimensional General Self-Efficacy Scale. Previous studies have indicated that this scale exhibits good reliability and validity when applied in the local context (Wang Caikang, 2001). It comprises ten items. Scoring employs a four-point scale ranging from 1 (\u0026lsquo;entirely untrue\u0026rsquo;) to 4 (\u0026lsquo;entirely truthful\u0026rsquo;), yielding an overall score between ten and forty points. Greater scores indicate higher levels of general self-efficacy. In this study, the Cronbach's α coefficient for this scale was 0.89.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.3 \u003cem\u003eProcedure\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eIn the study, an anonymous questionnaire survey was conducted among 200 adolescents suffering depressive disorders who met the inclusion criteria. The questionnaires were completed independently by both outpatient and inpatient adolescent patients with depressive disorders, with strict confidentiality maintained regarding their personal information. Each questionnaire took approximately 10\u0026ndash;20 minutes to complete. A total of 201 questionnaires were distributed. Following the survey, researchers promptly collated the responses, achieving a valid recovery rate of 99.5% with 200 usable questionnaires returned, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eInsert Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003e here\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data Analysis\u003c/h2\u003e \u003cp\u003ePerform a systematic process of the data using SPSS 29.0, and scale scores and general demographic factors were described using descriptive statistics. Subsequently, to assess the potential influence of demographic variables, one-way ANOVAs and independent samples t-tests were conducted to compare variations in core scale scores between adolescents of various education levels and genders. Through correlation analysis, pairwise preliminary relationship tests were used among childhood trauma, psychological resilience, depression, and NSSI. To further elucidate the intricate interrelationships among variables, a multiple mediation model was constructed, building upon the established foundation. Employing regression analysis techniques, we systematically examined whether psychological resilience, depression, and self-efficacy mediated the connection between childhood trauma and NSSI. To provide further validation of the robustness of the mediating effect and test the mediation model, confidence intervals for each indirect effect were calculated using model 80 in the PROCESS and the bootstrap technique, thereby enabling statistical inference regarding the significance of the mediating pathway.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003e3.1 Common method bias\u003c/h2\u003e\n \u003cp\u003eInclude all measurement items of variables in exploratory factor analysis and check for the potential impact of common method bias on data quality using Harman's single-factor experiment. Results revealed that 30 factors had eigenvalues exceeding 1, with maximum factor variance explained amounting to 18.80%. The research data has not been severely affected by common method bias because it is below the 40% crucial level.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003e3.2 Scores for childhood trauma, self-efficacy, psychological resilience, depression, and NSSI in adolescents suffering depressive disorders\u003c/h2\u003e\n \u003cp\u003eThe results showed that childhood trauma scores ranged from a maximum of 89 to a minimum of 25 (\u003cem\u003eM\u003c/em\u003e = 51.21, \u003cem\u003eSD\u003c/em\u003e = 10.52); self-efficacy scores ranged from a maximum of 40 to a minimum of 10 (\u003cem\u003eM\u003c/em\u003e = 20.27, \u003cem\u003eSD\u003c/em\u003e = 5.38); and psychological resilience ranged from a maximum of 117 to a minimum of 25 points (\u003cem\u003eM\u003c/em\u003e = 58.69, \u003cem\u003eSD\u003c/em\u003e = 16.62). Depression scores varied between a maximum of 1 and a minimum of 48 points (\u003cem\u003eM\u003c/em\u003e = 28.40, \u003cem\u003eSD\u003c/em\u003e = 7.65); NSSI behavior scores varied between 0 and 47 points (\u003cem\u003eM\u003c/em\u003e = 9.80, \u003cem\u003eSD\u003c/em\u003e = 9.21); and NSSI function scores varied from 0 to 64 points (\u003cem\u003eM\u003c/em\u003e = 23.14, \u003cem\u003eSD\u003c/em\u003e = 13.41).\u003c/p\u003e\n \u003cp\u003eAmong these, the top five items with the highest mean scores for NSSI functions were “alleviate feelings of stress or anxiety,” “to avoid things one dislikes or finds unpleasant, such as skipping school, doing homework, or undertaking chores,” “expressing one's anger,” “make oneself feel less lonely,” and “a form of self-punishment or atonement.” As shown in Table\u0026nbsp;1. Significant differences in NSSI across gender and education levels (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) by independent samples t-tests and one-way ANOVAs were revealed statistically. Significant correlations between scores for NSSI behavior and depression scores across different education levels (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). Intergroup comparison results indicate that participants in the junior secondary school group scored higher than those in the primary school and senior secondary school groups (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). (see Table\u0026nbsp;2).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eStatistics for NSSI Function Scores\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEntry\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eM ± SD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.Alleviate feelings of stress or anxiety.