Journal of Youth and Adolescence

, Volume 47, Issue 10, pp 2220–2230 | Cite as

Distress Intolerance Mediates the Relationship between Child Maltreatment and Nonsuicidal Self-Injury among Chinese Adolescents: A Three-Wave Longitudinal Study

  • Nan Kang
  • Yongqiang Jiang
  • Yaxuan Ren
  • Tieying Gong
  • Xiaoliu Liu
  • Freedom Leung
  • Jianing YouEmail author
Empirical Research


Nonsuicidal self-injury (NSSI) is a serious public health concern among adolescents. Identifying risk factors of NSSI is important to effectively prevent or reduce such behavior. Child maltreatment is one of the most widely recognized risk factors for NSSI. How child maltreatment and NSSI is related, however, is still unclear. The present study tested the temporal relationship between physical and emotional abuse and NSSI, with distress intolerance as the potential mediator. Potential gender differences on these associations were also tested. We assessed all study variables among 2259 Chinese adolescents (53.8% females; Mage = 15.11 years, SD = 1.57) for three times at 6-month intervals. The results showed that distress intolerance only mediated the relationship between emotional abuse and NSSI, but not between physical abuse and NSSI. In addition, this mediation effect of distress intolerance was significant only for females. The findings of this study can help researchers and practitioners understand pathways by which child maltreatment impacts adolescent NSSI. Implications for preventions and interventions of NSSI were discussed.


Nonsuicidal self-injury Child maltreatment Distress intolerance Emotional abuse Physical abuse 



This manuscript’s data will not be deposited.

Authors’ Contributions

N.K. conceived of the study, participated in its design and coordination and drafted the manuscript; Y.J. participated in the design of the study, performed the measurement, and drafted the manuscript; Y.R. participated in data collection and prepared the initial draft of introduction and discussion; T.G. performed the measurement, conducted statistical analyses, and interpreation of data; X.L. participated in the review of the literature and revised the manuscript; F.L. participated in the design of the study and provided critical revisons of the manuscript; J.Y. participated in its design and coordination and helped to draft the manuscript. All authors contributed to the writing of the manuscript. All authors read and approved the final manuscript.


This research was supported by the National Natural Science Foundation of China (Grant No. 31771228), National Social Science Foundation of China (Grant No. 14ZDB159), Major Projects of the Humanities and Social Science Research Base of Ministry of Education (17JJD190001 and 16JJD190001), Research Center for Crisis Intervention and Psychological Service of Guangdong Province, South China Normal University, and the base of psychological services and counseling for “Happiness” in Guangzhou. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


This manuscript’s data will not be deposited.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All testing materials and the procedures were approved by the ethical board of the Chinese University of Hong Kong and the participating schools’ authorities.

Informed Consent

Informed consent was obtained from all participants included in the study.


