title: Emotion dysregulation as a mechanism linking child maltreatment exposure and self-harm behaviors in adolescents.
abstract: Although child maltreatment exposure is a recognized risk factor for self-harm, mechanisms underlying this relationship remain unclear. Self-harm may function as a compensatory strategy to regulate distressing emotions. This cross-sectional study examines if emotion dysregulation mediates between the severity of maltreatment exposure and self-harm, adjusting for demographic variables and depressive symptoms. Participants were 108 adolescent patients recruited from a psychiatric hospital in Singapore (mean age 17.0 years, SD=1.65; 59.3% female). Study measures included the Childhood Trauma Questionnaire (CTQ-SF), Functional Assessment of Self-Mutilation (FASM), Difficulties in Emotion Regulation Scale (DERS), and the Patient Health Questionnaire (PHQ-8). Path analysis was conducted to examine the direct and indirect effects of maltreatment exposure on self-harm via emotion dysregulation, controlling for demographic variables and depressive symptoms. Indirect effects were tested using bootstrapped confidence intervals (CI). Results showed that self-harm was highly prevalent in our sample (75.9%). Emotion dysregulation and depressive symptoms were found to be associated with higher self-harm frequency. In addition, results from path analysis showed that the association between the severity of maltreatment exposure and self-harm frequency was significantly mediated by emotion dysregulation B=0.07, p<0.05, 95% CI [0.02, 0.16]. Thus, emotion dysregulation may be a proximal mechanism linking maltreatment exposure and adolescent self-harm. Notably, self-harm may represent maladaptive attempts to manage emotion dysregulation that may have resulted from maltreatment. Findings from the study have implications for the prevention and treatment of self-harm in maltreated youth.
authors.affiliation: Research Division, Institute of Mental Health, Singapore. Electronic address: Chao_Xu_PEH@imh.com.sg.
authors.forename: Chao Xu
authors.initials: CX
authors.lastname: Peh
authors.affiliation: Research Division, Institute of Mental Health, Singapore.
authors.forename: Shazana
authors.initials: S
authors.lastname: Shahwan
authors.affiliation: Research Division, Institute of Mental Health, Singapore.
authors.forename: Restria
authors.initials: R
authors.lastname: Fauziana
authors.affiliation: Research Division, Institute of Mental Health, Singapore.
authors.forename: Mithila V
authors.initials: MV
authors.lastname: Mahesh
authors.affiliation: Research Division, Institute of Mental Health, Singapore.
authors.forename: Rajeswari
authors.initials: R
authors.lastname: Sambasivam
authors.affiliation: Research Division, Institute of Mental Health, Singapore.
authors.forename: YunJue
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore; Department of Psychological Medicine, KK Women's & Children's Hospital, Singapore.
authors.forename: Say How
authors.initials: SH
authors.lastname: Ong
authors.affiliation: Research Division, Institute of Mental Health, Singapore.
authors.forename: Siow Ann
authors.initials: SA
authors.lastname: Chong
authors.affiliation: Research Division, Institute of Mental Health, Singapore.
authors.forename: Mythily
authors.initials: M
authors.lastname: Subramaniam
mesh_terms: D000293:Adolescent; D002649:Child Abuse / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression; D004644:Emotions; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D012846:Singapore; D011795:Surveys and Questionnaires
keywords: Adolescents; Child abuse; Child maltreatment; Emotion dysregulation; Self-harm