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.70 ± 1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.To avoid things one dislikes or finds unpleasant, such as skipping school, doing\u003c/p\u003e\n \u003cp\u003ehomework, or undertaking chores.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.53 ± 1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.Expressing one's anger.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.46 ± 1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.Make oneself feel less lonely.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.42 ± 1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.A form of self-punishment or atonement.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.32 ± 1.24\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\u003eThe five items with the highest average scores in the NSSI Functional Questionnaire of the ANSAQ (Adolescent Non-Suicidal Self-Injury Assessment Questionnaire).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eScores for Each Variable and Differences Across Demographic Variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNSSI behavior\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNSSI function\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGSES\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCD-RISC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCDI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCTQ\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScore(M ± SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.80 ± 9.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.14 ± 13.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.27 ± 5.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.69 ± 16.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.40 ± 7.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.21 ± 10.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale (\u003cem\u003en\u003c/em\u003e = 80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.78 ± 5.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.54 ± 12.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.33 ± 5.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.65 ± 18.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.15 ± 7.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.94 ± 10.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale(\u003cem\u003en\u003c/em\u003e = 120)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.82 ± 10.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.88 ± 13.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.23 ± 5.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.05 ± 15.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.57 ± 7.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.38 ± 10.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.770\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eprimary school① 59(29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.88 ± 5.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.49 ± 11.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.37 ± 6.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.10 ± 18.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.32 ± 8.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.58 ± 8.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ejunior secondary school② 92(46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.53 ± 11.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.97 ± 14.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.51 ± 5.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.18 ± 16.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.43 ± 7.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.04 ± 12.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esenior secondary school③ 49(24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.86 ± 7.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.57 ± 14.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.37 ± 4.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.69 ± 14.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.96 ± 6.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.59 ± 8.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultiple comparisons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e②\u0026gt;③\u0026gt;①\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e②\u0026gt;③\u0026gt;①\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eNSSI behavior, ANSAQ Behavior Subscale; NSSI function, ANSAQ Function Subscale; GSES, General Self-Efficacy Scale; CD-RISC, Connor-Davidson Resilience Scale; CDI, Children's Depression Inventory; CTQ, Childhood Trauma Questionnaire.\u003c/p\u003e\n \u003cp\u003eInsert Table\u0026nbsp;1 and Fig.\u0026nbsp;2 here\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003e3.3. Correlation Analysis Between Gender, Education Level, NSSI, Psychological Resilience, Depression, Childhood Trauma, and Self-Efficacy\u003c/h2\u003e\n \u003cp\u003eAs shown in Table\u0026nbsp;2, childhood trauma exhibited positive correlations with NSSI and depression (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), whilst demonstrating negative correlations with self-efficacy, psychological resilience, and their respective factors (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). NSSI showed a positive correlation with depression (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01) and no significant correlation with psychological resilience or self-efficacy. Rather, there was a substantial connection between NSSI and the optimism factor of psychological resilience (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). Depression showed a negative correlation with self-efficacy, psychological resilience, and all sub-factors (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), while self-efficacy exhibited positive correlations with psychological resilience and all its sub-factors (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01).