From early trauma to self-harm: a parallel and serial mediation model of self-efficacy, psychological resilience, and depression in adolescents

Abstract

Examining the associations between childhood trauma and non-suicidal self-injury (NSSI) among adolescents suffering depressive disorders, and the statistical mediating roles of self-efficacy, psychological resilience, and depression. 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. 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 showed a parallel and serial mediation with NSSI through self-efficacy, psychological resilience, and depression. Childhood trauma showed direct and indirect associations with NSSI, with self-efficacy, psychological resilience, and depression statistically accounting for the indirect association. These findings highlight the key role of psychosocial mechanisms in understanding NSSI and suggest that interventions for adolescents with childhood trauma may benefit from prioritizing screening, enhancing self-efficacy and resilience, and managing depressive symptoms.