Abstract
Although non-suicidal self-injury (NSSI) is a worldwide public health concern, the prevalence rate and risk factors for it among Chinese university students are not known. The present study aimed to address these knowledge gaps and examine the interrelationship between child abuse and NSSI frequency and functions as well as psychiatric co-morbidity with emotion dysregulation as a mediator and attachment style as a moderator. Five hundred and thirty-six (F = 359, M = 177) Chinese university students were recruited from two universities in Hong Kong and completed the Functional Assessment of Self-Mutilation, Childhood Trauma Questionnaire, Revised Adult Attachment Scale, Difficulties in Emotion Regulation Scale and General Health Questionnaire–28. The findings showed that the prevalent rate of NSSI was 22% in the past year. The results showed that child abuse was significantly correlated with psychiatric co-morbidity and emotion dysregulation, and the latter was also significantly correlated with positive and negative reinforcement, and psychiatric co-morbidity. Moderation effects were not established. Non-suicidal self-injurious behaviour was relatively common among Chinese university students in Hong Kong. Their difficulties in regulating their emotions may influence why they hurt themselves and the severity of psychological distress, especially for those who experienced a high level of child abuse in the past.
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The authors declare that all data supporting the findings of this study are available within the article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
Arens, A. M., Gaher, R. M., & Simons, J. S. (2012). Child maltreatment and deliberate self-harm among college students: Testing mediation and moderation models for impulsivity. American Journal of Orthopsychiatry, 82(3), 328–337. https://doi.org/10.1111/j.1939-0025.2012.01165.x.
Baiden, P., Stewart, S. L., & Fallon, B. (2017). The role of adverse childhood experiences as determinants of non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings. Child Abuse & Neglect, 69, 163–176. https://doi.org/10.1016/j.chiabu.2017.04.011.
Barlow, M. R., Goldsmith Turow, R. E., & Gerhart, J. (2017). Trauma appraisals, emotion regulation difficulties, and self-compassion predict posttraumatic stress symptoms following childhood abuse. Child Abuse and Neglect, 65, 37–47. https://doi.org/10.1016/j.chiabu.2017.01.006.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. https://doi.org/10.1037/0022-3514.51.6.1173.
Bond, M. H. (1993). Emotions and their expression in Chinese culture. Journal of Non-verbal Behaviour, 17(4), 245–262.
Bowlby, J. (1977). The making and breaking of affectional bonds. II. Some principles of psychotherapy. The fiftieth Maudsley Lecture. British Journal of Psychiatry, 130(5), 421–431. https://doi.org/10.1192/bjp.130.5.421.
Bowlby, J. (1982). Attachment and loss: Retrospect and Prospect. American Journal of Orthopsychiatry, 52(4), 664–678. https://doi.org/10.1111/j.1939-0025.1982.tb01456.x.
Breen, A. V., Lewis, S. P., & Sutherland, O. (2013). Brief report: Non-suicidal self-injury in the context of self and identity development. Journal of Adult Development, 20(1), 57–62. https://doi.org/10.1007/s10804-013-9156-8.
Bresin, K. (2013). Five indices of emotion regulation in participants with a history of nonsuicidal self-injury: A daily diary study. Behavior Therapy, 45(1), 56–66. https://doi.org/10.1016/j.beth.2013.09.005.
Briere, J. (1992). Methodological issues in the study of sexual abuse effects. Journal of Consulting and Clinical Psychology, 60(2), 196–203. https://doi.org/10.1037//0022-006X.60.2.196.
Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68(4), 609–620. https://doi.org/10.1037/h0080369.
Briere, J. (2002). Treating adult survivors of severe childhood abuse and neglect: further development of an integrative model (From The APSAC [American Professional Society on the Abuse of Children] Handbook on Child Maltreatment, P 175–203, 2002, John EB Myers, Lucy Berliner, et al., eds. 19.
Cabral, J., Matos, P. M., Beyers, W., & Soenens, B. (2012). Attachment, emotion regulation and coping in Portuguese emerging adults: A test of a mediation hypothesis. The Spanish Journal of Psychology, 15(3), 1000–1012. https://doi.org/10.5209/rev_SJOP.2012.v15.n3.39391.
Caputo, A. (2017). Social desirability bias in self-reported well-being measures: Evidence from an online survey. Universitas Psychologica, 16(2), 245-255. https://doi.org/10.11144/Javeriana.upsy16-2.sdsw.