\u003c/p\u003e\n \u003cp\u003eInsert Table\u0026nbsp;2 here\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3.4. The Effect of Childhood Trauma on NSSI: A Chain Mediation Analysis of Self-Efficacy, Psychological Resilience, and Depression\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFigure 3 presents a mediation effect analysis that was performed on standardized data using childhood trauma as the independent variable, NSSI as the dependent variable, self-efficacy, psychological resilience, and depression as mediating factors, and gender and education level as covariates. Childhood trauma was found to be a substantial and positive predictor of depression (\u003cem\u003eβ\u003c/em\u003e = 0.234, \u003cem\u003et\u003c/em\u003e = 4.442, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) and NSSI (\u003cem\u003eβ\u003c/em\u003e = 0.495, \u003cem\u003et\u003c/em\u003e = 9.416, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Additionally, it substantially and adversely predicted psychological resilience (\u003cem\u003eβ\u003c/em\u003e = 0.346, \u003cem\u003et\u003c/em\u003e = 5.160, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) and self-efficacy (\u003cem\u003eβ\u003c/em\u003e = -0.372, \u003cem\u003et\u003c/em\u003e = 5.615, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). When self-efficacy was the mediating variable, depression was negatively predicted by self-efficacy (\u003cem\u003eβ\u003c/em\u003e = -0.443, \u003cem\u003et\u003c/em\u003e = 5.191, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001); when psychological resilience was the mediating variable, depression was negatively predicted by psychological resilience (\u003cem\u003eβ\u003c/em\u003e = -0.185, \u003cem\u003et\u003c/em\u003e = 2.191, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05); in the path with self-efficacy, psychological resilience, and depression as mediating variables, self-efficacy (\u003cem\u003eβ\u003c/em\u003e = 0.173, \u003cem\u003et\u003c/em\u003e = 1.993, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05), psychological resilience (\u003cem\u003eβ\u003c/em\u003e = 0.341, \u003cem\u003et\u003c/em\u003e = 4.195, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), and depression (\u003cem\u003eβ\u003c/em\u003e = 0.576, \u003cem\u003et\u003c/em\u003e = 8.444, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) all positively predicted NSSI. See Table\u0026nbsp;4 and Fig.\u0026nbsp;1 for details.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eChain Mediation Effects Between NSSI and Childhood Trauma\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffect\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRelative Effect Proportion\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85.49%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma → Self-Efficacy → NSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma → Psychological Resilience → NSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.38%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma → Depression → NSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.32%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma → Self-Efficacy → Depression → NSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma → Psychological Resilience → Depression → NSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.39%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal indirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe various pathways from childhood trauma to NSSI are presented in Table\u0026nbsp;4. Childhood trauma itself is a very strong direct predictor of NSSI in adolescents. The direct impact of childhood trauma on NSSI had an impact value of 0.495 (\u003cem\u003eSE\u003c/em\u003e = 0.053, 95% \u003cem\u003eCI\u003c/em\u003e [0.391, 0.598]). In the simple mediation path, the independent mediated effect of self-efficacy was not statistically significant with an impact value of -0.064 (\u003cem\u003eSE\u003c/em\u003e = 0.046, 95% \u003cem\u003eCI\u003c/em\u003e [-0.162, 0.019]); the independent mediated effect of psychological resilience with an impact value of -0.118 (\u003cem\u003eSE\u003c/em\u003e = 0.043, 95% \u003cem\u003eCI\u003c/em\u003e [-0.211, -0.043]); the independent mediated effect of depression with an impact value of 0.135 (\u003cem\u003eSE\u003c/em\u003e = 0.033, 95% \u003cem\u003eCI\u003c/em\u003e [0.071, 0.201]). As per Wen and Ye's mediation effect testing protocol (Zhonglin \u0026amp; Baojuan, 2014), when both direct and indirect effects are significant but exhibit opposite signs, a masking effect is interpreted. Consequently, psychological resilience exhibits a masking effect in its independent mediated pathway. With an impact value of 0.095 (\u003cem\u003eSE\u003c/em\u003e = 0.033, 95% \u003cem\u003eCI\u003c/em\u003e [0.040, 0.167]), the combined mediated effect of depression and self-efficacy in the chained mediation route connecting childhood trauma to NSSI. The combined mediated impact of psychological resilience and depression in the chained mediation route connecting childhood trauma to NSSI, with an effect value of 0.037 (\u003cem\u003eSE\u003c/em\u003e = 0.021, 95% \u003cem\u003eCI\u003c/em\u003e [0.003, 0.085]).\u003c/p\u003e\n \u003cp\u003eInsert Fig.