  1. Ahmed, S. P., Bittencourt-Hewitt, A., & Sebastian, C. L. (2015). Neurocognitive bases of emotion regulation development in adolescence. Developmental Cognitive Neuroscience, 15, 11–25. Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th edn. Washington, DC: American Psychiatric AssociationGoogle Scholar
  3. Anestis, M. D., Kleiman, E. M., Lavender, J. M., Tull, M. T., & Gratz, K. L. (2014). The pursuit of death versus escape from negative affect: An examination of the nature of the relationship between emotion dysregulation and both suicidal behavior and non-suicidal self-injury. Comprehensive Psychiatry, 55, 1820–1830. Scholar
  4. Anestis, M. D., Knorr, A. C., Tull, M. T., Lavender, J. M., & Gratz, K. L. (2013a). The importance of high distress tolerance in the relationship between nonsuicidal self-injury and suicide potential. Suicide and Life Threatening Behavior, 43, 663–675. Scholar
  5. Anestis, M. D., Pennings, S. M., Lavender, J. M., Tull, M. T., & Gratz, K. L. (2013b). Low distress tolerance as an indirect risk factor for suicidal behavior: considering the explanatory role of non-suicidal self-injury. Comprehensive Psychiatry, 54, 996–1002. Scholar
  6. Arens, A. M. (2012). Psychological mechanisms linking child maltreatment and non-suicidal self-injury. Vermillion: University of South Dakota.Google Scholar
  7. Arens, A. M., Gaher, R. M., Simons, J. S., & Dvorak, R. D. (2014). Child maltreatment and deliberate self-harm: a negative binomial hurdle model for explanatory constructs. Child Maltreatment, 19, 168–177. Scholar
  8. Arbuckle, J. L. (1997). Amos users guide: Version3. Chicago: SmallWaters Corporation.Google Scholar
  9. Arbuckle, J. L. (2010). IBM SPSS Amos19 user’s guide. Chicago: IBM SPSS.Google Scholar
  10. Auerbach, R. P., Kim, J. C., Chango, J. M., Spiro, W. J., Cha, C., Gold, J., & Nock, M. K. (2014). Adolescent nonsuicidal self-injury: examining the role of child abuse, comorbidity, and disinhibition. Psychiatry Research, 220, 579–584. Scholar
  11. Banducci, A. N., Hoffman, E. M., Lejuez, C., & Koenen, K. C. (2014). The impact of childhood abuse on inpatient substance users: Specific links with risky sex, aggression, and emotion dysregulation. Child Abuse and Neglect, 38, 928–938. Scholar
  12. Bolger, K. E., & Patterson, C. J. (2001). Pathways from child maltreatment to internalizing problems: Perceptions of control as mediators and moderators. Development and Psychopathology, 13, 913–940.PubMedGoogle Scholar
  13. Bollen, K. A. (1989). Structural equations with latent variables. New York: Wiley.Google Scholar
  14. Bresin, K., & Schoenleber, M. (2015). Gender differences in the prevalence of nonsuicidal self-injury: a meta-analysis. Clinical Psychology Review, 38, 55–64. Scholar
  15. Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. Sociological Method and Research, 154, 132–162. Scholar
  16. Buckholdt, K. E., Parra, G. R., & Jobe-Shields, L. (2009). Emotion regulation as a mediator of the relation between emotion socialization and deliberate self-harm. American Journal of Orthopsychiatry, 79, 482–490. Scholar
  17. Buser, T. J., & Hackney, H. (2012). Explanatory style as a mediator between childhood emotional abuse and nonsuicidal self-Injury. Journal of Mental Health Counseling, 34, 154–169. Scholar
  18. Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behaviour Research and Therapy, 44, 371–394. Scholar
  19. Chen, Y., Liu, X., Huang, Y., Yu, H., Yuan, S., Ye, Y., & He, Q. (2017). Association between child abuse and health risk behaviors among Chinese college students. Journal of Child and Family Studies, 26, 1380–1387. Scholar
  20. Cui, N., & Liu, J. (2018). Physical abuse, emotional abuse, and neglect and childhood behavior problems: a meta-analysis of studies in mainland China. Trauma Violence Abuse, 1–19.
  21. Cui, N., Xue, J., Connolly, C. A., & Liu, J. (2016). Does the gender of parent or child matter in child maltreatment in China? Child Abuse and Neglect, 54, 1–9. Scholar
  22. Cummings, J. R., Bornovalova, M. A., Ojanen, T., Hunt, E., MacPherson, L., & Lejuez, C. (2013). Time doesn’t change everything: the longitudinal course of distress tolerance and its relationship with externalizing and internalizing symptoms during early adolescence. Journal of Abnormal Child Psychology, 41, 735–748. Scholar
  23. Garisch, J. A., & Wilson, M. S. (2015). Prevalence, correlates, and prospective predictors of non-suicidal self-injury among New Zealand adolescents: cross-sectional and longitudinal survey data. Child Adolescent Psychiatry and Mental Health, 9, 1–11. Scholar
  24. Glaser, D. (2002). Emotional abuse and neglect (psychological maltreatment): a conceptual framework. Child Abuse and Neglect, 26, 697–714. Scholar
  25. Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., & Lejuez, C. W. (2007). A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behavior Therapy, 38, 256–268. Scholar
  26. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. Scholar
  27. Jaffee, S. R. (2017). Child maltreatment and risk for psychopathology in childhood and adulthood. Annual Review of Clinical Psychology, 13, 525–551. Scholar
  28. Lerner, R. M., & Steinberg, L. (2009). Handbook of adolescent psychology. 3rd edn. Hoboken, NJ: Wiley.CrossRefGoogle Scholar
  29. Lewis, A. J., Kremer, P., Douglas, K., Toumborou, J. W., Hameed, M. A., & Patton, G. C., et al. (2015). Gender differences in adolescent depression: Differential female susceptibility to stressors affecting family functioning. Australian Journal of Psychology, 67, 131–139. Scholar
  30. Lin, M.P., You, J., Wu, Y.W., & Jiang, Y. (2017). Depression mediates the relationship between distress tolerance and nonsuicidal self-Injury among adolescents: one-year follow-up. Suicide and Life-Threatening Behavior, 1–12.