Chesin, M. S., Moster, A. N., & Jeglic, E. L. (2013). Non-suicidal self-injury among ethnically and racially diverse emerging adults: Do factors unique to the minority experience matter? Current psychology (New Brunswick, N.J.), 32(4), 318-328. https://doi.org/10.1007/s12144-013-9185-2, 32, 318, 328.
Cheung, Y. T. D., Wong, P. W. C., Lee, A. M., Lam, T. H., Fan, Y. S. S., & Yip, P. S. F. (2013). Non-suicidal self-injury and suicidal behavior: Prevalence, co-occurrence, and correlates of suicide among adolescents in Hong Kong. Social Psychiatry Psychiatric Epidemiology, 48(7), 1133–1144. https://doi.org/10.1007/s00127-012-0640-4.
Cole, D. A., & Maxwell, S. E. (2003). Testing Mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112(4), 558–577. https://doi.org/10.1037/0021-843X.112.4.558.
Colleen, M. L., & Komal, S. P. (2011). The relation between childhood maltreatment and self-injury: A review of the literature on conceptualization and intervention. Trauma Violence & Abuse, 12(1), 23–37. https://doi.org/10.1177/1524838010386975.
Connors, R. (1996). Self-injury in trauma survivors: 1. Functions and meanings. American Journal of Orthopsychiatry, 66(2), 197–206. https://doi.org/10.1037/h0080171.
Costigan, C. L., Hua, J. M., & Su, T. F. (2010). Living up to expectations: The strengths and challenges experienced by Chinese Canadian students. Canadian Journal of School Psychology, 25(3), 223–245. https://doi.org/10.1177/0829573510368941.
Crow, T., Cross, D., Powers, A., & Bradley, B. (2014). Emotion dysregulation as a mediator between childhood emotional abuse and current depression in a low-income African-American sample. Child Abuse & Neglect, 38(10), 1590–1598. https://doi.org/10.1016/j.chiabu.2014.05.015.
D'Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. A. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187–200. https://doi.org/10.1111/j.1939-0025.2012.01154.x.
Enders, C. K. (2011). Missing not at random models for latent growth curve analyses. Psychological Methods, 16(1), 1–16. https://doi.org/10.1037/a0022640.
Erozkan, A. (2016). The link between types of attachment and childhood trauma. Universal Journal of Educational Research, 4(5), 1071-1079. https://doi.org/10.13189/ujer.2016.040517.
Fox, K. R., Ribeiro, J. D., Kleiman, E. M., Hooley, J. M., Nock, M. K., & Franklin, J. C. (2018). Affect toward the self and self-injury stimuli as potential risk factors for nonsuicidal self-injury. Psychiatry Research, 260, 279–285. https://doi.org/10.1016/j.psychres.2017.11.083.
Goldberg, D., & Bridges, K. (1987). Screening for psychiatric illness in general practice: The general practitioner versus the screening questionnaire. The Journal of the Royal College of General Practitioners, 37(294), 15–18.
He, J., Zhong, X., Gao, Y., Xiong, G., & Yao, S. (2019). Psychometric properties of the Chinese version of the childhood trauma questionnaire-short form (CTQ-SF) among undergraduates and depressive patients. Child Abuse & Neglect, 91, 102–108. https://doi.org/10.1016/j.chiabu.2019.03.009.
Hentschel, U., Draguns, J. G., Ehlers, W., & Smith, G. (2004). Defense mechanisms: Current approaches to research and measurement. In U. Hentschel, G. Smith, J. G. Draguns, & W. Ehlers (Eds.), Defense mechanisms: Theoretical, research and clinical perspectives (pp. 3–41, chapter xviii, 646 pages). Elsevier Science Ltd, Oxford.
Holland, P. W. (1986). Statistics and causal inference. Journal of the American Statistical Association, 81(396), 945–960. https://doi.org/10.1080/01621459.1986.10478354.
Huh, H. J., Kim, K. H., Lee, H.-K., & Chae, J.-H. (2017). The relationship between childhood trauma and the severity of adulthood depression and anxiety symptoms in a clinical sample: The mediating role of cognitive emotion regulation strategies. Journal of Affective Disorders, 213, 44–50. https://doi.org/10.1016/j.jad.2017.02.009.