\u0026nbsp;3, Table\u0026nbsp;3, and Table\u0026nbsp;4 here\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eMediating Effects of Self-Efficacy, Psychological Resilience and Depression on the Relationship Between NSSI and Childhood Trauma\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eRegression equation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eIntegration fit index\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSignificance of regression coefficients\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResult variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrediction variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.517***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.416***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.993*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological Resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.195***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.444***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5.615***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological Resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5.160***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildhood Trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.442***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5.191***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological Resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.191*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cem\u003eNote.\u003c/em\u003e *\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 ***\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Demographic Differences in NSSI among Adolescent Patients with Depressive Disorders\u003c/h2\u003e \u003cp\u003eSignificant gender disparities in adolescent NSSI were found using independent samples t-tests. Female participants in this study exhibited significantly higher NSSI scores (11.82\u0026thinsp;\u0026plusmn;\u0026thinsp;10.51, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than males (6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This may stem from heightened negative affect levels and earlier peak emotional reactivity in females during early puberty due to hormonal shifts, coupled with a greater tendency to employ NSSI as a primary emotion-regulation strategy. Males, conversely, less frequently utilize this approach to address emotional distress (Guo et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), indicating adolescent females are more prone to regulating emotions or expressing distress through self-injury.\u003c/p\u003e \u003cp\u003eWhen stratifying by education levels, junior secondary students exhibited the highest scores for both NSSI and depression. This implies that junior secondary might be a crucial time for the emergence of depression and NSSI among adolescents. This pattern likely correlates with the psychological developmental tasks, academic pressures, familial influences, peer relationship changes, and insufficient emotional regulation capabilities encountered during this stage (Qu et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Correlation Analysis on Adolescent NSSI, Depression, and Childhood Trauma\u003c/h2\u003e \u003cp\u003eAdolescent NSSI and childhood trauma indicated that they were strongly positively correlated. Childhood trauma of any kind was more common among individuals who had NSSI than among those who had not NSSI (Bahali et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Even when trauma types differed, childhood trauma retained a unique role in adolescent NSSI (Thomassin et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This suggests childhood trauma may increase adolescent risk of NSSI through mechanisms affecting emotional regulation, self-perception, and coping strategies. Emotional abuse (EA) is more common than other types of childhood trauma among NSSI populations (Brown et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In order to maintain control, some family members may use verbal abuse, humiliation, belittling, excessive blaming, unreasonable demands, or even showing apathy and ignoring the child's emotional needs (Xie et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This form of trauma inflicts enduring damage to children's self-esteem and may distort their self-perception. Research indicates that high cognitive fusion and experiential avoidance may play a significant part in NSSI individuals' continued self-harming behavior (Hu et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, depression and NSSI are significantly correlated. When confronted with depression-related negative emotions and numbness, individuals typically exhibit NSSI (Marshall et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), while those engaging in NSSI are inclined to develop depression. Adolescents with depression experience greater difficulty in accurately identifying emotions, exhibit impaired expression of affect, and display features like inflexible thinking and poor imaging (Zhang et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), making them more prone to NSSI. Adolescent NSSI and depression are significantly correlated in both directions, according to research by Tilton-Weaver et al. (Tilton-Weaver \u0026amp; Schwartz-Mette, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). NSSI acts as an initial trigger, subsequently exacerbating depressive symptoms through emotional dysregulation and negative reinforcement mechanisms, ultimately forming a vicious cycle.