  31. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
  32. Liu, R. T., Scopelliti, K. M., Pittman, S. K., & Zamora, A. S. (2018). Childhood maltreatment and non-suicidal self-injury: a systematic review and meta-analysis. The Lancet Psychiatry, 5, 51–64. Scholar
  33. Muehlenkamp, J. J., Laurence, C., Lindsey, H., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Chinese Medicine, 6, 1–9. Scholar
  34. Muthén, L. K., & Muthén, B. O. (2012). Mplus user’s guide. 7th edn. Los Angeles, CA: Muthén and Muthén.Google Scholar
  35. Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 1–25. Scholar
  36. Nock, M. K., & Mendes, W. (2008). Physiological arousal, distress tolerance, and social problem solving deficits among adolescent self-injurers. Journal of Consulting and Clinical Psychology, 76, 28–38. Scholar
  37. Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: the role of gender. Annual Review of Clinical Psychology, 8, 161–187. Scholar
  38. Peh, C. X., Shahwan, S., Fauziana, R., Mahesh, M. V., Sambasivam, R., Zhang, Y., & Subramaniam, M. (2017). Emotion dysregulation as a mechanism linking child maltreatment exposure and self-harm behaviors in adolescents. Child Abuse and Neglect, 67, 383–390. Scholar
  39. Plener, P. L., Schumacher, T. S., Munz, L. M., & Groschwitz, R. C. (2015). The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature. Borderline Personality Disorder and Emotion Dysregulation, 2, 1–11. Scholar
  40. Preacher, K., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 20, 879–891. Scholar
  41. Selby, E. A., Franklin, J., Carson-Wong, A., & Rizvi, S. L. (2013). Emotional cascades and self-injury: Investigating instability of rumination and negative emotion. Journal of Clinical Psychology, 69, 1213–1227. Scholar
  42. Shen, A. C. T. (2009). Long-term effects of interparental violence and child physical maltreatment experiences on PTSD and behavior problems: A national survey of Taiwanese college students. Child Abuse and Neglect, 33, 148–160. Scholar
  43. Silvers, J. A., McRae, K., Gabrieli, J. D., Gross, J. J., Remy, K. A., & Ochsner, K. N. (2012). Age-related differences in emotional reactivity, regulation, and rejection sensitivity in adolescence. Emotion, 12, 1235–1247. Scholar
  44. Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: development and validation of a self-report measure. Motivation and Emotion, 29, 83–102. Scholar
  45. Swannell, S., Martin, G., Page, A., Hasking, P., Hazell, P., Taylor, A., & Protani, M. (2012). Child maltreatment, subsequent non-suicidal self-injury and the mediating roles of dissociation, alexithymia and self-blame. Child Abuse and Neglect, 36, 572–584. Scholar
  46. Tang, J., Li, G., Chen, B., Huang, Z., Zhang, Y., Chang, H., & Yu, Y. (2018). Prevalence of and risk factors for non-suicidal self-injury in rural China: results from a nationwide survey in China. Journal of Affective Disorders, 226, 188–195. Scholar
  47. Thomassin, K., Shaffer, A., Madden, A., & Londino, D. L. (2016). Specificity of childhood maltreatment and emotion deficit in nonsuicidal self-injury in an inpatient sample of youth. Psychiatry Research, 244, 103–108. Scholar
  48. Tull, M. T., SpringerAmpamp; Aldao, A. (2015). Editorial overview: new directions in the science of emotion regulation. Current Opinion in Psychology, 3, 4–10. Scholar
  49. Van Campen, K. S., & Russell, S. T. (2010). Cultural differences in parenting practices: What Asian American families can teach us (Frances McClelland Institute for Children, Youth, and Families Research Link, Vol. 2, No. 1). Tucson, AZ: The University of Arizona.Google Scholar
  50. World Health Organization. (2018). Maternal, newborn, child and adolescent health: adolescent development.
  51. Xing, X., Wang, M., Zhang, Q., He, X., & Zhang, W. (2011). Gender differences in the reciprocal relationships between parental physical aggression and children’s externalizing problem behavior in China. Journal of Family Psychology, 25, 699–708. Scholar
  52. Yates, T. (2004). The developmental psychopathology of self-injurious behavior: Compensatory regulation in posttraumatic adaptation. Clinical Psychology Review, 24, 35–74. Scholar
  53. You, J., & Leung, F. (2012). The role of depressive symptoms, family invalidation and behavioral impulsivity in the occurrence and repetition of non-suicidal self-injury in Chinese adolescents: A 2-year follow-up study. Journal of Adolescence, 35, 389–395. Scholar
  54. You, J., & Lin, M. P. (2015). Predicting suicide attempts by time-varying frequency of nonsuicidal self-injury among Chinese community adolescents. Journal of Consulting and Clinical Psychology, 83, 524–533. Scholar
  55. Zanarini, M. C., Gunderson, J. G., Frankenburg, F. R., & Chauncey, D. L. (1989). The revised diagnostic interview for borderlines: Discriminating BPD from other axis II disorders. Journal of Personality Disorders, 3, 10–19. Scholar
  56. Zhu, X. H., Li, J., Yang, Y. J., Wei, X. Y., Tian, Y. X., Qiao, J., & Zuo, X. W. (2006). Personal report of childhood abuse reliability and validity in a community. Chinese Journal of Behavioral Medicine Science, 11, 10451047.Google Scholar
  57. Zvolensky, M. J., & Hogan, J. (2013). Distress tolerance and its role in psychopathology. Cognitive Therapy and Research, 37, 419–420. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science and School of PsychologySouth China Normal UniversityGuangzhouPeople’s Republic of China
  2. 2.School of PsychologyBeijing Normal UniversityBeijingPeople’s Republic of China
  3. 3.Department of PsychologyChinese University of Hong KongHong KongPeople’s Republic of China

Personalised recommendations