Isohookana, R., Marttunen, M., Hakko, H., Riipinen, P., & Riala, K. (2016). The impact of adverse childhood experiences on obesity and unhealthy weight control behaviors among adolescents. Comprehensive Psychiatry, 71, 17–24. https://doi.org/10.1016/j.comppsych.2016.08.002.
Janoff-Bulman, R. (2010). Shattered assumptions. Simon and Schuster.
Jayawickreme, N., Jayawickreme, E., & Foa, E. B. (2013). Using the individualism-collectivism construct to understand cultural differences in PTSD. In (pp. 55–76). In K. Gow & M. Celinski (Eds.), Natural disaster research, prediction and mitigation. Mass trauma: Impact and recovery issues (p. 55–76). Nova Science Publishers.
Jennissen, S., Holl, J., Mai, H., Wolff, S., & Barnow, S. (2016). Emotion dysregulation mediates the relationship between child maltreatment and psychopathology: A structural equation model. Child Abuse & Neglect, 62, 51–62. https://doi.org/10.1016/j.chiabu.2016.10.015.
Jianing, Y., Congfen, M., Min-Pei, L., & Freedom, L. (2015). Comparing among the experiences of self-cutting, hitting, and scratching in Chinese adolescents attending secondary schools: An interview study. Behavioral disorders, 40(2), 122-137. https://doi.org/10.17988/BD-14-9.1.
Johnstone, J. M., Carter, J. D., Luty, S. E., Mulder, R. T., Frampton, C. M., & Joyce, P. R. (2016). Childhood predictors of lifetime suicide attempts and non-suicidal self-injury in depressed adults. Australian and New Zealand Journal of Psychiatry, 50(2), 135–144. https://doi.org/10.1177/0004867415585581.
Jungmeen, K.-S., Dante, C., & Fred, A. R. (2013). A longitudinal study of emotion regulation, emotion Lability-negativity, and internalizing symptomatology in maltreated and nonmaltreated children. Child Development, 84(2), 512–527. https://doi.org/10.1111/j.1467-8624.2012.01857.x.
Kharsati, N., & Bhola, P. (2016). Self-injurious behavior, emotion regulation, and attachment styles among college students in India. Industrial Psychiatry Journal, 25(1), 23–28. https://doi.org/10.4103/0972-6748.196049.
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226–239. https://doi.org/10.1016/j.cpr.2006.08.002.
Kokaliari, E. D. (2014). An exploratory study of the nature and extent of nonsuicidal self-injury among college women. International journal of population research, 2014, 1–7. https://doi.org/10.1155/2014/879269.
Lee, D. J., Witte, T. K., Weathers, F. W., & Davis, M. T. (2015). Emotion regulation strategy use and posttraumatic stress disorder: Associations between multiple strategies and specific symptom clusters. Journal of Psychopathology and Behavioral Assessment, 37(3), 533–544. https://doi.org/10.1007/s10862-014-9477-3.
Leong, C. H., Wu, A. M. S., & Poon, M. M.-y. (2014). Measurement of perceived functions of non-suicidal self-injury for Chinese adolescents. Archives of Suicide Research, 18(2), 193–212. https://doi.org/10.1080/13811118.2013.824828.
Li, J., Han, Z. R., Gao, M. M., Sun, X., & Ahemaitijiang, N. (2018). Psychometric properties of the Chinese version of the difficulties in emotion regulation scale (DERS): Factor structure, reliability, and validity. Psychological Assessment, 30(5), e1–e9. https://doi.org/10.1037/pas0000582.
MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39(1), 99–128. https://doi.org/10.1207/s15327906mbr3901_4.
Mickelson, K. D., Kessler, R. C., & Shaver, P. R. (1997). Adult attachment in a nationally representative sample. Journal of Personality and Social Psychology, 73(5), 1092–1106. https://doi.org/10.1037/0022-3514.73.5.1092.
Mikulincer, M., & Shaver, P. R. (2019). Attachment orientations and emotion regulation. Current Opinion in Psychology, 25, 6–10. https://doi.org/10.1016/j.copsyc.2018.02.006.
Mischel, W., & Shoda, Y. (1995). A cognitive-affective system theory of personality: Reconceptualizing situations, dispositions, dynamics, and invariance in personality structure. Psychological Review, 102(2), 246–268. https://doi.org/10.1037/0033-295X.102.2.246.