\u003c/p\u003e \u003cp\u003eSelf-efficacy and psychological resilience exhibited complex interactions within the model. Correlation analysis revealed that self-efficacy and psychological resilience showed non-significant negative correlations with NSSI. However, after incorporating all variables into the regression model, the predictive effects of self-efficacy and psychological resilience on NSSI became significant. This may be because correlation analysis represents simple bivariate relationships, whereas multiple regression analysis reveals the true connection between self-efficacy and psychological resilience with NSSI after controlling for childhood trauma and depression. Following this control, the predictive roles of self-efficacy and psychological resilience became apparent. Consequently, we employed the bootstrap method to directly test the mediating effects.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Functional Aspects of Adolescent NSSI\u003c/h2\u003e \u003cp\u003eThe results of this study demonstrate that alleviating distress or anxiety is the main purpose of adolescent NSSI, suggesting that self-harm is widely perceived within this sample as serving a distress-relieving function, consistent with prior research (Klonsky, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). The function of NSSI is to regulate upsetting or unpleasant thoughts or feelings through escaping, avoiding, substituting, or directly modifying these conditions (Taylor et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). For adolescents, particularly those in junior secondary school groups, self-injury serves as a functional behavior to achieve temporary relief when academic or familial pressures lack viable outlets.\u003c/p\u003e \u003cp\u003eEmotional instability, impulsivity, and lack of self-control may influence adolescent NSSI (Norouzi, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). This study suggests adolescents employ NSSI to express anger and evade undesirable situations, falling within the category of automatic negative reinforcement (Brown \u0026amp; Plener, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u0026mdash;a concept within the four-factor model (Nock \u0026amp; Prinstein, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Research indicates that loneliness diminishes following NSSI episodes (Nock et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), suggesting self-harm functions not only as an internal emotional regulator but also as an outward signal conveying psychological distress requiring attention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Analysis of the Mediating Effects of Self-Efficacy, Psychological Resilience, and Depression\u003c/h2\u003e \u003cp\u003eThe results reveal that childhood trauma exerts a strong direct effect on NSSI, representing 85.49% of the overall effect, confirming childhood trauma is a predictor for adolescents developing NSSI. Self-efficacy, psychological resilience, and depression have a chain-mediated impact between childhood trauma and NSSI, according to mediational analysis. In addition to being a favorable predictor of NSSI, childhood trauma has an indirect impact on it through self-efficacy, psychological resilience, and depression.\u003c/p\u003e \u003cp\u003eThis indirect influence operates via five pathways. The first pathway, mediated by self-efficacy, yielded non-significant effects, whereas childhood trauma exhibited significant effects through the chain-mediated pathway formed by \u0026ldquo;self-efficacy \u0026rarr; depression.\u0026rdquo; This indicates that self-efficacy primarily influences NSSI by affecting depression in this study. Childhood trauma predisposes adolescents to internalize negative self-beliefs like \u0026ldquo;I'm incapable\u0026rdquo; or \u0026ldquo;I'm unworthy\u0026rdquo; (Konanur \u0026amp; Muller, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), thereby diminishing their sense of self-efficacy. Self-efficacy directly contributes to depression or indirectly by its influence on academic achievement, prosocial behavior, and problem behavior (Bandura et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1999\u003c/span\u003e), subsequently increasing NSSI.\u003c/p\u003e \u003cp\u003eThe third pathway, mediated by depression, accounts for the largest proportion of relative effects among the four pathways. Existing research indicates that childhood trauma correlates with alterations in HPA axis function, which highly overlap with the neurobiological features of depression (Heim et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Childhood trauma shapes negative self-perceptions and emotionally unstable personality traits, directly increasing susceptibility to depression (Birch et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The risk of NSSI escalates with worsening depressive symptoms (Xingfang et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Thus, childhood trauma may render individuals more vulnerable to depression and NSSI during adolescence by influencing brain development and fostering maladaptive coping patterns.