Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China.
RATIONALE: Although childhood maltreatment is known to be associated with non-suicidal self-injury (NSSI), few studies have investigated the mediating effect of self-esteem on this relationship. Additionally, it is unknown whether the impacts vary by sex or only-child status.
OBJECTIVE: We investigated the mediating effects of self-esteem on the relationship between childhood maltreatment and NSSI in adolescents and identified the significance of sex and only child status.
METHOD: An adolescent health survey was conducted in 15 schools in China between 2013 and 2014. In total, 9704 students aged 11-19 years completed standard questionnaires to report the details of childhood maltreatment, NSSI, and self-esteem.
RESULTS: Childhood maltreatment was negatively correlated with self-esteem and positively correlated with the frequency of NSSI. Lower self-esteem was also correlated with higher NSSI frequency. Self-esteem mediated the relationship between childhood maltreatment and NSSI, and the estimated ratio of the total effect of childhood maltreatment that could be explained by mediation through self-esteem was 16.3%. The ratio was higher in boys (28.6%) than in girls (9.9%), and it was higher in only children (31.5%) than in children with siblings (11.0%).
CONCLUSIONS: Childhood maltreatment is positively correlated with the frequency of NSSI and may be mediated by self-esteem. Interventions aimed at reducing NSSI associated with childhood maltreatment may be enhanced by efforts to strengthen self-esteem, especially in boys and only children.