Mortenson, S. T. (2006). Cultural differences and similarities in seeking social support as a response to academic failure: A comparison of American and Chinese college students. Communication Education, 55(2), 127–146. https://doi.org/10.1080/03634520600565811.
Navarro-Haro, M. V., Wessman, I., Botella, C., & García-Palacios, A. (2015). The role of emotion regulation strategies and dissociation in non-suicidal self-injury for women with borderline personality disorder and comorbid eating disorder. Comprehensive Psychiatry, 63, 123–130. https://doi.org/10.1016/j.comppsych.2015.09.001.
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-Mutilative behavior. Journal of Consulting Clinical Psychology, 72(5), 885–890. https://doi.org/10.1037/0022-006X.72.5.885.
Pascuzzo, K., Cyr, C., & Moss, E. (2013). Longitudinal association between adolescent attachment, adult romantic attachment, and emotion regulation strategies. Attachment and Human Development, 15(1), 83–103. https://doi.org/10.1080/14616734.2013.745713.
Paul, E., Tsypes, A., Eidlitz, L., Ernhout, C., & Whitlock, J. (2014). Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors. Psychiatry Research, 225(3), 276–282. https://doi.org/10.1016/j.psychres.2014.12.026.
Powers, A., Cross, D., Fani, N., & Bradley, B. (2014). PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample. Journal of Psychiatric Research, 61, 174–179. https://doi.org/10.1016/j.jpsychires.2014.12.011.
Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7(2), 147–177. https://doi.org/10.1037/1082-989X.7.2.147.
Tan, A. C. Y., Rehfuss, M. C., Suarez, E. C., & Parks-Savage, A. (2015). Nonsuicidal self-injury in an adolescent population in Singapore (vol 19, pg 58, 2014). Clinical Child Psychology and Psychiatry, 20(3), 525–525. https://doi.org/10.1177/1359104515594961.
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. https://doi.org/10.1016/j.psychres.2016.07.050.
Thomson, P., & Jaque, S. V. (2018). Childhood adversity and the creative experience in adult professional performing artists. Frontiers in Psychology, 9, 111–111. https://doi.org/10.3389/fpsyg.2018.00111.
Tresno, F., Ito, Y., & Mearns, J. (2012). Self-injurious behavior and suicide attempts among Indonesian college students. Death Studies, 36(7), 627–639. https://doi.org/10.1080/07481187.2011.604464.
Tresno, F., Ito, Y., & Mearns, J. (2013). Risk factors for nonsuicidal self-injury in Japanese college students: The moderating role of mood regulation expectancies. International Journal of Psychology, 48(6), 1009–1017. https://doi.org/10.1080/00207594.2012.733399.
Unger, J. A. M., & De Luca, R. V. (2014). The relationship between childhood physical abuse and adult attachment styles. Journal of Family Violence, 29(3), 223–234. https://doi.org/10.1007/s10896-014-9588-3.
Van der Kolk, B. A., Perry, J. C., & Herman, J. L. (1991). Childhood origins of self-destructive behavior. American Journal of Psychiatry, 148(12), 1665–1671.
Wu, W. L., Zhang, W., & Liu, X. H. (2004). The reliability and validity of adult attachment scale (AAS-1996 revised edition): A report on its application in China. Sichuan Da Xue Xue Bao. Yi Xue Ban, 35(4), 536–538.
Yates, T. M. (2004). The developmental psychopathology of self-injurious behavior: Compensatory regulation in posttraumatic adaptation. Clinical Psychology Review, 24(1), 35–74. https://doi.org/10.1016/j.cpr.2003.10.001.
You, J., Leung, F., Fu, K., & Lai, C. M. (2011). The prevalence of nonsuicidal self-injury and different subgroups of self-injurers in Chinese adolescents. Archives of Suicide Research, 15(1), 75–86. https://doi.org/10.1080/13811118.2011.540211.
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Wong, S.L., Chung, M.C. Child abuse and non-suicidal self-injury among Chinese university students: the role of emotion dysregulation and attachment style. Curr Psychol 42, 4862–4872 (2023). https://doi.org/10.1007/s12144-021-01832-2
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DOI: https://doi.org/10.1007/s12144-021-01832-2