\u003c/p\u003e \u003cp\u003eA masking effect emerged in the pathway using psychological resilience as a mediating variable. On one hand, childhood trauma directly and positively predicted NSSI. On the other hand, childhood trauma negatively impacted psychological resilience, while psychological resilience positively influenced NSSI, thereby forming an indirect pathway opposite to the direct effect. The actual impact of childhood trauma on NSSI is obscured through this reverse indirect path. The contradictory effect of psychological resilience on NSSI may stem from the study's inclusion of participants with diagnosed depressive disorders; the specificity of this sample likely accounts for the unique manifestation of psychological resilience's influence. George A. Bonanno's theory posits that psychological flexibility forms the bedrock of resilience (Bonanno et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), with the essence of resilience lying in selecting the most appropriate coping strategy for a given situation. Under societal pressure, individuals may suppress or conceal genuine distress to meet expectations of resilience. This \u0026ldquo;putting on a brave face\u0026rdquo; constitutes neither authentic resilience nor genuine emotional processing and healing, potentially hindering genuine emotional processing and healing and leading to more severe psychological or physiological issues. In this study, the high psychological resilience exhibited by adolescents with depressive disorders may represent a rigid, pseudo-resilience formed under prolonged stress, centered on emotional suppression and avoidance. Due to its lack of flexibility and tendency to deplete psychological resources, it may paradoxically increase NSSI. This suggests that future interventions should address the paradoxical effects of psychological resilience on NSSI by designing differentiated programs. These should focus on cultivating resilience in problem-solving rather than promoting self-control and repair through emotional suppression.\u003c/p\u003e \u003cp\u003eFinally, childhood trauma influences NSSI through a chain of mediation involving psychological resilience and depression. Psychological resilience serves as a crucial bridge linking childhood trauma risk and depressive symptoms (Baiyu et al., 2025). Childhood trauma diminishes psychological resilience, exacerbates depressive levels, and consequently increases NSSI. Consequently, adolescent mental health interventions should prioritize screening for childhood trauma to identify high-risk individuals and enable early intervention. Building upon trauma resolution, efforts should focus on alleviating depressive symptoms while cultivating adaptive psychological resilience, thereby establishing a multi-tiered NSSI prevention framework.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Innovation\u003c/h2\u003e \u003cp\u003eThis study investigated the mediated effects of self-efficacy, psychological resilience, and depression in the association between childhood trauma and NSSI among adolescents suffering depressive disorders through a chain mediation model. It elucidated how childhood trauma, self-efficacy, psychological resilience, and depression collectively influence NSSI, while also identifying the paradoxical impact of childhood trauma on NSSI via psychological resilience. Future research may further investigate the underlying mechanisms, offering novel perspectives for clinical interventions and treatment in adolescent mental health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Limitations\u003c/h2\u003e \u003cp\u003eFirstly, the results may not be as representative of the adolescent community as they may seem because all participants of this study were selected from a single hospital. To improve the conclusions' generalizability, future studies should take samples from wider geographic regions. Secondly, the general information questionnaire's design was incomplete, failing to incorporate additional information such as household registration status, economic level, and parental marital status. These aspects should be supplemented and refined in subsequent studies. Thirdly, conclusive causal correlations cannot be proved because of the cross-sectional nature of this study. Longitudinal surveys may be employed in further studies to clarify causal linkages between variables. Lastly, the exclusive use of self-report measures may introduce assessment bias.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn conclusion, childhood trauma has an indirect influence on NSSI through self-efficacy, psychological resilience, and depression, along with having a direct influence on NSSI among adolescents suffering depressive disorders. The association between childhood trauma and NSSI is mediated in a chain-like manner by self-efficacy, psychological resilience, and depression. This study aims to enhance adolescents' psychological health and offer guidance for developing intervention strategies targeting NSSI in young people.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003eOMPETING\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;I\u003c/strong\u003e\u003cstrong\u003eNTERESTS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSTATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that they have no conflicting interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIf an appropriate request is received, the corresponding author will offer the datasets used and analyzed in the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Bengbu Medical University Human Research Ethics Committee thoroughly reviewed the full procedure before approving it (Project No. bydc2023019). Both the individual in question and the minor\u0026apos;s legal guardian gave their informed approval for all data to be collected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants gave their consent for publishing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCJY, WYH, ZXY, JZQ, LYZ, and WKX drafted the manuscript. CJY analyzed the data and prepared the figures. ZRX compiled the references.