The Influence of Childhood Adversity and Negative Emotional States on Non-Suicidal Self-Injury in Chinese College Students

Objective: The current study examines associations between childhood adversity, negative emotional states and the presence of non-suicidal self-injury (NSSI) in Chinese college students.

Methods: The study used convenience sampling. Participants were 1,510 Chinese college students (response rate 83%) in Suzhou city, East Mainland China, aged between 18 and 24 (M=19.17, SD=1.06), 58% female. Data were collected via anonymous self-report questionnaires administered in classes on campus. Main measures include Deliberate Self-Harm Inventory, Childhood Trauma Questionnaire, Witnessing Inter-parental Violence (CTS2-CA), The Experience of Shame Scale, Trait Anger Subscale (STAXI-T), and Depression (PHQ-9). First, age, physical abuse, sexual abuse, emotional abuse, witnessing inter-parental violence were entered in the Model 1 of a logistic regression analysis. In Model 2, shame, anger and depression were added to the model. The analysis runs separately by gender.

Results: The lifetime prevalence of NSSI among Chinese college students was 26.5% (n=1510), and was similar between females (25.5%, n=223) and males (27.9%, n=177). The logistic regression analysis results differed by gender. In Model 1, compared to no child maltreatment and intimate partner violence exposure, emotional abuse (OR1.75, 95% CI 1.18-2.58), physical abuse (OR2.07, 95% CI 1.18-3.63), sexual abuse (OR2.11, 95% CI 1.23-3.62) and witnessing inter-parental violence (OR1.62, 95% CI 1.16-2.26) independently increased the odds of NSSI among females after controlling for age. Emotional abuse (OR2.44, 95% CI 1.56-3.81) and witnessing inter-parental violence (OR2.12, 95% CI 1.44-3.11) independently increased the odds of NSSI among males after controlling for age. In Model 2, negative emotional states were added to the model. For females, shame and depression had a significant effect on the presence of NSSI after childhood adversity variables and age were controlled for. Moreover, emotional abuse was not significantly associated NSSI when negative emotional states were included in the model. For males, anger had a significant effect on the presence of NSSI after childhood adversity variables and age were controlled for.

Conclusion: The present study revealed gender differences in the association between childhood maltreatment types, negative emotional states and later NSSI in Chinese college students. The result indicated that physical abuse, sexual abuse, witnessing inter-parental violence, shame and depression were strongly associated with NSSI for female Chinese students. What is important is that the introduction of shame and depression in the model 2 reduces the effect of emotional abuse to nonsignificance. This makes clear the reason why NSSI were linked to emotional abuse: emotional abuse tends to endorse shame and depression, which in turn account for NSSI. After shame and depression were taken into account, childhood emotional abuse has no additional effect on NSSI for female Chinese students. Furthermore, emotional abuse, witnessing inter-parental violence, anger were strongly associated with NSSI for male Chinese students. Intimate partner violence exposure increased the odds of NSSI for both males and females. Negative emotional states were significant predictors of NSSI after age and childhood-violence experiences were controlled for. The study suggests that preventive and intervention program for NSSI in Chinese college students requires addressing both childhood violence trauma and negative emotional states.