Clinical features and psychological resilience of adolescent patients with depressive disorder and non-suicidal self-harm behaviors:A survey analysis of the depressive dual-pathway model

CAI Lifei; WANG Shibin; SHAO Hua; LUO Guowei; XIAO Yuqing; JIA Fujun

doi:10.3969/j.issn.1006-5725.2025.24.005

Abstract：Objective To investigate the clinical characteristics of depressive disorders in adolescents with non-suicidal self-injury(NSSI)behaviors and to analyze the impact mechanism of childhood trauma on NSSI through a psychological resilience-depression dual-pathway model.Methods A case-control study was conducted involving 99 participants aged 12～18 years,comprising 51 individuals with depression and NSSI(KD group),24 healthy controls(NOR1 group),and 24 patients with depression but without NSSI(NOR2 group).The Child-hood Trauma Questionnaire(CTQ),Resilience Scale for Chinese Adolescents(RSCA),and the 24-item Hamilton Depression Rating Scale(HAMD-24)were administered to assess childhood trauma,psychological resilience,and depressive symptom severity,respectively.Structural equation modeling was used to examine the mediating role of psychological resilience and the moderating effect of depression severity in the relationship between childhood trauma and NSSI.Results In the KD group,84.3%of participants reported experiencing childhood trauma,with emotional neglect(64.7%)and physical neglect(50.1%)being the most prevalent types.Emotional neglect(r=0.582,P<0.001)and physical abuse(r=0.464,P=0.002)were significantly associated with NSSI behaviors.Mediation analysis indicated that psychological resilience partially mediated the relationship between childhood trauma and NSSI,such that trauma exposure indirectly increased NSSI risk through reduced psychological resil-ience,with this indirect effect accounting for 45.7%(95%CI:15.3%～48.1%,P<0.01).Moderation analysis further revealed that the effect of trauma on NSSI was more pronounced among individuals with high levels of depression(HAMD-24≥20),where the association was statistically significant(β=0.603,P<0.01).Conclusions This study reveals that childhood trauma,particularly emotional neglect and abuse,is highly prevalent(>84%)among adolescents exhibiting depressive symptoms and NSSI.A moderated mediation model was constructed and vali-dated,demonstrating that childhood trauma not only directly predicts NSSI but also exerts an indirect effect through diminished psychological resilience,with depressive symptoms serving as a dual moderator in both the direct and indirect pathways.These findings offer a multi-targeted foundation for clinical interventions,highlighting the importance of systematic trauma screening,the promotion of psychological resilience,and the active manage-ment of depressive symptoms.