\u0026nbsp;WWJ and LL made key changes to the manuscript. The manuscript was reviewed and suggested by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRole of funding sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Provincial Education Department Natural Science Key Project (grant numbers: 2024AH051196), the 2023 Provincial Quality Engineering Project for Education in the New Era (grant number: 2023cxcysj160),\u0026nbsp;the\u0026nbsp;Innovative Training Program for Chinese College Students (grant number: 202510367034),\u0026nbsp;the\u0026nbsp;Anhui Province New Era Graduate Education Quality Engineering Project (grant numbers: 2024zyxwjxalk187, 2024shsjsfkc028), and the\u0026nbsp;Bengbu Medical University Graduate Student Research Innovation Program Project (grant number: Byycxz24015).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to extend our sincere gratitude to all of the participants who assisted us as well as the researchers who worked on the project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAboussouan, A., Snow, A., Cerel, J. \u0026amp; Tucker, R. 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(2014). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://kns.cnki.net/kcms2/article/abstract?v=lqoStndJ5wGGV8yFdpNR1pNWvkdu-HrrUwGzZDE0J3HXsmfPYjl9yn8d_p3VgBU2Iqn0eaNsaY9kH7fLSW1yfX4YLRXv48tde1zPE_O9UJ-qX4FMgZ6BgbyPG8nofN8VlKa0ZP62wLjNsHe5hi8UUp3vn-uA1SuFXC_ym720bZ7YNjmK3J5zEQ==\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/span\u003e\u003cspan address=\"https://kns.cnki.net/kcms2/article/abstract?v=lqoStndJ5wGGV8yFdpNR1pNWvkdu-HrrUwGzZDE0J3HXsmfPYjl9yn8d_p3VgBU2Iqn0eaNsaY9kH7fLSW1yfX4YLRXv48tde1zPE_O9UJ-qX4FMgZ6BgbyPG8nofN8VlKa0ZP62wLjNsHe5hi8UUp3vn-uA1SuFXC_ym720bZ7YNjmK3J5zEQ==\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"childhood trauma, adolescents, self-efficacy, psychological resilience, depression, non-suicidal self-injury (NSSI)","lastPublishedDoi":"10.21203/rs.3.rs-8697764/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8697764/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eExamining the mechanisms through which childhood trauma influences non-suicidal self-injury (NSSI) among adolescents suffering depressive disorders via self-efficacy, psychological resilience, and depression, thereby providing theoretical support for adolescent mental health interventions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe Children's Depression Inventory (CDI), the Childhood Trauma Questionnaire (CTQ), the Connor-Davidson Resilience Scale (CD-RISC), the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire (ANSAQ), and the General Self-Efficacy Scale (GSES) were used to assess 201 adolescents aged 10\u0026ndash;19 years with depressive disorders who attended a psychiatric hospital in Zhejiang Province from September 2024 to March 2025. After excluding outliers (calculated using Mahalanobis distance), data analysis was conducted on 200 patients.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eChildhood trauma was positively associated with NSSI and depression, and inversely linked to adolescents' self-efficacy and psychological resilience. NSSI was positively associated with depression. Childhood trauma exerted a chained mediating effect on NSSI via self-efficacy, psychological resilience, and depression.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eChildhood trauma exerted a serial mediating effect on NSSI through self-efficacy, psychological resilience, and depression, implicating these three factors as key conduits in the childhood trauma to NSSI pathway. These findings highlight the key role of psychosocial mechanisms in NSSI etiology and suggest that interventions for adolescents with childhood trauma should prioritize enhancing self-efficacy and resilience while concurrently managing depressive symptoms, thereby disrupting the cascading trajectory from trauma to self-injury.\u003c/p\u003e","manuscriptTitle":"From Early Trauma to Self-Harm: A Sequential Mediation Model of Self-Efficacy, Psychological Resilience, and Depression in Adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 06:16:12","doi":"10.21203/rs.3.rs-8697764/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-01T07:09:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-30T17:56:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-05T01:02:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T11:42:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234464211716801354254782874674571375645","date":"2026-03-04T10:52:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"313662559187490029939959684642913156364","date":"2026-03-02T08:19:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2762114874638347875062088468697781841","date":"2026-02-26T13:27:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250483353085795900811196948539409932137","date":"2026-02-25T03:50:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-12T11:35:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-12T11:17:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-10T22:22:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-07T09:09:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-07T08:57:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a159ef65-33d5-436c-bbd8-5104a9653db2","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":62930759,"name":"Health sciences/Diseases"},{"id":62930760,"name":"Health sciences/Health care"},{"id":62930761,"name":"Biological sciences/Psychology"},{"id":62930762,"name":"Social science/Psychology"},{"id":62930763,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-04-16T18:53:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 06:16:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8697764","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8697764","identity":"rs-8697764","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}