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Longitudinal Relations Between Childhood Maltreatment, Emotion Regulation Difficulties, and Suicidal Ideation and Non-Suicidal Self-Injury: An 18-Month Investigation of Psychiatrically Hospitalized Adolescents


Within the Dimensional Model of Adversity and Psychopathology, extant research shows that exposure to threat—including emotional, physical, and sexual abuse—is linked to psychopathology among adolescents; problems with emotion regulation may, at least in part, explain this association. Both theoretical and empirical work also suggests that emotion regulation difficulties—particularly access to emotion regulation strategies—may mediate the relation between threat and self-injurious thoughts and behavior, though no studies to date have explicitly tested this model. The current study tested relations between threat, limited access to emotion regulation strategies, and self-injurious thoughts and behaviors among high-risk youth across an 18-month follow-up. The sample consisted of 180 adolescents (Mage = 14.89; SD = 1.35; ages 12–17; 71.7% female; 78.9% White; 55.0% heterosexual) recruited from an inpatient psychiatric unit. Threat was assessed at baseline using the abuse subscales from Childhood Trauma Questionnaire. Access to emotion regulation strategies was assessed using the Difficulties in Emotion Regulation Scale at baseline, 6-, and 12-months. Presence (versus absence) of non-suicidal self-injury and suicidal ideation severity were assessed at baseline, 12-, and 18-months using the Self-Injurious Thoughts and Behaviors Interview and the Suicidal Ideation Questionnaire-JR, respectively. After accounting for baseline levels of the mediator, outcome, and depressive symptoms, structural equation models supported the role of 12-month access to emotion regulation strategies as a mediator between baseline threat and 18-month suicidal ideation and non-suicidal self-injury. Treatment aimed at bolstering access to emotion regulation strategies may help reduce suicide risk among youth who have experienced childhood abuse.

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Data Availability

Data available upon request.


  1. Using this procedure, the 12-month SI model initially calculated a small, non-significant negative residual variance for baseline emotional abuse (σ = -0.18, p = 0.978). In line with SEM conventions, this residual was constrained to zero, which did not significant degrade model fit (S-B \(\Delta \chi^{2}\)(1) = 0.002, p = 0.969; see Kolenikov & Bollen, 2012). Therefore, this altered model with a constrained residual variance for baseline emotional abuse became the model from which the most parsimonious model was obtained for the 12-month SI outcome.

  2. As significant predictors of SITBs (Cha et al., 2018), sex and sexual identity were included in the initial models. However, the pattern of results was equivalent to those presented here. For parsimony and space considerations, results were reported without these predictors in the model.


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Preparation of this manuscript was supported in part by the National Institute of Mental Health of the National Institutes of Health under Award Numbers R01MH101138, R01MH115905, RF1MH120830, R01MH124899, and F32MH127795.

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Correspondence to Jennifer A. Poon.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the the Rhode Island Hospital Institutional Review Board.

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Poon, J.A., López, R., Marie-Shea, L. et al. Longitudinal Relations Between Childhood Maltreatment, Emotion Regulation Difficulties, and Suicidal Ideation and Non-Suicidal Self-Injury: An 18-Month Investigation of Psychiatrically Hospitalized Adolescents. Res Child Adolesc Psychopathol 51, 1315–1326 (2023).

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